Texas Legislative Update
Presentation to the Texas State
Health Information Management
Spring Conference
Nora Belcher, Executive Director
Texas e-Health Alliance
April 25, 2014
Overview
This presentation will:
– Assess the state of Texas in terms of implementation of
the HITECH Act,
– Discuss how legislation and public policy involving HIT
have evolved, and
– and provide an overview of HIT trends and an
assessment of the future of HIT in Texas.
Slide 2
Internet Revolution: Value to Users
70
Internet use exploded once
content became accessible
and useful.
% U.S. Households Using the Internet at
Home
60
50
40
30
TCP/IP
Standard
Mosaic Web
Browser
HIT
Today
Prodigy
20
10
Computer
developed - IBM
0
1930
1950
First email
ARPANET sent
1960
1970
1980
WWW
HTML
1990
1995
1997
2000
2001
2003
2007
Today, health care information technology (HIT)
is at the “1997” of the Internet age
Source: U.S. Census Bureau, Population Division, Education & Social Stratification Branch, “Reported
Internet Usage for Households, by Selected Householder Characteristics,:2007”
© Ingenix, Inc. 3
HITECH
• Texas Status Pre-HITECH
– Privacy protections in Chapter 181 Health and Safety
Code in 2001
– Texas Health Services Authority created in 2007
– Most statutes and processes geared toward paper/fax
• HITECH passage in 2009 included 3 key
components:
– EHR Adoption Incentives and Penalties
– HIE Planning and Implementation
– Strengthening HIPAA to Protect Patient Privacy
HITECH in Texas
• State Level Implementation
– HHSC administered EHR Incentive Program and local
HIE grant program (over $ 1 billion)
– THSA implementing white space strategy and statelevel shared services
– Local HIEs completed planning and moving into
implementation
• Federal Implementation
– HIPAA final rules implementing HITECH final in January
2013
– FDA guidance on mobile medical devices
– ONC working through the stages of meaningful use
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
Page 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
Page 7
2013 Texas Legislature
• SB 1367 (Duncan/Smithee)- winds down the
risk pool at TDI, and provides THSA with $5
million dollars in bridge funding.
• SB 1643 (Williams/Alvarado)- includes the
changes needed to allow HIEs to access the
prescription drug monitoring program at DPS.
Page 8
2013 Texas Legislature
• Medicaid
– SB 7 (Nelson/Raymond)- Medicaid delivery and
quality reforms, including managed care
expansion for long term care
– SB 8 (Nelson/Kolkhorst)- Medicaid fraud and
abuse program changes
• HB 300 Technical Corrections
– SB 1609 (Schwertner/Kolkhorst)- training
clarifications
– SB 1610 (Schwertner/Kolkhorst)- breach
notification clarifications
Page 9
2013 Texas Legislature
• Providers
– SB 166 (Deuell/Larson)- allows providers to read
and store mag stripe data from driver's license
– SB 406 (Nelson/Kolkhorst)- allows for limited but
extended prescriptive authority for ANPS under
physician delegation
– SB 945 (Nelson/S. Davis)- mandates that hospital
employees involved in direct patient care wear
photo IDs
Page 10
2013 Texas Legislature
• Department of Insurance
– SB 644 (Huffman/Zerwas)- creates a standardized
prior authorization form for prescription drug
benefits
– SB 1216 (Eltife/S. Davis)- creates a standardized
prior authorization form for medical care and
health care services
• Cancer Prevention and Research Institute of
Texas (CPRIT)
– SB 149 (Nelson/Keffer)- CPRIT reforms
Page 11
2013 Texas Legislature
• Department of Information Resources
– HB 2738 (Elkins/Ellis)- DIR to study state agency
technology efficiency
– SB 1102 (Van de Putte/Larson)- Creates a new
position at DIR for a cybersecurity director
• Tax Policy
– HB 800 (Murphy/Deuell)- research and
development tax credit
– HB 1133 (Otto/Estes)- sales tax exemption for
telecom manufacturing
Page 12
Topics for 2015
• Interoperability and use of standards in state
agency IT systems
• HHS System Sunset review
• Access to public health registries for HIEs
• Provider/HIE “safe harbors”
• Remote monitoring
• Consumer telemedicine
Page 13
Conclusion
• Texas was well positioned for success with the passage of HITECH.
• The legislature and the related state agencies have been
identifying- and making- needed changes to foster the adoption of
HIT.
• Progress is being made in EHR adoption at the physician and
hospital level; work remains to be done in long term care and
mental health.
• Significant barriers still exist to EHR and HIE adoption, which will
need to be overcome for HIT to be successful.
• Policymakers are concerned about privacy and security, costs,
quality, and the rate and volume of changes that providers have to
react to.
• Policymakers in the future will be responding to growing concerns
about patient access to their records and consumer engagement.
“Patient Engagement is
the blockbuster drug of
st
the 21 Century”
-Leonard Kish, August 28, 2012
Page 15
Nora Belcher
Texas e-Health Alliance
512/536-1340
nora@txeha.org
© 2013 HIMSS