1. Health Information Technology Issues in the 2015 Texas Legislative Session Nora Belcher, Executive Director Texas e-Health Alliance December 12, 2014

2. What is the Texas e-Health Alliance? State’s leading advocate, from local communities to the national level, for the use of health information technology to improve the health system for patients 501(c)6 non-profit started in 2009 Serves as a trade association for HIT companies Slide 2 Background

3. This presentation will: Provide an update on state level HIT activities, Preview a number of HIT topics that will be discussed during the 2015 session of the Texas Legislature, and Update attendees on the current state of the Sunset Commission review of Texas HHS system. Slide 3 Overview

4. Internet Revolution: Value to Users Internet use exploded once content became accessible and useful. © Ingenix, Inc. 4 Computer developed - IBM ARPANET Mosaic Web Browser Today, health care information technology (HIT) is at the “1997” of the Internet age Prodigy WWW HTML TCP/IP Standard Source: U.S. Census Bureau, Population Division, Education & Social Stratification Branch, “Reported Internet Usage for Households, by Selected Householder Characteristics,:2007” % U.S. Households Using the Internet at Home HIT Today First e- mail sent

5. State Level Activities Electronic Health Record and Health Information Exchange Initiatives – – HHSC administered EHR Incentive Program and local HIE grant program (over $ 600 million) – – Texas Health Services Authority and local HIEs moving into implementation and interconnectivity Telemedicine, Telehealth and Home Monitoring – – TMB adopted 2 models of telemedicine in Fall 2010 – – SB 293 (2011) expanded telemedicine and telehealth in FFS Medicaid and set up a remote monitoring benefit – – SB 7 (2013) encouraged the use of telemedicine in nursing homes by managed care plans – – TMB rule review fall 2014

6. Texas Legislature Before 2005 – 0 health IT bills filed 2005 – 1 health IT bill filed 2007 – 6 health IT bills filed 2009 – 30 health IT bills filed 2011- 3 health IT bills filed – Electronic prescribing – Privacy – Telehealth/remote monitoring 2013 – 1 health IT specific bill filed – Driver’s license mag swipes THSA funding DPS drug database access Telemedicine in nursing homes Page 6

7. Topics for 2015 Interoperability and use of standards in state agency IT systems – HB 2939 filed in 2013 but did not pass – HHSC adopted policy in summer 2014 Requires state agencies to develop interoperability plans and move towards using standards in IT systems Much work is needed to further define what data can be shared with who and when Long term view: the state should see improvements in data quality, provider reporting, and project management Page 7

8. Topics for 2015 Access to public health registries for HIEs – Many of the governing statutes for public health registries (immunization, lab reporting, etc) predate HIE – Legal concerns have been raised that providers cannot delegate their required reporting to the state to their local HIE – DSHS and THSA Sunset reports identify this as a barrier – Long term view: this will support a business case for HIEs to do reporting, creating administrative simplification for the state and for providers, and improving the timeliness and accuracy of the data Page 8

9. Topics for 2015 Medicaid/CHIP Health Information Exchange – Created by HB 1218 in 2009, before HITECH state grants for HIE were public – Intended to create a function similar to the Foster Care Passport, and provide claims data to Medicaid providers – Project implementation was delayed due to concerns about consent and privacy; currently in pilot – Long term view: through Sunset, this project needs to be reviewed and revised to better align with state HIE strategy. Page 9

10. Topics for 2015 Remote monitoring – Medicaid remote monitoring benefit was created by SB 293 in 2011 – Benefit was limited in scope and confined to certain diagnoses and included a Sunset provision for the benefit unless recreated by the Legislature in 2015 – Long term view: The shift to managed care makes the Medicaid fee for service rule less important, but still necessary. Medicare penalties for readmission rates have strongly increased hospital interest in this benefit. Page 10

11. Topics for 2015 Consumer telemedicine – Current Texas Medical Board rules require a face to face visit or a referral before a patient can receive telemedicine services from a non-clinic location – Tech companies and insurers are developing totally virtual clinic models in response to consumer demand and increasing sophistication of devices and peripherals – Long term view: The legislature will have to weigh access and convenience for consumers and businesses vs. some risk that virtual visits may not present the physician with 100% of the needed data Page 11

12. Topics for 2015 Provider/HIE “safe harbors” – Providers frequently cite the lack of legal precedents around the use of HIEs as a barrier to HIE adoption – Concerns have been raised about who is liable if the information in an HIE is incorrect and used in a treatment decision – THSA through Sunset is pursuing clarification that providers and HIEs are responsible only for their own errors – Long term view: as more and more data becomes available to providers, a standard of care will need to evolve that gives providers clear guidance as to their obligations regarding HIE Page 12

13. Sunset Process THSA, HHSC, DADS, DARS, DSHS, DFPS, and the Texas Health Care Information Council are all under review – Self-evaluation reports are available for all agencies – Sunset staff reports and commission decisions are available for DADS, DFPS, DARS, and DSHS – THSA, THCIC, HHSC and HHS enterprise reports will be out in October/November Page 13

14. What Does It Mean? Intense pressure on the state and on providers to show ROI for HIE Federated approach means localized data, so many providers will still juggle multiple interfaces Consumer demand will rise for: – curation and aggregation of their data. No one wants 10 separate patient portals – online access to their doctor- or a doctor. Page 14

15. Nora Belcher Texas e-Health Alliance 512/536-1340 nora@txeha.org © 2013 HIMSS