1. 0 Arizona Rural & Critical Access Hospitals HIT/Quality Workshop December 6, 2013 Connie K. Ihde Regional Extension Center Director ~ Programs Director Arizona Health-e Connection

2. 1 Health IT Activities in Arizona: An Update

3. 2 Agenda Overview of Health IT: The Arizona Landscape – EHR Incentive Program – Arizona E-Prescribing Initiative – Arizona Regional Extension Center – Arizona HIE Marketplace

4. 3 National EHR Progress & Challenges As of July 2013: –61% of CAHs had attested to Stage 1 MU (Figure 1). –68% of other (non-CAH) eligible hospitals had attested to Stage 1 MU at this same point in time. 89% of CAHs plan to attest to Stage 1 MU by the end of 2013 Another 10% of CAHs plan to attest to MU by the end of 2014 or beyond Less than two percent do not have plans to attest to MU. Overall, 89% of CAHs reported that they currently use an EHR system 49% of CAHs planned to upgrade/install a new EHR within one year SOURCE: ONC analysis of HIMSS Analytics 2013 CAH Survey Supplement and Medicare and Medicaid EHR Incentive Program data Note: Attestation is based upon ONC analysis of Medicare and Medicaid EHR Incentive Program data

5. 4 Arizona EHR Progress $ Arizona Eligible Hospital Medicare And Medicaid Payments January 2011 to September 2013 AIU and MU Total Payments to Hospitals: $164,876,517 Program Type AIU CountAIU Amount MU CountMU Amount Total CountTotal Amount Medicaid (AHCCCS) 2$ 4,580,9611$ 1,409,9603$ 5,990,921 Medicare/Medicaid 64$71,283,45723$18,412,31687$89,695,772 Medicare 48$69,189,823 Total $164,876,517

6. 5 Arizona Health-e Connection Arizona E-Prescribing Initiatives Arizona Regional Extension Center Arizona HIE Marketplace Program Activities

7. 6 Arizona E-Prescribing Initiative

8. 7 AZ eRx Initiative: Areas of Focus

9. 8 AzHeC eRx Goals By end of 2013, aim to achieve the following: 70% of all Arizona prescription electronically routed to pharmacies 60% of Arizona prescribers routing prescriptions electronically 100% of Arizona pharmacies with e-prescribing capabilities

10. 9 EPCS is LEGAL in Arizona DEA’s Interim Final Rule for Electronic Prescriptions for Controlled Substances was published on March 31, 2010 at 75 FR 16236- 16319 and became effective on June 1, 2010. CHAPTER 184 HOUSE BILL 2369 CONTROLLED SUBSTANCES IN SCHEDULES II, III, IV AND V MAY BE DISPENSED AS ELECTRONICALLY TRANSMITTED PRESCRIPTIONS IF THE PRESCRIBING MEDICAL PRACTITIONER IS ALL OF THE FOLLOWING: 1. PROPERLY REGISTERED BY THE UNITED STATES DRUG ENFORCEMENT ADMINISTRATION. 2. LICENSED IN GOOD STANDING IN THE UNITED STATES JURISDICTION IN WHICH THE MEDICAL PRACTITIONER PRACTICES. 3. AUTHORIZED TO ISSUE SUCH PRESCRIPTIONS IN THE JURISDICTION IN WHICH THE MEDICAL PRACTITIONER IS LICENSED. 9

11. 10 Surescripts National SafeRx Ranking Surescripts ranks Arizona as 29 th in its annual SafeRx rankings Arizona – 29 th 201020112012 Total Prescriptions Routed Electronically5.9M10.8M16.4M % of Total Prescriptions Represented by Renewal Response26%27%21% Prescription benefit requests9.6M8.5M22.4M Rate of Response to Benefit Requests (Year-End) 115%64%62% Total Responses to Medication History Requests (est) 2.7M2.8M5.2M * Rankings are calculated to reflect new prescriptions plus responses to prescription renewal requests to mail order and retail pharmacies as a percentage of all prescriptions within a state that are able to be submitted electronically. * Total number of physicians per state sourced from SK&A. In addition to physicians, nurse practitioners and physician assistants may also e- prescribe in the state. Despite the number 29 ranking, Arizona experienced explosive growth in ePrescribing by nearly tripling the number of ePrescriptions from 2010 thru 2012

12. 11 SafeRx Project Initial Findings 21% of total transactions are Refill Responses –Above average, but number should be higher 50% of eligible prescriptions transmitted electronically –Top 5 average = 66% 70% of visits with Rx benefit eligibility requests –Top 5 average = 97% 26% of visits with medication history responses –Top 5 average = 49% 56% of patients with available Rx benefit & Med history data –Top 5 average = 73% Surescripts ranks Arizona as 29 th in its annual SafeRx rankings

13. 12 Strategy to Improve SafeRx Ranking Payer Outreach –Low percentage of visits for which eligibility, benefit and medication history data is available Targeted Prescribers –Low percentage of requests medication history (EHR) –Low percentage of eligible prescriptions routed electronically (prescriber) Community Awareness –Low percentage of eligible prescriptions routed electronically (patient) The three components are complementary of one another, and the success of one will positively effect the others. The net result of the approach will increase the volume of SafeRx-measured transactions

14. 13 Technical Assistance Program Need assistance with e-prescribing workflow or technical issues? AzHeC is available to provide FREE assistance to solve your problems! Contact AzHeC at 602-688-7200, ehr@azhec.org or visit http://www.azhec.org/?page=Provider_Assistance to get assistance today!ehr@azhec.org http://www.azhec.org/?page=Provider_Assistance

15. 14 Arizona Regional Extension Center

16. 15 Arizona’s trusted, unbiased health IT and Meaningful Use resource… assisting 18 CAHs/RHs and over 2,500 Arizona providers to achieve Meaningful Use and other health IT goals! What is the REC?

17. 16 REC CAH/RH Progress to Date M1 = Sign-up M2 = Go-Live on certified EHR M3 = Stage 1 Meaningful Use Goal: 18 CAH to Stage 1 Meaningful Use by April 5, 2014

18. 17 REC Provider Progress to Date M1 = Sign-up M2 = Go-Live on certified EHR M3 = Stage 1 Meaningful Use Goal: 1,958 PPCPs to Stage 1 Meaningful Use by April 5, 2014

19. 18 Arizona Health Information Exchange (HIE) Marketplace

20. 19 Arizona HIE Marketplace Phase 1 Phase 2 BasicRobust Purpose Provide viable options for health information exchange (HIE) to Arizona health care providers.

21. 20 Who Uses Direct Exchange? Direct Exchange can be used by multiple individuals and entities for health care coordination purposes.

22. 21 Health Information Network of Arizona (HINAz)

23. 22 Current Participation Current participation includes 35 entities: 12 hospitals, including 4 CAHs 7 health plans 3 community health centers 1 reference lab 7 community providers 3 long term care facilities 2 county corrections departments

24. 23 Sample of Current Participants Banner Health Maricopa Integrated Health System Tucson Medical Center Carondelet Health Network Northern Arizona Healthcare Pima County Corrections El Rio Health Center Marana Health Center Villa Maria Care Center Cardiovascular Consultants Genesis Ob/Gyn Yuma Regional Medical Center Casa Grande Regional Medical Center Little Colorado Medical Center Copper Queen Community Hospital Sonora Quest Laboratories UnitedHealthcare Blue Cross Blue Shield of Arizona Care1st Arizona AND MORE!

25. 24 Participant Status Data suppliers status: Banner Health – fully live Carondelet Health Network – fully live Sonora Quest Laboratories – fully live Benson Hospital – fully live Maricopa Integrated Health Systems – mostly live Multi-Specialty Interdisciplinary Clinics (Children’s Rehabilitation Services) – partially live Cardiovascular Consultants – partially live Data users status: Pima County Detention Center

26. 25 Getting the Support You Need E-Prescribing Initiative –www.azhec.org/?page=eRx_Initiativewww.azhec.org/?page=eRx_Initiative Arizona Regional Extension Center –www.arizonarec.orgwww.arizonarec.org HIE Marketplace –www.azhec.org/?page=HIE_Marketplacewww.azhec.org/?page=HIE_Marketplace Health Information Network of Arizona –www.hinaz.orgwww.hinaz.org Arizona Health-e Connection 602-688-7200 ehr@azhec.org