Quality and the Health Information Technology Movement: Could Louisiana Become A Leader in Technolog

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Quality and the Health Information Technology
Movement Could Louisiana Become A Leader in
Technology Modernization Efforts?
Quality and the Health Information Technology
Movement Could Louisiana Become A Leader in
Technology Modernization Efforts?
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Panelists Roxane A. Townsend, M.D. Deputy
Secretary, LA DHH Christopher B. Sullivan,
Ph.D. Administrator, Office of HIT Florida Center
for Health Information and Policy Analysis Agency
for Health Care Administration Robert
Olmedo Director of Technology Palm Beach County
Community Health Alliance
Panel Moderator
Anthony Keck
Anthony Keck
BSIOE, M.P.H. Tulane University School of Public
Health Tropical Medicine
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Creating A Healthy Future for Louisiana Through
the Power of Information
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• Health Information Technology

?Develop systems for monitoring and reporting
quality of care using recognized standards
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Health Information Technology Pre-Katrina/Rita

• Initiatives

• Health Information Technology Summit
• HIFA 1115 Waiver HIT Infrastructure
• RFP for e-Prescribing
• Electronic Medical Records
• Critical Access Hospitals Grant
• Provider Decision Support Tool
• Louisiana PHIN (Public Health Information
  Network)
• DHH response to HHS/ONC RFP for NHIN

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Health Information Technology Summit

• State CANNOT be the sole owner of the agenda
• State CAN provide leadership and direction
• State and Regional Collaboration
• Must create a Value Proposition
• Importance of assuring
  privacy and security

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KATRINA

• We were not prepared!

• The most challenging issues had nothing to do
  with technology and everything to do with
  challenges regarding

• Legal

• Policy

• Business

• Two areas that need critical attention were
  validated

• The shelter phase is very different from
  the community phase

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Health Information in Katrina

• Environmental Factors Human

• 1.2 million people separated from their medical
  history
• Most being cared for by providers theyve never
  previously seen
• Estimate 20 in shelters and emergency facilities
  with medical personnel available, dropping to 10
  within 2 weeks (i.e., majority of dislocated
  people will be getting care in the community)
• Significant concerns about coverage, access to
  current prescriptions
• Likely continued mobility across U.S.
• Many will have other documentation problems
  (property titles, vital records, insurance) as
  well
• Physicians from affected areas may start to
  practice elsewhere most records lost
• No guarantee physicians or patients will return
  to affected areas
• Uncertain level of trust in first response
  services

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www.KatrinaHealth.org

• Once authorized to use KatrinaHealth.org, health
  professionals were able to access an evacuee's
  medication history from the following sources

• Louisiana and Mississippi Medicaid
• Commercial pharmacies
• Pharmacy Benefit Managers
• Veterans Health Administration

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PMAC
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LINKS Unexpected Successes

• LINKS was successfully accessed from all 50
  United States, Canada, Mexico, Ecuador,
  Guatemala and the United Kingdom
• Over 56,000 records were successfully retrieved
  for Katrina evacuees OUTSIDE of Louisiana
• The Houston Harris County Immunization Registry
  (HHCIR) staff estimated that use of the HHCIR to
  retrieve LINKS data (via HL7 messaging) saved the
  Houston immunization program approximately 1.5
  million dollars in vaccines
• Total estimate of over 6.3 million in savings
  for vaccines due to the availability of
  vaccination records in LINKS

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Health Information Technology Post-Katrina/Rita

• Initiatives

• KatrinaHealth.org
• Louisiana Health Information Exchange (LaHIE)
• Contract between HHS and LA DHH
• Prototype for Interoperable Health
  Information Exchange
• Gulf Coast Information Technology Task Force
• HISPC
• Medicaid HIT Transformation Grant

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Louisiana Health Information Exchange (LaHIE)

• Contract between DHH and HHS/Office of National
  Coordinator Health Information Technology

• Develop a prototype for health information
  exchange

• Primary focus to recover and recreate medical
  histories for Hurricane Evacuees

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Louisiana Health IT Project Overview

• Awarded Contract on Sep 30, 2005
• One Year Implementation Timeline
• Using Proven Technology
• Following all Standards and
  Privacy Policies
• Public, Private, and Educational
  Project Team
• Primary Focus Electronic Health Records
• Not Electronic Medical Records
• Start Small - 2 Markets
• New Orleans (Recovery)
• Baton Rouge

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Louisiana Health IT Project Overview

• Project Will Demonstrate
• Health Information Exchange
  Between Providers
• Timely Access to Patient
  Continuity of Care Information
• Trauma
• Emergency Room
• Provider Facilities
• Long-Term Personal Health Records
• First Functional Demonstration Target July 2006
• Begin Requirements Gathering February 2006
• Proven Provider Credentialing

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Guiding Principles

• Patients and their doctors will retain control
  over how their data is used

• Healthcare costs will be reduced by minimizing
  waste and improving efficiency

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Project Goals

• To design, develop, and implement the necessary
  infrastructure to demonstrate functional
  interoperability in collaboration with Louisiana
  healthcare providers through
  the standardized exchange of
  patient information by September 30,
  2006

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LA HIE High Level Architecture
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Louisiana Medicaid- Pay for Performance -

• Vaccines for Children Program
• Utilizing LINKS in the office
• Achieving State average for toddler immunizations
• Achieving National average for toddler
  immunizations

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HbA1c Test in Past Year, HEDIS, Adjusted
Denominator HEDIS Diabetes
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Regional HgbA1c Averages
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Health Information Security and Privacy
Collaborative

• Awarded Contract from RTI in May 2006
• Identifying barriers to electronic health
  information sharing
• Legal
• Business Practices
• Policies
• Workgroups formed
• Solutions to barriers being sought

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Medicaid Transformation Grant

• Goal
• To provide incentives to physicians for
  HIT adoption
• Target New Orleans area
• 325 providers
• Technical assistance with EMR adoption
• Software and hardware purchase
• Announcement of awards pending

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Health Care Redesign Collaborative

• Medical Home Model
• Health Information Technology
• Louisiana Quality Forum

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Panelists Roxane A. Townsend, M.D. Deputy
Secretary, LA DHH Christopher B. Sullivan,
Ph.D. Administrator, Office of HIT Florida Center
for Health Information and Policy Analysis Agency
for Health Care Administration Robert
Olmedo Director of Technology Palm Beach County
Community Health Alliance
Panel Moderator
Anthony Keck
BSIOE, M.P.H. Tulane University School of Public
Health Tropical Medicine
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Developing the Florida Health Information Network
through a Grants Program for Regional Health
Information Organizations
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The Florida Health Information Network is the
Result of

• Health policy decisions in the Florida
  Legislature and Governors Office endorsing the
  Florida Health Information Network (FHIN)

• Funding from the Legislature for grants to
  Regional Health Information Organizations (RHIOs)
• Leadership from the Governors Health Information
  Infrastructure Advisory Board

Policy Decisions
Funding
Leadership
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The Florida Health Information Network Strategy

• Build out health information networks using a
  grants program to leverage the development of
  local RHIOs

• Integrate the RHIOs with a state-level server
  that will manage data exchange among RHIOs and
  other state and federal databases
• Create a not-for-profit organization
  to maintain the FHIN and set
  standards of
  interoperability
  for the RHIOs

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Executive Order Initiates the Florida Health
Information Network

• Floridas Governor Jeb Bush signed Executive
  Order Number 04-03 on May 4, 2004 addressing the
  need for state leadership in the area of health
  information technology infrastructure development

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The Governors Health Information Infrastructure
Advisory Board

• Advisory Board formed to create
• a plan to promote the development and
  implementation of a Florida health information
  infrastructure

• The Boards 2005 Interim Report of the GHIIAB
  called for the creation of the Florida Health
  Information Network

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Health Information Networks Included as an
Innovative Idea in 2007

• Idea 85 of Speaker Marco Rubios 100 Innovative
  Ideas addresses health information exchange

• Improve patient care through technology by
  expanding electronic health records and regional
  health information networks

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Definition
Florida Health Information Network -
the statewide network that will integrate the
Regional Health Information Networks to enable
statewide health information exchange
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Functions of the Florida Health Information
Network

• The Florida Health Information Network will
  facilitate communications and data exchange
  among the RHIOs by coordinating requests for
  medical records inside and outside of Florida

• The Florida Health Information Network will
  specify and maintain technical standards for
  interoperability among the RHIOs

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Florida Health Information Network
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Florida Health Information Network
1. Big Bend RHIO 2. Tampa Bay RHIO 3. Palm Beach
County Community Health Alliance 4. South Florida
HII 5. Escambia HIN 6. JaxCare, Inc. 7. Community
Health Information Organization 8. Central
Florida RHIO 9. Pinellas RHIO 10. Space Coast RHIO
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The Florida Health Information Network White Paper

• Originally written to address
• The technical architecture of the Florida Health
  Information Network
• The requirements of interoperability among the
  RHIOs and the Florida Health Information Network
• The needed security precautions to ensure
  confidentiality of data exchange
• Has become an ongoing strategic document to
  address new technical issues as they arise

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Technical Standards for the FHIN
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The Florida Health Information Network Begins at
the Local Level

• The Florida Health Information Network is being
  built from the local community up

• An essential element of the strategic plan is to
  empower local stakeholder collaborations focused
  on health information exchange
• The driver of this plan is the FHIN Grants
  Program and Regional Health
  Information Organizations in the
  local community

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What Is A Regional Health Information
Organization?
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Grants Program to Develop Regional Health
Information Organizations

• Planning Grants Support engaging local health
  care stakeholders to develop a strategic plan for
  health information exchange

• Implementation Grants Support projects that
  demonstrate health information exchange among two
  or more competing providers
• Training Grants Support practitioner training
  designed to increase physician and dentist use of
  electronic health record systems

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Grants Program 2006-2007

• In 2005 the Legislature appropriated 1.5 million
  for grants which the Agency awarded to nine
  projects
• 5 Planning Grants
• 3 Implementation Grants
• 1 Training Grant

• In 2006 the Agency awarded seven grants with
  another 2 million appropriated by the
  Legislature
• 7 Implementation Grants

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Geography of the FHIN

• Florida RHIOs
• Big Bend RHIO
• Central Florida RHIO
• 3. Community Health Information Organization
• 4. Escambia HIN
• 5. JaxCare, Inc.
• 6. Palm Beach County Community Health Alliance
• 7. Pinellas RHIO
• 8. Space Coast RHIO
• 9. South Florida HII
• 10. Tampa Bay RHIO

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Florida RHIA Example
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Palm Beach County Community Health Alliance
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Western Palm Beach County
Health Information Infrastructure Operations
and Evaluation Project

• 28 uninsured rate
• Glades General Hospital is only Acute Care
  facility
• 17,753 ER visits 1,900 Medicaid discharges in
  2002
• Prevent duplication between hospital and clinics

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All-Care Shared Health Record

• Real-time electronic interface to existing data
  systems used by
• Hospitals
• Clinics

• Mental Health Centers
• Other safety net providers

• Free clinics, Federally Qualified Health Centers,
  Palm Beach County Medical Society Project Access
  and key competitor safety net hospitals are
  participating
• Viewable via the Web after patients have signed
  authorizations

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All-Care Clinical Data List

• Date of Visit and Encounter Type
• Clinic and Provider Names
• Diagnosis and CPT code(s)
• (Hospital) Discharge code
• Prescribed and Filled drugs
• Lab results
• Radiology Results

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All-Care Encounter Summary
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All-Care Encounter Summary
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Next Steps for the Florida Health Information
Network

• Establish a statutory entity
• Florida Health Information Network Corporation
• to implement the state level network

• As a not-for-profit organization, the Florida
  Health Information Network Corporation would be
  accountable to the public and responsive to
  health care providers

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The Florida Health Information Network Will

• Specify standards to ensure interconnectivity and
  maintain security
• Develop uniform policies regarding
  confidentiality of patient records and patient
  authorization
• As a public-private partnership, will develop the
  critical mass of information resources to achieve
  a sustainable statewide system of regional
  networks

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The Future of the Florida
Health Information Network

• The Florida Health Information Network vision
  will integrate clinical health information
  exchange in Florida through a network
  architecture that will empower physicians
  to access timely and accurate medical
  records in order to deliver high
  quality medical care for their patients

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Christopher B. Sullivan, Ph.D. Agency for Health
Care Administration Florida Center for Health
Information and Policy Analysis Office of Health
Information Technology 2727 Mahan
Drive Tallahassee, FL 32309 sullivac_at_ahca.myflorid
a.com
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Panelists Roxane A. Townsend, M.D. Deputy
Secretary, LA DHH Christopher B. Sullivan,
Ph.D. Administrator, Office of HIT Florida Center
for Health Information and Policy Analysis Agency
for Health Care Administration Robert
Olmedo Director of Technology Palm Beach County
Community Health Alliance
Panel Moderator
Anthony Keck
BSIOE, M.P.H. Tulane University School of Public
Health Tropical Medicine
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Questions and Answers
Questions and Answers