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
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?
3
State Health & Human Services Information Network
Needs, Utilization/Payments, & Outcomes
4. Specialty Behavioral
Health/SAMHSA
5. Other 6. Hospital
7. State Information Exchange/ONC
Specialty
Health
8. State Insurance Exchange/ONC
9. State Medicaid/CMS
3. FQHC/HRSA
10. Medicare/CMS
Un-Silo
2. Primary Care
11. Children & Family
Agency/ACF
1. Health
Home
20. Oversight/
GAO & IGs
Family &
Individual
History
19. Tax & Other Adm.
Agencies/IRS
18. Criminal
Justice/DoJ
Research
12. Public Health
/CDCP
13. Pharma-Medical
Device Vender/FDA
14. School/DOE
17. Income
Maintenance/SSA
15. Housing Agency/HUD
16. Other Safety-Net
Agencies/DoA-WIC
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!
5
Standard Terminology ASAP!!
•
SNOMED-CT
•
LOINC
•
RxNorm
•
Core Data Sets to measure needs,
quality, & outcomes
6
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
7
State Health & Human Services Information Network
Public Sector IT Spending Plans & Expectations
5. Other 6. Hospital
7. State Information Exchange/ONC
Specialty
4. Specialty Behavioral
Health
8. State Insurance Exchange/ONC
Health/SAMHSA
2. Primary Care
1. Health Home
20. Oversight/
GAO & IGs
9. State Medicaid/CMS
Service Systems Integration
3. FQHC/HRSA
10. Medicare/CMS
SAMHSA:
• Primary Behavioral Health Care
•
•
•
•
Other Federal
• Medicaid $10Bs/yr
11. Children & Family
Agency/ACF
Care Integration $15M 2011
• HRSA $B’s/yr
OBHITA/REM $3.2M/yr 2009-13
• ACF $Bs/yr
12. Public Health
ONC Privacy Project $2.77M 2011
• IHS $10Ms/yr
/CDCP
Quality Measures $100Ks/yr
Suicide Hotline w/DOD $0
Reusable Open Source 13. Pharma-Medical
• VA/DOD $Bs/yr
Device Vender/FDA
19. Tax & Other Adm.
Agencies/IRS
18. Criminal 17. Income
Justice/DoJ Maintenance/SS
A
14. School/DOE
15. Housing Agency/HUD
16. Other Safety-Net
Agencies/DoA-WIC
Federal IT Investments
8
Performance Measurement
• Encounter & episode quality measures
o Priority needs met first?
o Patient self-reports
o Automated EHRs extracts
• 3rd Party verification (needs & Outcomes):
o Cross-check records from different
providers
o Cross check safety net beneficiary records
across State agencies
9
State Health & Human Services Information Network
Public Spending for Performance Monitoring
5. Other 6. Hospital
7. State Information Exchange/ONC
Specialty
4. Specialty Behavioral
Health
8. State Insurance Exchange/ONC
Health/SAMHSA
9. State Medicaid/CMS
3. FQHC/HRSA
SAMHSA*
2. Primary
Care
20. Oversight/
GAO & IGs
Other Federal*
• GPRA Data Warehouse
1. Health Home
$10M/yr, 5 yrs
• Block Grant/DASIS-TEDS
$ Ms/yr
• Prescription Drug Monitoring
$Ms before 2011, $0 after
19. Tax & Other Adm.
Agencies/IRS
18. Criminal
Justice/DoJ
* Tank sizes not to scale
relative to each other
17. Income
Maintenance - SSA
10. Medicare/CMS
•
•
•
•
•
•
•
CMS $?
CDCP $?
FDA $?
HRSA $?
ACF $?
IHS $?
VA/DOD $?
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
Federal IT Investments
San Francisco Regional meeting
10
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
11
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.
12
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
o
o
Health Home Reference Electronic Health Information Model (REM)
Safety Net Information Banking Service (SIBS) for Personal History Records
Partnerships with VA and leading States
13