1. Assisting NCHICA members in transforming the US healthcare system through the effective use of information technology, informatics and analytics. Transitions in Healthcare: Transitions in Healthcare: Migration from Paper to Digital and Managing Legacy Data ARMA International: Charlotte-Piedmont Chapter March 20, 2014 Presentation by: Holt Anderson, Executive Director NCHICA (NC Healthcare Information & Communications Alliance, Inc.)

2. Assisting NCHICA members in transforming the US healthcare system through the effective use of information technology, informatics and analytics. Agenda About NCHICA Accelerants Challenges at the State Level – One State’s Landscape and Activities –Health Systems –Applications –HIEs Legacy Data Task Force Vision of a Future Healthcare System HIPAA - “Business Associates” and their subcontractors now covered by HIPAA

3. Assisting NCHICA members in transforming the US healthcare system through the effective use of information technology, informatics and analytics. About NCHICA Established in 1994 as 501(c)(3) Nonprofit ~300 organizations across healthcare spectrum Serves as neutral, collaboration hub for developing consensus-based approaches to policy compliance and technology implementation

4. Assisting NCHICA members in transforming the US healthcare system through the effective use of information technology, informatics and analytics. Transition of Mission 1994 –Improving health and healthcare in NC by accelerating the adoption of information technology and enabling policies. 2011 –Assisting NCHICA members in accelerating the transformation of the US healthcare system through the effective use of information technology, informatics and analytics.

5. Assisting NCHICA members in transforming the US healthcare system through the effective use of information technology, informatics and analytics. NCHICA Collaboration Activities CIO-CMIO Roundtable Informatics & Analytics Roundtable –Legacy Data Task Force Privacy & Security Officials Workgroup Legal Workgroup Transactions, Code Sets & Identifiers Workgroup –ICD-10 Task Force & Focus Groups Enterprise Integration Workgroup –HIE Task Force Technology Resources Workgroup –Telehealth Task Force NC Consumer Advisory Council on Health Information Educational Conferences and Workshops

6. Assisting NCHICA members in transforming the US healthcare system through the effective use of information technology, informatics and analytics. Transition Accelerants 1996 – Health Information Portability and Accountability Act (HIPAA) 1999 - To Err is Human 2001 - Crossing the Quality Chasm 2004 – HHS Office of the National Coordinator for Health Information Technology (ONC) established 2005 – ONC initiation of eHealth Exchange (née NHIN or Nationwide Health Information Network) efforts 2009 – American Recovery and Reinvestment Act (ARRA) & Health Information Technology for Economic and Clinical Health Act (HITECH) & Meaningful Use (MU = $) MU = EHR + HIE + Reporting (Quality & Public Health) 2010 - Patient Protection and Affordable Care Act (PPACA) or Affordable Care Act (ACA)

7. Assisting NCHICA members in transforming the US healthcare system through the effective use of information technology, informatics and analytics. Transition Challenges Standards –Policy (Federal, State, Local & Enterprise) Privacy & Security - Accountability –Data elements –Technology (applications, systems, networks) Transition from Fee-for-Service (transactions) to Payment for Outcomes Emphasis on Wellness (Accountable Care Organizations - ACOs) Business Models –Reimbursements Legacy Systems: Data & Policies

8. Assisting NCHICA members in transforming the US healthcare system through the effective use of information technology, informatics and analytics. Transitions in the Business Model Fee for Service Payment for Outcomes TransactionsWellness

9. Assisting NCHICA members in transforming the US healthcare system through the effective use of information technology, informatics and analytics. Challenges for North Carolina: Multiple, Strong IDNsMultiple, Strong IDNs EHR LandscapeEHR Landscape

10. Assisting NCHICA members in transforming the US healthcare system through the effective use of information technology, informatics and analytics. Major IDNs - Statewide Landscape

11. Assisting NCHICA members in transforming the US healthcare system through the effective use of information technology, informatics and analytics. in North Carolina in North Carolina          Indicates primary service area

12. Assisting NCHICA members in transforming the US healthcare system through the effective use of information technology, informatics and analytics.

13. Other EHR Vendors Include: RPMS VistA

14. Assisting NCHICA members in transforming the US healthcare system through the effective use of information technology, informatics and analytics. Ambulatory Systems Include: Chart courtesy of NC HIE

15. Assisting NCHICA members in transforming the US healthcare system through the effective use of information technology, informatics and analytics. Transitions Create Legacy Data Anticipating future needs and uses: –Clinical care of patients –Business requirements Billing Auditing Legal (eDiscovery) –Research

16. Assisting NCHICA members in transforming the US healthcare system through the effective use of information technology, informatics and analytics. NCHICA Legacy Data Task Force Established in May 2013 Goal: Develop consensus approach to handling legacy data during and after system transition Organizations involved in discussions include: –Carolinas HealthCare System –Novant –UNC Health Care –Legacy Data Access –Allscripts –Duke Health –Others ???

17. Assisting NCHICA members in transforming the US healthcare system through the effective use of information technology, informatics and analytics.

19. Vision of a Future Healthcare System Making appropriate clinical decisions at the point of care informed by a “Learning Health System” –Consolidates and updates the Patient’s health history from all sites across the continuum of care – create a profile –Profile includes the Patient’s family heath history and DNA –Develop search criteria based on Patient’s profile including complaint, current tests, and preliminary diagnosis –Initiate search in millions+ of records to match profile –Return results from treatments and outcomes for 1,000 profile matches –A decision support system organizes, prioritizes and presents best treatment options at point of clinical decision. –Now we have 1,001 profiles for future reference

20. Assisting NCHICA members in transforming the US healthcare system through the effective use of information technology, informatics and analytics. HIPAA (not HIPPA ) Health Insurance Portability and Accountability Act HIPAA contains a set of federal standards to protect the privacy and security of patients' medical records and other health information maintained by Covered Entities and now Business Associates and their subcontractors. Enforcement activities as of January 31, 2014 Since compliance date of April 2003: 91,721 HIPAA complaints 85,612 resolved 21,148 through investigation and enforcement 9,948 through investigation and finding no violation 53,516 closure of cases not eligible for enforcement Compliance issues in order of frequency Impermissible uses and disclosures of protected health information; Lack of safeguards of protected health information; Lack of patient access to their protected health information; Uses or disclosures of more than the minimum necessary protected health information; and Lack of administrative safeguards of electronic protected health information.

21. Assisting NCHICA members in transforming the US healthcare system through the effective use of information technology, informatics and analytics. Business Associates [45 CFR 160.103] A “business associate” is a person or entity that performs certain functions or activities that involve the use or disclosure of protected health information on behalf of, or provides services to, a covered entity. Business associate services are: legal; actuarial; accounting; consulting; data aggregation; management; administrative; accreditation; and financial. http://www.hhs.gov/ocr/privacy/hipaa/understanding/coveredentities/businessassociates.html

22. Assisting NCHICA members in transforming the US healthcare system through the effective use of information technology, informatics and analytics. Business Associates Workshop Tentative Agenda - June 5, 2014 at UNC-C Center City TIME TRACK 1TRACK 2 7:30-8:30 AM REGISTRATION AND CONTINENTAL BREAKFAST 8:30-9:30 AM OPENING PLENARY: HIPAA Omnibus Obligations for BAs and Other Subcontractors 9:30-9:45 AM BREAK 9:45-10:45 AM Vendor Management Strategies – What Does “Satisfactory Assurances” Really Mean? Beyond SureCrypt – Implementation of Safe Harbor Encryption Program 10:45-11:00 AM BREAK 11:00 AM-noon Compliance Strategies for Cloud Providers in the Healthcare Space How to Link Risk Assessments to Technology Investments 12:00-1:00 PM LUNCH 1:00-2:00 PM Using Outside Counsel for HIPAA Compliance Providing Satisfactory Assurances for External Audits: Understanding SSAE 16, FEDRAMP & ISO 2:00-2:15 PM BREAK 2:15-3:15 PM Breach Response for BAs Vendor Management Program (Policy) – Pushing Requirements Down to the Subcontract Level 3:15-3:30 PM BREAK 3:30-4:30 PM CLOSING PLENARY: Compliance Management Process: What Does it Mean? 4:30 PM ADJOURN

23. Assisting NCHICA members in transforming the US healthcare system through the effective use of information technology, informatics and analytics. Questions ??? Contact: Holt@nchica.org www.nchica.org