Maryland Task Force to Study Electronic Health Records

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Maryland Task Force to Study Electronic
Health Records

• January 15, 2008
• Peter Basch, MD, FACP
• Medical Director, Ambulatory Clinical Systems
• MedStar Health
• Task Force Chair

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Overview

• A Review of SB-251 and the Charge to the Task
  Force
• Our Approach
• Task Force Recommendations
• The Task Force s Final Report is available at
  http//mhcc.maryland.gov/latebreaking.aspx

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SB 251 - Established by 2005 Legislation

• Called for a Task Force to Study Electronic
  Health Records
• Two-year examination of the current use and
  potential expansion of electronic health records
  in Maryland
• Twenty-six members
• Twenty appointed by the Governor to represent a
  broad range of provider and consumer interests

• The cost of implementing these above three
  practices in Maryland
• School health records
• Patient safety

• Electronic transfer
• Electronic prescribing
• Computerized physician order entry

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Viewpoints Represented

• MD/DC Collaborative for Healthcare
• Information Technology
• MD Department of Health and
• Mental Hygiene
• Maryland Hospital Association
• Medical Records Privacy Commission
• Non-Hospital Based
• Physician
• Non-Hospital Based
• Psychiatrist

• Department of Budget and
• Management
• Health Insurance Industry
• Home Health Care
• Information Technology
• Field
• Licensed Dentist
• Licensed Pharmacist
• Long-Term Care
• Medical Laboratory

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Task Force Membership

• Peter Basch, MD, FACP Chair
• Kenneth Yale, DDS, JD Vice Chair
• Thomas Allen, MD
• Stephanie Amey, RN
• Beverly Collins, MD
• Barbara Cook, MD
• Rex Cowdry, MD
• Jimmie Drummond Jr., MD
• John Eichensehr, MT, MSHA
• Michael Flores

• The Honorable Paula Hollinger
• Aubrey Knight, MD
• Carey Leverett
• Thomas Lewis, MD
• Gina McKnight-Smith, PharmD
• Susan Newbold, MS, RNBC, FAAN
• The Honorable Shane Pendergrass
• Victor Plavner, MD
• Jack Schwartz, JD
• Kevin Sexton

Workgroup Leads
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Key Contributors

• DeWayne Oberlander, MBA, MPH
• Traci Phillips
• Denise Reeser
• Grace Zaczek

• Elaine Frazier, RN
• Chris Gibbons, MD
• Joyce Hunter
• Joshua Freemire, JD
• Steven Mandel, MS, MLA
• Mary Etta Mills, RN

• Special thanks
• David Sharp
• MHCC Staff

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Task Force Workgroups and Areas of Concentration

• Electronic Patient Information Policy
  Development
• Electronic Health Records
• Personal Health Records
• Computerized Prescribing Policy Development
• e-Prescribing
• Computerized Physician Order Entry
• Infrastructure Management Policy Development
• Health Information Exchange

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Our Approach

• Seek clarity in terminology if clarity did not
  exist, we would (at least for the report) create
  it
• Produce one report, where analysis and
  recommendations represents a consensus view from
  all Task Force members
• Produce a report that the Governor and General
  Assembly would find useful
• Avoidance of hype
• Inclusion of research that showed lack of benefit
  or even a negative impact to health information
  technology

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General Conclusions

• Health information technology (including
  electronic health records, personal health
  records, e-prescribing, computerized physician
  order entry, health information exchange) is not
  a panacea for all that ails health care at best,
  it provides a powerful infrastructure
• While it can be used to improve quality, safety,
  and efficiency,
• it per se does not
• To realize optimal benefits for all stakeholders
• Health information technology should not be
  considered in isolation, but as part of broad
  payment reform, which includes appropriate
  payment for health management and quality
  outcomes
• Consumers must trust that their health
  information is secure and private
•  
• Any remaining legal and regulatory barriers must
  be identified and resolved

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Develop a statewide outreach
and education program

• The Task Force recommends that the State develop
  programs aimed at educating consumers on the
  various aspects of electronic health information
  and the many ways HIT can be used to improve
  health care
• The Task Force viewed education as critical to
  shaping consumer acceptance of electronic health
  information exchange and to building consumer
  trust
• Task Force members viewed education as a critical
  component for consumer acceptance of HIT that
  should be funded through general funds, involve
  key stakeholder groups, and coordinated by an
  agency such as the MHCC

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Encourage adoption of EHR systems by physicians

• Adoption of EHR systems (which includes clinical
  decision support) by most physicians is necessary
  to achieve the full promise of HIT
• Physicians are strongly encouraged to adopt EHR
  systems
• The Task Force viewed physician incentives as a
  key component for expanding voluntary adoption of
  EHRs
• The Task Force felt that funding incentives are
  necessary to help defray the initial acquisition
  and implementation costs of EHRs and with the
  subsequent costs related to integrating these
  systems with a statewide HIE
• Incentive vehicles discussed included tax
  credits, grants, small business loans, and
  increased third-party payment
• Physician adoption of EHRs has been slow in part
  due to high startup costs and the length of time
  it takes to implement an EHR system

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Encourage implementation by hospitalsof EHR
systems and CPOE

• Universal adoption of EHR systems (including
  CPOE) by hospitals is necessary to achieve the
  full promise of HIT
• Hospitals are strongly encouraged to adopt EHR
  systems (including CPOE) as soon as possible
• Almost all hospitals have a five year technology
  plan that calls for the implementation of EHR
  systems
• The Task Force felt that funding incentives are
  not critical for hospital adoption of technology
  but legislation or incentives are needed in
  order to hasten implementation

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Encourage adoption of EHR systems in school-based
health centers

• The Task Force believes that EHR system adoption
  should occur in all 61 SBHCs in Maryland
• The Task Force agreed that their use will improve
  patient care and workflow management within SBHCs
• The Task Force felt that funding incentives are
  necessary to help defray the initial acquisition
  and implementation costs of EHRs
• Funding for school health programs inevitably
  competes with academic agendas

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Allow market forces to drive consumer adoption of
personal health records

• The Task Force concludes that PHRs have the
  potential to develop into a secure, reliable
  communications platform that enables consumers
  and health care providers to improve coordination
  of health care decisions and promote positive
  health behaviors
• The State should not mandate personal health
  records (PHRs),
• but allow the marketplace to drive adoption

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Implement a statewide health information exchange

•  
• The Task Force supports the States efforts to
  implement a health information exchange, and
  agrees that the State should provide funding for
  development costs
• The Task Force supports the efforts of the MHCC
  and Health Services Cost Review Commission
  (HSCRC) to fund several parallel planning
  projects, followed by a single implementation
  project
• The HSCRC expects to fund several planning
  projects for a total of up to 750,000 through
  hospital rate adjustments
• As part of the implementation phase, MHCC and
  HSCRC will use the ideas developed from these
  planning projects to implement a statewide health
  information exchange

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Incentives and Payment Reform

• Fix misaligned costs and benefits for optimal use
  of HIT through reform of the existing
  reimbursement system
• August 8, 2007 Governor Martin OMalley appointed
  six individuals to participate on the Task Force
  on Health Care Access and Reimbursement (TFHCAR)
• TFHCAR is charged with examining physician and
  health care reimbursement trends in the State,
  and developing recommendations for presentation
  to the Governor and the General Assembly in June

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Encourage e-Prescribing as part of EHR system
adoption and use

•  
• The Task Force did not support mandating
  physician adoption of e-prescribing systems
• The Task Force concluded that while there may be
  some value to standalone e-prescribing, there is
  far greater value to e-prescribing
  integrated within an EHR system
• While the Task Force did not conclude that
  financial incentives were needed to promote the
  adoption of e-prescribing, it did conclude that
  some level of financial incentive is needed to
  promote the optimal use of e-prescribing

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Policy / Legal Recommendations

• Develop statewide privacy and security policies
  for health information exchange
• Modify existing statutes to resolve conflicts
  between statutes, and develop new legislation
  where necessary
• Resolve differences between State privacy and
  security laws and HIPAA between FERPA and HIPAA

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• QUESTIONS?