1. Kevin W. Ryan JD, MA Associate Director – ACHI Assistant Professor – UAMS COPH Rural TeleCon ’06 10th Annual Conference of the Rural Telecommunications Congress

2. The coming tsunami of electronic health information exchange – important dates 2014 - EHR to be widespread 2009 – e-prescribing required by MMA 2006 – ?

3. Where are we today in 2006? EHR usage study shows slow progress toward Bush’s 2014 goal – Healthcare IT News <10% of physicians employee an EHR system that benefits patient care <5% of hospitals use computerized physician order entry Reasons for slow progress Lack of interconnectivity / interoperability Costs Fear of legal burdens Uncertain tech support Concerns about rapid obsolescence Rural area providers least likely to adopt EHR

4. Rationale for an interoperable EHR Cost savings Decreased medical errors Improved public health surveillance

5. General issues with EHR Verification of patient consent for release of medical records information. Forwarding patient information without a signed release form. Perceived need to obtain IRB approval for release of identified patient data.

6. General barriers to obtaining an interoperable EHR “The way we have always done it” mentality Ownership of responsibility Discrepancy in application and interpretation of HIPAA State law regarding mandated reporting / privacy of communicable diseases “Just say no!”

7. Interoperability issues Lack of common platform Legal / regulatory / policy impediments to information exchange Bandwidth

8. US DHHS Health Information Exchange Plan Harmonize standards Create certification criteria for EHR products / technology Develop prototype network architecture Identify / address variations in state laws / business policies affecting privacy and security that impedes / facilitates exchange of health information

9. Health Information Security and Privacy Collaboration - HISPC Funded by DHS Agency for Healthcare Quality and Research Managed by NGA / RTI 33 states and Puerto Rico

10. Mission Bring together broad range of stakeholders Identify legal / policy / practice barriers to electronic exchange of health information Develop through a consensus process recommended solutions Create state level report to Federal government Cooperate in establishment of NHIN

11. Arkansas HISPC Project The Arkansas HISPC project management team consists of various partners within the state with interest or expertise in the areas of Health Information Technology, HIPPA and Law. –AR Center for Health Improvement –AR Department of Health and Human Services –AR Foundation for Medical Care –The Brock-Chad Group (Legal Consultants) –Stakeholders / interested parties

12. Present Arkansas Health Information Exchange Initiatives Arkansas Hospital Association: Investigation of statewide EHR Employee Benefits Division (EBD), Quality Sub-Committee: Quality of care measurement standards – link with EHR Arkansas Blue Cross/Blue Shield: Convening quality initiative stakeholders Arkansas Foundation for Medical Care: Aligning forces for regional quality healthcare improvement. Arkansas Center for Health Improvement: VISTA feasibility study. Assisting EBD with quality sub-committee. Arkansas Public Health Bioterrorism System: Statewide public health agency system implementation ANGELS Project: Telemedicine:

13. Arkansas HISPC Project Evaluation of legal issues regarding information sharing. Community buy-in regarding the need and mechanisms for application. Formation of collaborative partners in the activities around health information exchange. Access to information and issues experienced by other states, who can serve as a resource as Arkansas’s activities develop.

14. Stakeholder Representation and Outreach Hospitals Pharmacy Payers Professional association / societies Public health agencies Community clinics / health centers Legal representatives Consumers Industry

15. Data Collection Process Facilitated face-to-face meetings discussing health information exchange scenarios. E-group input

16. Challenges Convening sufficiently diverse groups Perceived lack of need Perceived inability to address issue

17. Deliverables Establishment of a sustainable state level initiative Linked activities with regional / national efforts Reports –Interim –Final

18. Your participation in this project is welcomed. Kevin W. Ryan JD, MA –501.526.2244 –ryankevinw@uams.eduryankevinw@uams.edu Shirley Tyson – HISPC Project Director –501.526.2257 –tysonshirley@uams.edu