Health IT and Health Care
Transformation – NYS Strategy Update
Rachel Block,, Deputy
p y Commissioner
NYS Department of Health
Office of Health Information Technology Transformation
Academyy Health
June 2010
NYS Office of Health Information Technology Transformation
General Points of Agreement
• Need to advance broad adoption and use of
health information technology
• Agreement on definitions and implementation of
common standards
• Alignment of payment incentives for use
ADVANCING THESE OBJECTIVES REQUIRES
COORDINATION OF POLICY AND
IMPLEMENTATION ACTIVITIES
2
NYS Office of Health Information Technology Transformation
Broad Goals for NY’s
Health IT Strategy
• B
Build
ild h
health
lth iinformation
f
ti iinfrastructure
f t t
tto supportt state
t t
health reform goals
– Support clinicians and consumers with information at
point of care
– Advance care coordination
– Strengthen public health surveillance and response
– Enhance quality and outcome measures
OVERALL STRATEGY IS ABOUT SYSTEMS
CHANGE NOT JUST HEALTH IT
CHANGE,
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NYS Office of Health Information Technology Transformation
HEAL funding for HIT
• HEAL I – formation of regional health information organizations (~ 20
projects = ~$50 million)
• HEAL V – (($106 million = 19 p
projects)
j
)
–
–
–
–
Development of statewide network infrastructure
Development and support of the NYeC state wide collaborative process
Implementation of EHRs in physician practices
support of EHR implementation for clinical use cases including medication
management, quality reporting, clinical decision support, connecting NYers
to clinicians and connectivity to NYS DOH to improve public health
– Support of evaluation through HITEC
• HEAL X – (total $100 million)
– EHR implementation to achieve improved care coordination through support
of the patient centered medical home (60%)
– Continuation of the NYeC state wide collaborative process (5%)
– Further development and support of the SHIN-NY infrastructure (30%)
– Continuation of HITEC evaluation ((5%))
4
NYS Office of Health Information Technology Transformation
EHR with Unshared Services
Pharmacies
•Weak integration
Hospitals
Labs
•Costly
•Deadend solution
Immunization
Health Plans
Clinician
EHR
Radiology clinics
Public health
•No path to future
interoperability
•Increased risk of
duplication
•Increased risk
missing data
Medicaid
Consumers
•HIGH
G risk for
f failed
f
implementation
Clinicians
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NYS Office of Health Information Technology Transformation
5
*RHIOs = Policy
**SHIN-NY = Technology
Public Health
Other NYS DOH
Databases
Medicaid
CDC Biosurveillance
and Public Health
I
Investigation
i i Project
P j
Immunization
and Child
Health
CDC
NYS DOH
UPHN
Local Health Depts.
SHIN-NY**
NYC Health Dept.
Multiple RHIOs*
Home Health
Care and
T l
Telemedicine
di i
Diagnostic
Centers
SHIN-NY**
Pharmacies
and PBMs
Patients’
P
ti t ’
Secure
Personal
Health
R
Records
d
Managed
Care
Physicians
Offices
and Clinics
NYS Office of Health Information Technology Transformation
Hospitals, Nursing
Hospitals
Homes, IDNs, etc
6
CHITA projects
Policy Context for HIT Adoption,
HIE and Sustainability
• Privacy and security are keys to protect and
move information
• Public-private partnership including funding
• Infrastructure serves public good
• Correct for market failures that hinder effective
implementation
• Determine minimum necessary protections to
establish a level playing field in a dynamic
marketplace
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NYS Office of Health Information Technology Transformation
Translating Policy into Effective
Implementation
•
•
•
•
Multi-stakeholder governance
Community ownership
Strong alignment of policy and incentives
Significant opportunities for administrative
st ea
streamlining
g
• Patient-centered system
8
NYS Office of Health Information Technology Transformation
Overview – ARRA/HITECH
Distribution
Agency
Entitlemen
nt Funds
Roughly $34B in gross
ys
outlay
Program
Medicare
Payment
Incentives
CMS
Use of Funds
Fund Recipients / Beneficiaries
Incentives through Carriers
• Acute care hospital
• Children’s hospitals
Physicians/
Dentists
Medicaid
Payment
Incentives
CMS &
States
• Nurse Practitioner
• Midwife
Incentives through States
Requires “Meaningfful” use of EHR
Funding
Apprropriated Funds
$2B
FQHC
Planning Grants
HIE Planning and
Development
ONC
EHR Ad
Adoption
ti
Loan Program
ONC
State Designated Entity
Implementation Grants
Loan Funds for States
States
L
Loans
Loan Funds for Indian Tribes
HC Providers
Indian Tribes
Health IT
Extension
Program
ONC
Workforce
Training Grants
HHS,
NSF
New Technology
Research and
Development
Grants
NIST,
NSF
Health IT Research Center
Regional Extension Centers
Services
• Non-profit
Least Advantaged
Providers
Medical Health Informatics
EHR in Med School Curricula
Health Care Information
Enterprise Integration Research
Centers
• Higher Education
• Medical School
• Graduate schools
• Federal Gov’t Labs
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NYS Office of Health Information Technology Transformation
Bending the Curve Towards Transformed Health
Achieving Meaningful Use of Health Data
2009
2011
2013
2015
IImproved
d
outcomes
Advanced
clinical
processes
Data capture
and sharing
10
10
NYS Office of Health Information Technology Transformation
Focus on MU Measures
• B
Broad
d categories
t
i – hospital,
h
it l eligible
li ibl providers
id
(physicians plus…)
• Health Outcomes Policy Priorities:
– Improving quality, safety, efficiency, and reducing
health disparities
p
((this includes but is not limited to
reporting on current CMS/NQF measures for
hospitals and physicians)
– Engage patients and families in their health care
– Improve care coordination
– Improve population and public health
– Ensure adequate privacy and security
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NYS Office of Health Information Technology Transformation
National and State Efforts
Support Care Improvement
• G
Growing
i body
b d off research
h supports
t ffocus on
organizational capacity to improve care
• Capacity includes coordination of care across settings
settings,
practice structure, multi-disciplinary teams, patient
outreach, AND health IT
• Specific focus and support for care models that
emphasize capacity and outcomes – patient centered,
primary care focused; chronic care management
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NYS Office of Health Information Technology Transformation
Summary
• Medicare/Medicaid incentive payments tied to
meaningful use constitute largest component of federal
strategy supporting health IT adoption
• Broad goals make sense, but impact could be limited for
a variety of reasons,
reasons and interoperability components
need to be strengthened
• MU
U cou
could
d se
serve
e as a foundation
ou dat o to ccreate
eate bette
better syste
systems
s
of care if linked to broader policy and payer interventions
• State strategy
gy should leverage
g national developments,
p
and drive implementation to serve state and local needs
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NYS Office of Health Information Technology Transformation