2. Open Source HIT Richard Thoreson Substance Abuse Mental Health Services Administration U.S. Department of Health & Human Services Regional HIT Conference San Francisco, CA  Thursday, July 21, 2011

3. 3 Getting to Meaningful Use, 2015 1. Better health, better health care, with spending limits 2. Service & Informationsystems integration a. Specialty MH and SA together? b. With primary care/health homes? c. With other safety net services? d. With criminal justice?

4. State Health & Human Services Information Network Needs, Utilization/Payments, & Outcomes 1. Health Home 2. Primary Care 3. FQHC/HRSA 4. Specialty Behavioral Health/SAMHSA 5. Other Specialty Health 6. Hospital 7. State Information Exchange/ONC 8. State Insurance Exchange/ONC 9. State Medicaid/CMS 10. Medicare/CMS 11. Children & Family Agency/ACF 12.Public Health /CDCP 13. Pharma-Medical Device Vender/FDA 14. School/DOE 15. Housing Agency/HUD 16. Other Safety-Net Agencies/DoA-WIC 17. Income Maintenance/SSA 18. Criminal Justice/DoJ 19. Tax & Other Adm. Agencies/IRS 20. Oversight/ GAO & IGs Un-Silo Family & Individual History Research

5. 5 Electronic Health Record systems (EHRs)  The technology foundation for incremental quality improvement (doing more with less!)  Get better information to clinicians & patients when they need it  Develop knowledge faster We can’t improve what we don’t measure!

6. 6 Standard Terminology ASAP!! SNOMED-CT LOINC RxNorm Core Data Sets to measure needs, quality, & outcomes

7. 7 Services Oriented Architecture (SOA) Centrally-hosted Web-based services User communities drive system requirements Venders compete around replaceable Web services Low barriers to vender entry into markets

8. State Health & Human Services Information Network Public Sector IT Spending Plans & Expectations Service Systems Integration SAMHSA: Primary Behavioral Health Care Care Integration $15M 2011 OBHITA/REM $3.2M/yr 2009-13 ONC Privacy Project $2.77M 2011 Quality Measures $100Ks/yr Suicide Hotline w/DOD $0 Other Federal Medicaid $10Bs/yr HRSA $B’s/yr ACF $Bs/yr IHS $10Ms/yr Reusable Open Source VA/DOD $Bs/yr Federal IT Investments 1. Health Home 5. Other Specialty Health 6. Hospital 9. State Medicaid/CMS 13. Pharma-Medical Device Vender/FDA 12.Public Health /CDCP 15. Housing Agency/HUD 18. Criminal Justice/DoJ 17. Income Maintenance/SS A 14. School/DOE 16. Other Safety-Net Agencies/DoA-WIC 4. Specialty Behavioral Health/SAMHSA 2. Primary Care 3. FQHC/HRSA 7. State Information Exchange/ONC 8. State Insurance Exchange/ONC 10. Medicare/CMS 11. Children & Family Agency/ACF 19. Tax & Other Adm. Agencies/IRS 20. Oversight/ GAO & IGs 8

9. 9 Performance Measurement Encounter & episode quality measures o Priority needs met first? o Patient self-reports o Automated EHRs extracts 3 rd Party verification (needs & Outcomes): o Cross-check records from different providers o Cross check safety net beneficiary records across State agencies

10. State Health & Human Services Information Network Public Spending for Performance Monitoring SAMHSA* GPRA Data Warehouse $10M/yr, 5 yrs Block Grant/DASIS-TEDS $ Ms/yr Prescription Drug Monitoring $Ms before 2011, $0 after Other Federal* CMS $? CDCP $? FDA $? HRSA $? ACF $? IHS $? VA/DOD $? * Tank sizes not to scale relative to each other Federal IT Investments 10 San Francisco Regional meeting 20. Oversight/ GAO & IGs 1. Health Home 5. Other Specialty Health 6. Hospital 9. State Medicaid/CMS 13. Pharma-Medical Device Vender/FDA 12.Public Health /CDCP 15. Housing Agency/HUD 18. Criminal Justice/DoJ 17. Income Maintenance - SSA 14. School/DOE 16. Other Safety-Net Agencies/DoA-WIC 4. Specialty Behavioral Health/SAMHSA 2. Primary Care 3. FQHC/HRSA 7. State Information Exchange/ONC 8. State Insurance Exchange/ONC 10. Medicare/CMS 11. Children & Family Agency/ACF 19. Tax & Other Adm. Agencies/IRS

11. 11 Open Source Advantages? Share all best practices & lessons learned, no black box technology Build once, re-use software at no cost, minimize vender lock-in User-driven software development based on common, public sector needs

12. 12 SAMHSA Open Behavioral Health Information Technology Architecture Project  Next Generation Open Source EHR can be used for meaningful use quality measure pilots Fully Meaningful Use Compliant Integrated Primary & Behavioral Health Services Reference Electronic Health Record Model (REM) – Standards derived model EHR application »HL7 Reference Information Model »HL7 Clinical Document Architecture »Common Terminology Server (CTS), U.S. standard o SNOMED-CT, LOINC, ICD, etc.

13. 13 SAMHSA’s 3 Largest HIT Investment Projects in 2011 GPRA Data Warehouse (draft RFC) Contract to automate reporting, storage, and analysis of performance data from SAMHSA’s discretionary grantees. Primary Behavioral Health Care Integration (PBHCI) HIT Enhancement Grants $500k for 4 years + one time $200K IT Supplement per grantee (64 grantees) $500k Grants to 5 States to integrate specialty behavioral health into State Health Information Exchange (HIE) Open Behavioral Health Information Technology Architecture (OBHITA) Contract to develop open source EHRs and HIE systems & related terminology & quality measures o Health Home Reference Electronic Health Information Model (REM) o Safety Net Information Banking Service (SIBS) for Personal History Records o Partnerships with VA and leading States