Accelerating Reform Initiative
February 2010 Learning Session
Critical Factors Influencing
Implementation:
Information Systems
Presented by:
Rebecca Novak
Healthcare Perspective, LLC
Agenda
• Understanding Current Initiatives related to
Healthcare Information Systems
– Setting the Stage for Health Care Reform is Already
Underway
• ARRA/HITECH
– Meaningful Use – What Does it Mean?
– Health Information Exchange
• Other Federal Initiatives
– HIPAA 5010
– ICD-10
• Steps to Survival
ARRA/HITECH
• ARRA – American Resources for Recovery Act
– This is the stimulus package that was passed in February
2009.
– Set aside $19.2 Billion Dollars for Health Care IT
– Infrastructure Grants – another $7-$8 Billion.
– Reimbursement Incentives - $17 Billion
• HITECH Section - Health Information Technology for
Economic and Clinical Health Act includes:
–
–
–
–
Meaningful Use – Reimbursement Enhancement
Health Information Exchange
Health Information Technology Exchanges
New Privacy and Security Provisions
Major Goals and Objectives for
Healthcare IT
• Goals:
– Increase national adoption of Health IT
– Assure systems are interoperable, improve quality and
improve care coordination
• Tactics:
– Government to lead and promulgate standards
development
– Over $19 Billion for HIT Infrastructure
– Significant savings of Federal dollars long term
– Updates and strengthens HIPAA regulations.
ARRA/HITECH Provisions
• Codifies Office of the National Coordinator
(ONC)
• Creates an HIT Policy Committee
• Creates an HIT Standards Committee
• Introduces new Privacy and Security standards
• Creates $17 Billion dollars in Medicare and
Medicaid incentives
– Focus of funds is on Meaningful Use adoption
– No upfront funds – based on use of certified
products
– Requirements increase over time and money follows
Components of ARRA/HITECH
• Medicare/Medicaid incentive begin as early as
2011 and can flow as late as 2016
• Early adoption is incentivized by payments
• Late adoption is discouraged by:
– Reduction incentive payments
– Eventually (2016) by penalties
• Medicaid payments are based on minimum
volumes and will flow through the States
• Payments require important conditions based
on “Meaningful Use” and “Certified EHR
Products”
Components of ARRA/HITECH
• Privacy and Security
– HIPAA applies to business associates same as to
covered entities (CE)
– Covered entity must notify individuals within 60 days
if breach occurs and if affects > 500 – then both HHS
and Media must be notified
– Patients have right to accounting of disclosures
– New CE – PHR (Personal Health Record) Vendors and
HIE (Health Information Exchange) Vendors
– Introduces “minimum necessary” data sets for uses
and disclosures.
– Suggestion: Make sure Privacy Officers are aware of
these changes.
– http://www.himss.org/ASP/topics_privacy.asp
Message from ONC
Interoperability through HIE and CCD
Provider EHR
CCD
formatted
file
Health Information Exchange
CCD
formatted
file
CCD
formatted
file
Provider EHR
Provider EHR
CCD Contents
CCD - Human Readable Format
CCD - Machine Readable Format
EMR Adoption Rates
HITECH Priority Grants
• State Health Information Exchange Grant Programs
– Grants are being issues early in 2010 to begin
development of Local and State HIEs
– CMS is requiring state Medicaid agencies to participate
– Focus initially on electronic labs and eprescribing
– Focus eventually on full EHR interoperability
– Must address needs of special
populations…including…those with mental and substance
abuse disorders…medically underserved…
– Build trust in and support for a statewide HIE
– http://www.hhs.gov/recovery/programs/hitech/stateinfo
exch.html
HITECH Priority Grants
• Health Information Technology Extension Program
– Offer technical assistance, guidance and information on best
practices to support and accelerate health care provider’s
efforts to become meaningful users of EHRs
– Established at least 70 regional centers that will offer technical
assistance.
– HITECH acts clearly prioritizes access to health information
technology for historically underserved and other specialneeds programs.
– Regional centers will focus…community health centers and in
other settings that predominantly serve uninsured,
underinsured and medically underserved populations.
– Full operations by December 2010.
– http://www.hhs.gov/recovery/programs/hitech/factsheet.html
ARRA/HITECH
Quick Notes
• Meaningful Use
– Still being defined but generally understood
• Electronic lab data
• Electronic prescribing
• Electronic order entry by clinicians (CPOE)
– Increasing standards between 2011 and 2015
• Health Information Exchange
– Electronic exchange of clinical data
– Appears to be following HL-7 CCD/CCR
• Clinical Care Document/Continuity of Care Record
– State driven process with linkage to NHIN (National
Health Information Network)
– Fully operational by 2015
ARRA HIT Incentive Stages
Other Federal Initiatives
• HIPAA 5010 and ICD-10
– Final Rule issued January 2009
– Convert from HIPAA Version 4010 to 5010 by
January 1, 2012
– Convert from ICD-9 to IDC-10 by October 1, 2013
Other Federal Initiatives
• HIPAA 5010 and ICD-10
– Final Rule issued January 2009
– Convert from HIPAA Version 4010 to 5010 by
January 1, 2012
– Convert from ICD-9 to IDC-10 by October 1, 2013
5010 and IDC-10
• 5010
– Major changes to 837 (claims), 835 (remittance), 270/271
(eligibility) and other HIPAA transactions
– Required for ICD-10
– Major testing efforts between providers and payers
• ICD-10
– Coding involves more specificity, more codes, more
complexity
– Core billing systems will need to change
– All interfaces that include diagnosis will need to change
and be tested
Steps to Survival
• Fully Implement EHR at your Agency
– Must first digitize the core EMR at your agency
– Clinical Care, Assessments and Clinical Orders
• Implement e-Prescribing as soon as possible (2011)
– Important first step towards meaningful use criteria
• Implement the CCD/CCR as soon as possible (2011)
– Look for opportunities for grants
– Look for HIEs in your area – pay attention
– Look to state and especially Medicaid for information
• Talk your vendors
– New releases and technology will most likely be needed
to meet the requirements for Meaningful Use
• Begin preparing individuals providing services – timeliness of
documentation is key……
Strategies
•
•
•
•
Strategic Synergy
Focus and Defer
Manage Through
Outsource
Strategic
Synergy
Approach:
Appropriate for
Organizations:
View the changes as strategic investments,
look for opportunities to create synergies
among the efforts
Aging or inadequate infrastructure
Ability to make strategic investment
Strong in-house or outsourced project
management
Risks:
Ability to meet short timeframes
Ability to maintain multi-year investment
Focus and
Defer
Approach:
Appropriate for
Organizations:
Risks:
Prioritize initiatives and defer, where
possible, less critical initiatives
Have significant challenges
Limited Resources
Lack of long term strategy may require
revisiting tactical investments
Ongoing deferral of strategic solutions will
create backlog
Manage
Through
Approach:
Work through the changes as a typical project
effort with modest investment of resources
Appropriate for
Organizations:
Where infra-structure is in place and changes
are less dramatic and more incremental
Strong project management
Risks:
May underestimate changes required
More difficult to up-size after setting initial
stakeholder expectations of modest level of effort
Example: Provider with current HER and PMS
Outsource
Approach:
Appropriate for
Organizations:
Risks:
Outsource all major initiatives to a strategic
partner (or partners)
Minimal current capabilities
Able to find a trusted strategic partner
Ability to manage vendor who will have many
competing clients all with similar deadlines
Industry Resources
• Department of Health and Human Resources
• NIATx
• National Council for Behavioral Health
(NCCBH)
• Bazelon Center
• Healthcare Information and Management
Systems Society (HIMSS)
Final Comments & Questions