What the Stimulus Bill Means for the Future of Health Information Technology

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What the Stimulus Bill Means for the Future of
Health Information Technology

• March 16, 2009
• 130 PM EDT
• Please dial 1-866-642-1665
• Passcode 342441
• to listen to the audio portion of the webinar
• You will not be able to listen to the audio over
  the web

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David Zook and Vince Ventimiglia
David Zook david.zook_at_bakerd.com
Vincent J. Ventimiglia, Jr. vincent.ventimiglia_at_b
akerd.com
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Agenda

• Introductions
• Overview of ARRA HIT provisions
• Office of National Coordinator
• Policy Standards
• HIT grants and loans
• Medicare Medicaid incentives
• Privacy provisions
• Telemedicine overview
• Impact Engagement

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Call for Stimulus
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Stimulus overview

• ARRA signed into law February 17, 2009
• 787 billion in new spending and tax cuts
• Congressional Budget Office estimates that the
  bill will add 185 billion to the economy in 2009
  and 399 billion next year
• Federal agencies and states involved in
  implementation
• Exceptional requirements for speed, duration,
  transparency, and accountability

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• Our recovery plan will invest in electronic
  health records and new technology that will
  reduce errors, bring down costs, ensure privacy,
  and save lives.
• President Obama Address to Joint Session
  of Congress
• February 24, 2009

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(No Transcript)
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ARRA Health IT Components

• Office of the National Coordinator of HIT
• Funding to support infrastructure and EHR
  adoption
• Incentives to providers through Medicare
  Medicaid
• Significant privacy and security components

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Office of National Coordinator

• Codified through ARRA
• Standards
• Review federal health IT investments to ensure
  they are meeting objectives of federal health IT
  strategic plan
• Establish HIT Standards Committee (consider role
  of National eHealth Collaborative)
• Review and determine within 45 days whether to
  endorse standards, implementation specifications,
  and certification criteria for electronic
  exchange and use of health information
  recommended by HIT Standards Committee
• Policy
• Coordinate policy and programs
• Establish HIT Policy Committee (consider role of
  National eHealth Collaborative)
• ONC chief privacy officer appointed by HHS
  Secretary within 12 months to advise National
  Coordinator and assist states, regions, and other
  nations 

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Office of National Coordinator

• Federal Health IT Strategic Plan
• Update the plan with other federal agencies to
  address several key components (electronic
  exchange, overall utilization, privacy and
  security, specifications, public engagement,
  continuous improvements)
• Update through public and private sector
  collaboration
• Measurable outcome goals
• Published and accessible

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Office of National Coordinator

• HIT Policy Committee
• Recommend policy framework for nationwide health
  information technology infrastructure
• Recommend and prioritize areas in which
  standards, implementation specifications, and
  certification criteria are needed
• Consider recommendations for appropriate use such
  as quality, care coordination, vulnerable
  populations
• Encourage broad stakeholder input
• Members appointed by Secretary, Senate, House,
  President, Comptroller General (specific
  expertise)
• Letters of nomination for GAO positions were due
  March 6 appointments by the end of the month
• Letters of nomination for HHS position due to ONC
  on March 16

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Office of National Coordinator

• HIT Policy Committee
• Areas for review
• Appropriate use of nationwide health IT
  infrastructure for collection of quality data,
  biosurveillance, public health, medical and
  clinical research, and drug safety
• Self-service technologies for exchange of patient
  information
• Telemedicine technologies
• Home health care
• Reduce medical errors
• Promote continuity of care
• Meet needs of diverse populations
• Facilitate secure access to PHI

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Office of National Coordinator

• HIT Standards Committee
• Recommend standards, implementations
  specifications, and certification criteria
• Provide for NIST testing
• Within 90 days, develop schedule for assessment
  of recommendations for HIT Policy Committee
• Open public meetings
• Membership to include providers, ancillary
  healthcare workers, consumers, purchasers, health
  plans, technology vendors, researchers, federal
  agencies, expert individuals
• Specific stakeholder input with sector balance
• Letters of nomination due to ONC on March 16

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Federal Adoption of Standards

• Within 90 days, Secretary will determine whether
  or not to propose adoption of current standards
• By 12/31/09, Secretary shall adopt, by rulemaking
  process, an initial set of standards,
  implementation specifications, and certification
  criteria
• As each agency implements IT systems, it will use
  systems meeting the standards
• Voluntary adoption by private sector

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Federal Health IT

• National Coordinator will support development and
  updating of quality HIT technology unless
  Secretary determines that the needs of providers
  are being met through marketplace
• Pilot testing of standards and specifications by
  NIST with HIT Standards Committee
• NIST to support establishment of conformance
  testing infrastructure and may accredit
  independent, non-federal labs to perform testing

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HIT

• 2 billion total through the Office of the
  National Coordinator (HHS)
• 300 million to support regional health
  information exchanges
• 20 million for NIST work on health care
  information enterprise integration
• the balance spread among the new grant programs
  in unspecified amounts and at largely unspecified
  times

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HIT

• Other Health IT funding outside ONC
• 85 million for Indian Health Service for HIT
• 1.5 billion for community health centers, which
  can be used for IT acquisition
• 500 million for Social Security Administration,
  of which 40 million may be used for health IT
  research and adoption

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HIT

• Funding to strengthen infrastructure
• Health IT architecture to support nationwide
  exchange and use of health information
• Development and adoption of certified electronic
  health records for providers not eligible for
  support under Medicare/Medicaid
• Training and dissemination on best practices to
  integrate health IT and EHRs
• Acquisition of health IT that meets standards
  adopted by HHS
• Funded through ONC and administered by agencies
  with relevant expertise (such as HRSA, AHRQ, CMS,
  CDC and Indian Health Service), grants will be
  made available for health information exchanges
  (HIEs), federal agencies, providers, community
  health centers, 340B entities, telemedicine
  providers, holders of health information and
  public health departments
• HHS is required to invest 300 million to
  "support regional or sub-national efforts toward
  health information exchange."

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HIT

• Implementation assistance
• State grants to promote HIT
• Planning or implementation grants to states or
  state-designated qualified entities to expand
  electronic health information exchange
• States must provide matching funds on sliding
  scale (discretionary in FY09 and 10 110 in
  FY11, 17 in FY12, 13 in FY13)
• Competitive grants to states and Indian tribes
  for loan programs
• Funded through ONC, these grants will be made
  available to states or Indian tribes to establish
  loan funds for health care providers to acquire
  EHR technology (private contributions allowed)
• Programs to integrate HIT into education
• Competitive awards to health professions schools
  to develop curricula to integrate EHR technology
  into education
• HHS, with NIST, provide funding to higher
  education for medical health informatics
  education programs at undergrad and grad levels

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HIT

• Implementation assistance (cont.)
• Health Care Information Enterprise Integration
  Research Centers
• NIST grants to higher ed institutions or
  consortia to establish multidsciplinary centers
• Generate innovative approaches to health care
  information enterprise integration and
• Pursue development of health information
  technologies and other complementary fields.
• Health Information Technology Extension Program
• ONC will establish a health IT extension program
  to assist providers to adopt, implement, and use
  certified EHR technology
• Collaborate with other agencies such as NIST in
  implementing the program
• Health Information Technology Research Center
• HHS will create a HIT Research Center to provide
  technical assistance and develop best practices
  to support effective use of health IT
• Health Information Technology Regional Extension
  Centers
• HHS will assist with creation of regional centers
  to provide technical assistance and disseminate
  best practices from the national Research Center
• Regional centers will be affiliated with US-based
  nonprofit institutions
• Up to four years of federal assistance, capped at
  50 of the capital and annual operating costs

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HIT Medicare and MedicaidIncentives

• Medicare incentives for providers
• Up to 18k if in 2011, then, 12k, 8k, 4k, 2k in
  subsequent years
• Payment reduction begins in 2015-- 1, 2, 3
• Must meet standards
• Medicare incentives for hospitals
• Up to 16 million over 4 years if using HIT in
  2011
• Additional penalties if not adopted
• Must meet standards
• Medicaid incentives
• Pays states incentive payments to support costs
  incurred for adoption

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Next steps

• ARRA provisions direct funding at high level
• Specific details, including funding targets and
  processes for disbursement under development
• How does this fit into your strategic plan?
• Health provisions, but others that could impact
  you (research, construction, energy, etc.)
• Are you communicating with Agency officials and
  congressional representatives about your
  interests/needs?
• Are you monitoring implementation?

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Additional ARRA details available

• www.recovery.gov
• www.HHS.gov/recovery
• www.AHRQ.gov
• www.CDC.gov
• www.CMS.gov
• www.HRSA.gov
• www.NIH.gov
• www.bakerdconsulting.com
• www.bakerdaniels.com

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BD Consulting

• National advisory and advocacy consulting group
  based in Washington, DC
• 50 professionals with deep sector
  concentrations www.bakerdconsulting.com
• Division of Baker Daniels LLP
• Health Life Sciences consulting practice
  focused on technical and political aspects of the
  U.S. healthcare system

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Joan S. Antokol
Joan S. Antokol Partner, Baker
Daniels joan.antokol_at_bakerd.com
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Remember Your HIPAA Headache??
What are the new requirements for Business
Associates?
What is the impact on Covered Entities?
How has ARRA changed the security breach
reporting obligations?
How has ARRA affected enforcement?
What is the impact, if any, How has ARRA changed
the security breach reporting obligations?
How has ARRA expanded HIPAA in terms of
additional entities that must now comply?
What new rights do patients have under the ARRA?
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The Evolving Privacy and Security Landscape

• 70 countries have passed sweeping laws
• More on the way
• US is considered to be less strict than the EU,
  Canada, Switzerland
• Impact of ARRA goes far beyond the US

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ARRA Overview

• Security breaches what has changed
• HIPAA expansion and new requirements
• Enforcement federal and state

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Security Breaches

• Overview of existing state law obligations
• ARRA obligations
• Who must comply?
• What must you do to comply?
• What has changed from prior state law
  obligations?
• Do the state laws still apply too?
• What enforcement can occur if you fail to comply?
• What is the impact on patients?

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HIPAA--Before and After ARRA

• Expanded scope of coverage
• Limitation on permissible activities
• Expanded patient access rights
• Additional administrative responsibilities
• Additional risks (enforcement, litigation)

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HIPAA Examples of Impact

• Third party management process
• Internal management and documentation
• Changes to procedures, training
• Changes to auditing

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Enforcement

• New tiered penalties
• Expanded public notification
• Additional pressure on HHS to enforce

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Moving Forward

• Next BD webinar on privacy and security
• April 10, 2009, 130-3 pm
• More detailed discussion of these issues
• Call or email me at any time
• [phone]
• Joan.antokol_at_bakerd.com

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David D. Storey
David D. Storey Associate, Baker
Daniels david.storey_at_bakerd.com
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What Is Telemedicine?

• Telemedicine is not new.
• Definition of telemedicine varies.
• Generally refers to the use of technology for
  the delivery of healthcare when the healthcare
  practitioner and patient are not in the same
  physical location. Telemedicine Survey and
  Analysis of Federal and State laws, Mayo Kepler
  (AHLA).

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Who Is Practicing Telemedicine?

• Numerous healthcare providers Family physicians,
  radiologists, dermatologists, psychiatrists,
  hospitals, rural health clinics and many, many
  others.
• Consultation with Specialist Telemedicine
  consultations with a specialist physician is one
  of the more common types of telemedicine.
• Wide variety of services Telephone
  consultations, telephone cross-coverage, live
  video patient assessments, store and forward
  image analysis, etc.

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Brief History of Telemedicine Legal Issues

• Technology has continued to advance, but the law
  has not kept up.
• Providers, lawmakers, payors, patients and other
  interested parties have repeatedly attempted to
  address telemedicines legal issues and expand
  telemedicine.
• Examples

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Major Legal Obstacles

• Licensure and credentialing
• Liability for patient injuries
• Federal and State regulations
• Security of patient health information
• Reimbursement

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Recent Developments

• ABA addressed state licensure issue during August
  2008 annual meeting
• Number of originating sites for Medicare
  reimbursement was expanded effective Jan. 1, 2009
• ARRA/HITECH Act provides additional funding for
  telemedicine

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Future of Telemedicine

• Impact of ARRA/HITECH Act
• Key obstacles to overcome
• Is telemedicine important to the future of
  medicine?

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Questions?

• David Zook david.zook_at_bakerd.com
• 202.589.2809 phone
• Vincent J. Ventimiglia, Jr. vincent.ventimiglia_at_
  bakerd.com
• 202.312.7463 phone
• Joan S. Antokol joan.antokol_at_bakerd.com
• 317. 569.4665 phone
• David D. Storey david.storey_at_bakerd.com
• 260.460.1681 phone