1. Florida Agency for Health Care Administration Florida Center for Health Information and Policy Analysis Florida Association of Medical Directors of Information Systems First Annual Conference, March 17, 2007 Florida RHIOs: Where Are We Headed? How Do We Get There? Christopher B. Sullivan, Ph.D. Florida Center for Health Information and Policy Analysis Agency for Health Care Administration Florida Association of Medical Directors of Information Systems March 17, 2007

2. Florida Agency for Health Care Administration Florida Center for Health Information and Policy Analysis Florida Association of Medical Directors of Information Systems First Annual Conference, March 17, 2007 5.4 Million years 50 years The Shape Of Things To Come? The Shape Of Things To Come? The Economist, December 13, 2003 Where Is Health Care Headed?

3. Florida Agency for Health Care Administration Florida Center for Health Information and Policy Analysis Florida Association of Medical Directors of Information Systems First Annual Conference, March 17, 2007 Transform health care through adoption of health information technology to realize higher quality health care at a lower cost. April 2004, President Bush signed an Executive Order establishing the position of the National Coordinator for Health Information Technology July 2004, David J. Brailer M.D., proposes a Framework for Strategic Action, for national adoption of health information technology. HEALTH INFORMATION TECHNOLOGY LEADERSHIP PANEL FINAL REPORT The Lewin Group, Inc., March 2005 A Solution at the Federal Level: The Nationwide Health Information Network

4. Florida Agency for Health Care Administration Florida Center for Health Information and Policy Analysis Florida Association of Medical Directors of Information Systems First Annual Conference, March 17, 2007 Health information technology (Health IT) allows comprehensive management of medical information and its secure exchange between health care consumers and providers. It will: http://www.hhs.gov/healthithttp://www.hhs.gov/healthit/ Framework for Strategic Action oImprove health care quality oReduce health care costs oDecrease paperwork oExpand access to affordable care

5. Florida Agency for Health Care Administration Florida Center for Health Information and Policy Analysis Florida Association of Medical Directors of Information Systems First Annual Conference, March 17, 2007 oEarly detection of infectious disease outbreaks Improved chronic disease management; and oEvaluation of health care based on quality information that can be compared. HHS - Framework for Strategic Action http://www.hhs.gov/healthit Interoperable health IT will improve individual patient care, but it will also bring many public health benefits including:

6. Florida Agency for Health Care Administration Florida Center for Health Information and Policy Analysis Florida Association of Medical Directors of Information Systems First Annual Conference, March 17, 2007 Predicted Cost Savings from HIT Studies in ambulatory care settings estimate that EHRs would save $112 billion per year (7.5% of health care spending) $34 billion annually for in-office reduction $78 billion annually from interoperability of those EHRs. ONC estimates annual savings attributable to widespread EHR adoption lie between 7.5% and 30% of annual health care spending. HEALTH INFORMATION TECHNOLOGY LEADERSHIP PANEL FINAL REPORT The Lewin Group, Inc., March 2005

7. Florida Agency for Health Care Administration Florida Center for Health Information and Policy Analysis Florida Association of Medical Directors of Information Systems First Annual Conference, March 17, 2007 Nationwide Health Information Network The NHIN will “link all health records through an interoperable system that protects privacy as it connects patients, providers and payers, resulting in fewer medical mistakes, less hassle, lower costs and better health.“ HHS Secretary Mike Leavitt http://www.hhs.gov/healthit/

8. Florida Agency for Health Care Administration Florida Center for Health Information and Policy Analysis Florida Association of Medical Directors of Information Systems First Annual Conference, March 17, 2007 Nationwide Health Information Network

9. Florida Agency for Health Care Administration Florida Center for Health Information and Policy Analysis Florida Association of Medical Directors of Information Systems First Annual Conference, March 17, 2007 The Florida Health Information Network Florida’s Health Information Networks 1. Big Bend RHIO 2. Central Florida RHIO 3. Community Health Information Organization 4. Escambia HIN 5. Jacksonville Health Information Network 6. Palm Beach County Community Health Alliance 7. Pinellas RHIO 8. Space Coast Health Information Network 9. South Florida HII 10. Tampa Bay RHIO See: http://ahca.myflorida.com/dhithttp://ahca.myflorida.com/dhit

10. Florida Agency for Health Care Administration Florida Center for Health Information and Policy Analysis Florida Association of Medical Directors of Information Systems First Annual Conference, March 17, 2007 Health policy decisions in the Florida Legislature and Governor’s Office endorsed developing Florida’s health information technology infrastructure Governor Jeb Bush signed an Executive Order in May 2004 creating the Governor’s Health Information Infrastructure Advisory Board to lead Florida’s development of health information exchange The Florida Health Information Network in Health Care Policy

11. Florida Agency for Health Care Administration Florida Center for Health Information and Policy Analysis Florida Association of Medical Directors of Information Systems First Annual Conference, March 17, 2007 The Governor’s Health Information Infrastructure Advisory Board The Board’s 2005 Interim Report of the GHIIAB called for the creation of the Florida Health Information Network The Florida Health Information Network is the statewide network that will integrate the Regional Health Information Networks to enable statewide health information exchange

12. Florida Agency for Health Care Administration Florida Center for Health Information and Policy Analysis Florida Association of Medical Directors of Information Systems First Annual Conference, March 17, 2007 Build out health information networks using a grants program to leverage the development of local RHIOs Integrate the RHIOs with a state-level server that will manage data exchange among RHIOs and other state and federal databases Create a not-for-profit organization to maintain the FHIN and set standards of interoperability for the RHIOs The Florida Health Information Network Strategy:

13. Florida Agency for Health Care Administration Florida Center for Health Information and Policy Analysis Florida Association of Medical Directors of Information Systems First Annual Conference, March 17, 2007 Functions of the Florida Health Information Network The Florida Health Information Network will facilitate communications and data exchange among the RHIOs by coordinating requests for medical records inside and outside of Florida The Florida Health Information Network will specify and maintain technical standards for interoperability among the RHIOs

14. Florida Agency for Health Care Administration Florida Center for Health Information and Policy Analysis Florida Association of Medical Directors of Information Systems First Annual Conference, March 17, 2007 Florida Health Information Network Medicaid Florida Center DOH SHOTs Vital Statistics Certification of Physicians with DOH Licensing Database 1. Big Bend RHIO 2. Tampa Bay RHIO 3. Palm Beach County Community Health Alliance 4. South Florida HII 5. Escambia HIN 6. Jacksonville HIN 7. Community Health Information Organization 8. Central Florida RHIO 9. Pinellas RHIO 10. Space Coast HIN

15. Florida Agency for Health Care Administration Florida Center for Health Information and Policy Analysis Florida Association of Medical Directors of Information Systems First Annual Conference, March 17, 2007 Technical Standards for the FHIN

16. Florida Agency for Health Care Administration Florida Center for Health Information and Policy Analysis Florida Association of Medical Directors of Information Systems First Annual Conference, March 17, 2007 The Florida Health Information Network Begins at the Local Level The Florida Health Information Network is being built from the local community up An essential element of the strategic plan is to empower local stakeholder collaborations focused on health information exchange The driver of this plan is the FHIN Grants Program and Regional Health Information Organizations in the local community

17. Florida Agency for Health Care Administration Florida Center for Health Information and Policy Analysis Florida Association of Medical Directors of Information Systems First Annual Conference, March 17, 2007 Grants Program to Develop Regional Health Information Organizations Planning Grants: Support engaging local health care stakeholders to develop a strategic plan for health information exchange Implementation Grants: Support projects that demonstrate health information exchange among two or more competing providers Training Grants: Support practitioner training designed to increase physician and dentist use of electronic health record systems

18. Florida Agency for Health Care Administration Florida Center for Health Information and Policy Analysis Florida Association of Medical Directors of Information Systems First Annual Conference, March 17, 2007 Grants Program, 2006-2007 In 2005 the Legislature appropriated $1.5 million for grants awarded to nine projects Five Planning Grants Three Implementation Grants One Training Grant In 2006 the Agency awarded six grants with another $2 million appropriated by the Legislature

19. Florida Agency for Health Care Administration Florida Center for Health Information and Policy Analysis Florida Association of Medical Directors of Information Systems First Annual Conference, March 17, 2007 What is a Regional Health Information Organization?

20. Florida Agency for Health Care Administration Florida Center for Health Information and Policy Analysis Florida Association of Medical Directors of Information Systems First Annual Conference, March 17, 2007 An Example of a Florida RHIO: Palm Beach County Community Health Alliance All-Care Health Record System Glades and West Palm Beach, Florida

21. Florida Agency for Health Care Administration Florida Center for Health Information and Policy Analysis Florida Association of Medical Directors of Information Systems First Annual Conference, March 17, 2007 Palm Beach County Community Health Alliance PBC Community Health Alliance (An Alliance of Funders and Providers Serving Health Care Consumers) Care Expansion Language Access Common Eligibility Shared EHR Project Access Private Funders Hospitals Public Funders Health Dept. Free Clinics Social Services

22. Florida Agency for Health Care Administration Florida Center for Health Information and Policy Analysis Florida Association of Medical Directors of Information Systems First Annual Conference, March 17, 2007 Western Palm Beach County Health Information Infrastructure Operations and Evaluation Project The Glades Community 28% uninsured rate Glades General Hospital is only Acute Care facility 17,753 ER visits; 1,900 Medicaid discharges in 2002 Prevent duplication between hospital and clinics

23. Florida Agency for Health Care Administration Florida Center for Health Information and Policy Analysis Florida Association of Medical Directors of Information Systems First Annual Conference, March 17, 2007 All-Care Shared Health Record Real-time electronic interface to existing data systems used by hospitals, clinics, mental health centers, and other safety net providers Free clinics, Federally Qualified Health Centers, Palm Beach County Medical Society Project Access and key competitor safety net hospitals are participating Viewable via the Web - after patients have signed authorizations

24. Florida Agency for Health Care Administration Florida Center for Health Information and Policy Analysis Florida Association of Medical Directors of Information Systems First Annual Conference, March 17, 2007 All-Care Clinical Data List Date of Visit and Encounter Type Clinic and Provider Names Diagnosis and CPT codes (Hospital) Discharge code Prescribed and Filled drugs Lab results Radiology Results

25. Florida Agency for Health Care Administration Florida Center for Health Information and Policy Analysis Florida Association of Medical Directors of Information Systems First Annual Conference, March 17, 2007 An Example of a Florida Regional Health Information Organization: Big Bend RHIO Tallahassee, Florida

26. Florida Agency for Health Care Administration Florida Center for Health Information and Policy Analysis Florida Association of Medical Directors of Information Systems First Annual Conference, March 17, 2007 Region Served by the Big Bend RHIO Tallahassee

27. Florida Agency for Health Care Administration Florida Center for Health Information and Policy Analysis Florida Association of Medical Directors of Information Systems First Annual Conference, March 17, 2007 Big Bend RHIO is Anchored in the Community Board members represent local providers Most clinical Board members have sophisticated Electronic Medical Record systems in use FSU College of Medicine, Tallahassee Community College included on Board Capital Health Plan covers 37% of patients Optical Fiber medical area network (pMAN), currently providing connectivity

28. Florida Agency for Health Care Administration Florida Center for Health Information and Policy Analysis Florida Association of Medical Directors of Information Systems First Annual Conference, March 17, 2007 Radiology TDI CRMC TMH VSA CHP CHP. NFWC TNC VPN Remote & VPN Users BBRHIO RHIN Urology pMAN Network

29. Florida Agency for Health Care Administration Florida Center for Health Information and Policy Analysis Florida Association of Medical Directors of Information Systems First Annual Conference, March 17, 2007 VPN Big Bend RHIO RHIN Architecture Small organizations can connect either directly to the RHIN or through a VPN gateway Organizations can connect bi-directly to feed their data and receive data directly into their EMR In the early Phases CHP, CRMC & TMH will provide a one way feed of their data. They have the largest repositories and the priority is to make their data available ASAP

30. Florida Agency for Health Care Administration Florida Center for Health Information and Policy Analysis Florida Association of Medical Directors of Information Systems First Annual Conference, March 17, 2007 Health Information Exchange Services Big Bend RHIO will establish a community repository for the storage and retrieval of: Demographic/encounter data Medication claims data and e-prescribing Document viewer including lab/radiology Secure messaging Disaster recovery Remote data backup outside service area

31. Florida Agency for Health Care Administration Florida Center for Health Information and Policy Analysis Florida Association of Medical Directors of Information Systems First Annual Conference, March 17, 2007 Next Steps for the Florida Health Information Network Establish a statutory entity, the Florida Health Information Network Corporation to implement the state level network As a not-for-profit organization, the Florida Health Information Network Corporation would be accountable to the public and responsive to health care providers

32. Florida Agency for Health Care Administration Florida Center for Health Information and Policy Analysis Florida Association of Medical Directors of Information Systems First Annual Conference, March 17, 2007 Health Information Networks Included as an “Innovative Idea” in 2007 Idea 85 of Speaker Marco Rubio’s 100 Innovative Ideas addresses health information exchange “Improve patient care through technology by expanding electronic health records and regional health information networks.”

33. Florida Agency for Health Care Administration Florida Center for Health Information and Policy Analysis Florida Association of Medical Directors of Information Systems First Annual Conference, March 17, 2007 FHIN Bills in the 2007 Legislative Session H1121 and S 2348 – Florida Health Information Network Act H 1123 – Florida Health Information Network Corporation, public records exemption Patient medical or health records confidential Cannot be disclosed without patient consent, unless in a life-threatening emergency.

34. Florida Agency for Health Care Administration Florida Center for Health Information and Policy Analysis Florida Association of Medical Directors of Information Systems First Annual Conference, March 17, 2007 Proposed FHIN Budget 2007-2010 Budget Estimates for the Florida Health Information Network Based on Recommendations from the FHIN Budget Workgroup Budget Estimate for HB 1121 Bill Analysis Projections 2007-08 ($9.4M)2008-09 ($8.7M)2009-10 ($7.7M) Operations Administration$1,372,000 Core Functions of the FHIN$6,445,000$2,960,000$2,130,000 Core Services of the FHIN$967,000$3,750,000$3,550,000 Subtotal$7,412,000$6,710,000$5,680,000 Communication and Training$616,000$618,000$648,000 Totals$9,400,000$8,700,000$7,700,000

35. Florida Agency for Health Care Administration Florida Center for Health Information and Policy Analysis Florida Association of Medical Directors of Information Systems First Annual Conference, March 17, 2007 The Future of the Florida Health Information Network The Florida Health Information Network vision will integrate clinical health information exchange in Florida through a network architecture that will empower physicians to access timely and accurate medical records in order to deliver high quality medical care for their patients.

36. Florida Agency for Health Care Administration Florida Center for Health Information and Policy Analysis Florida Association of Medical Directors of Information Systems First Annual Conference, March 17, 2007 Christopher B. Sullivan, Ph.D. Agency for Health Care Administration Florida Center for Health Information and Policy Analysis Office of Health Information Technology 2727 Mahan Drive Tallahassee, FL 32309 sullivac@ahca.myflorida.com