Lathrop

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Lathrop Gage Health Law Now Making House Calls
Launching soon at www.lathrophealthlawyers.com
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Lathrop Gage Web SeminarStark Illogical,
Unintelligible and Ever Changing . . . But It's
Still the LawSeptember 25, 20081200 - 130
PMTo register, please e-mail us at
HCWebinar_at_lathropgage.com.
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Objectives

• Discuss the Big Picture HIE Initiatives at
  State / National Level
• Operating in the Big Picture Considerations
  for Selecting EHR
• Practical Implementation Strategies

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The National Discussion

• Movement Toward Health Information Exchange (HIE)
• Example of Banking and Insurance Industry
• Technology Advances
• Health Care Data Intensive
• Payer / Patient Expectations
• Barriers to HIE
• Privacy and Security Concerns
• Complexity of Environment
• Confused Expectations
• Focus of Effort

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Addressing the Challenge

• HIPAA
• Technology (interoperability)
• Antiquated Statutory Structure
• Education
• Policy-makers
• Patients
• Providers
• Payers

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Recent HIE Developments at the National Level
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Presidents August 2006 Executive Order

• Directs Federal agencies that administer or
  sponsor federal health insurance programs to
• Increase transparency in pricing
• Increase transparency in quality
• Encourage adoption of health information
  technology (IT) standards
• Provide options that promote quality and
  efficiency in health care

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Secretary Leavitts Four Cornerstones

• Connect the system (standards)
• Measure and publish quality
• Measure and publish price
• Create positive incentives

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Lack of Comprehensive Privacy Policy

• Early focus on interoperability standards
• Lack of focus on privacy
• January 2007 GAO report emphasizes need for
  comprehensive approach
• American Health Information Community (AHIC)
  Privacy Workgroup
• State-level Health Information Privacy and
  Security Collaboration (HISPC)

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State Alliance for e-Health

• HHS Contract with National Governors Association
• Governance models
• Sustainable business models for HIE
• Role of private payers
• Integration of state public health and health
  care programs

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Congressional Bills

• SB 3454 (Brownback) and HR 5559 (Moore
  co-sponsor)
• Establish independent health record trusts,
  modeled after banking industry
• Create lifetime EHRs with health plan and debit
  card functionality
• Connect EHRs and build a national health
  information network
• Provide health information data (within
  authorized boundaries) to emergency departments
  and researchers
• Offers tax credits to employers to encourage
  employee participation
• Creates source of tax-free income to support
  operations of the trust

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HIT / HIE Resources

• Agency for Healthcare Research and Quality
  National Resource Center for HIT www.ahrq.gov
• Connecting for Health / Markle Foundation
  www.connectingforhealth.org/commonframework/
• U.S. Dept. Health and Human Services (ONC, AHIC,
  NHIN, etc.) www.hhs.gov/healthit/
• Certification Commission for HIT (CCHIT)
  www.cchit.org
• eHealth Initiative www.ehealthinitiative.org
• Healthcare IT News www.healthcareitnews.com

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Key Recommendations from HIE Workgroups

• Establish leadership group
• Create public / private entity
• Provide education
• Leverage existing resources
• Demonstrate impact of HIE
• Resolve privacy and security barriers
• Seek funding from multiple sources

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Developments at State Level

• HISPC Collaborative Efforts
• HISPC State Efforts

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The Kansas Example

• H4C and HIE Commission
• Kansas Health Policy Authority
• Advisory Council
• Purposes
• Create favorable statutory / regulatory
  environment
• Leverage purchasing power of state to promote HIT
• Provide resource center
• Provide policy recommendations
• State-wide community health record
• Insurance card standardization
• Medical home

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Environmental Scan

• Central Plains Regional Health Care Foundation
• Clinic Patient Index
• Community Health Center (Health Choice) Project
• Jayhawk Point of Care
• Care Entrust
• Northwest Kansas Health Alliance
• Kansas Public Health Exchange
• Kansas City Quality Improvement Consortium
• Kan-Ed
• Sedgwick County EHR

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Goals of National and State Efforts

• Improve Quality / Safety
• Improve Cost Effectiveness of Care
• Improve Communication
• Maintain Privacy and Security

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GET READY
It has to happen
It will happen
But the environment is still murky
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Selecting an EHR in the Current Environment
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Where to Begin Resources

• CCHIT (www.cchit.org)
• Recognized certification body for EHRs
• Certifies ambulatory, inpatient and emergency
  department EHR products
• Certification standards for each product type
  available on Web site
• Web site lists vendors withcertified products

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Where to Begin Resources

• Doctors Office Quality Information Technology
  Program (DOQ-IT) University
• Launched in April 2007
• Interactive Web-based tool
• Tools / resources for assessment planning and
  implementation activities
• Associations
• Health Information Management Systems Society
  (HIMSS) (www.himms.org)
• Variety of EHR related links
• American Health Information Management
  Association (AHIMA) (www.ahima.org)
• Variety of e-HIM links

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Selection Core Considerations

• Functional Considerations
• What can the product do?
• Interoperability Considerations
• How can the product communicate?
• Privacy / Security Considerations
• How is data protected?

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Functional Considerations

• Integration of existing records
• Integration of external records
• Correspondence
• Records from other providers
• Merging or separation of records
• Merger of practice
• Split of practice

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Functional Considerations

• Production of records
• Patient requests
• Legal requests
• Litigation holds
• Reports
• Customization
• De-identification of information

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Interoperability Considerations

• Interface requirements / capabilities
• Practice management system
• Lab, imaging systems
• Hospital outpatient systems
• Data Reporting
• Quality data
• Public health
• Health information exchange participation

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Security Considerations

• Access Controls
• Establishes access rights
• Access in emergencies
• Audit Controls
• Ability to record and examine activity within the
  system
• Integrity Controls
• Protection from alteration / destruction
• Transmission integrity
• Authentication
• Verification of user identity

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Vendor Relationships Request for Proposal (RFP)
Components

• Background Information
• Organization Background
• Current systems
• Current hardware
• Vendor Background
• Age, size
• Acquisitions / mergers
• Location (field offices)
• References

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Vendor Relationships RFP Components

• Product Features (Functionality)
• Administrative / Clinic Management
• Clinical Care / Management
• Workflow Management
• Interoperability
• Existing Internal Systems
• External Systems
• Security
• Existing law, industry standard
• On-site systems vs. Application Service Providers
  

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Vendor Relationships RFP Components

• Support
• During Implementation
• After Implementation
• Training
• Time-lines
• Resources
• Pricing
• Number of users
• Patient Volume
• Number of computers
• Expectation that quoted prices are the lowest /
  best

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Vendor Relationships RFP Components

• Fixed due-date for proposal submission
• Date that proposal evaluation will begin
• Period for which proposal is expected to remain
  valid
• Confidentiality of proposal information

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Vendor Relationships Contracting

• General Vendor Obligations
• Software
• Upgrade notifications
• Prior version support
• Non-vendor software / upgrades
• Support
• Hours of availability
• Term of availability
• Resolution time-frames
• Location of support

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Vendor Relationships Contracting

• General Vendor Obligations
• Interfaces
• Responsibility for developing interface
• Ownership of interface
• Responsibility for troubleshooting the interface
• Training
• Number of hours covered
• Updates
• General Provider Obligations
• Requirements for base hardware
• Fees

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Vendor Relationships Contracting

• Security Issues
• Guaranteed data availability
• Data back-up
• Minimum down-times
• HIE / Legal Environment
• Support for required reporting, pay for
  performance
• Connectivity with HIEs
• Maintenance of product certification
• Updates for legal changes

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Vendor Relationships Contracting

• Costs Current
• Progressive payment schedule based on milestones
• Upgrades
• Interface programming and maintenance fees
• Maintenance fees generally
• Implementation vs. go-live
• Training
• Hourly vs. per-diem rates
• Additional fees
• After-hours support
• Costs Future
• Annual fees
• Discounts on future products / services

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Vendor Relationships Contracting

• Termination
• Grounds
• Bilateral termination
• Material breach
• Termination by default
• Vendor ceases to exist
• Consequences
• Ownership of data
• Ownership / availability of source code
• Make whole remedies

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Vendor Relationships Contracting

• Other provisions
• Liability / Indemnification
• Ever-green clauses
• Choice of law
• Transfer of agreement
• Confidentiality of patient / proprietary
  information

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Practical Considerations

• Anticipate
• Disruption of workforce
• Delayed billing / collection
• Disparate levels of acceptance
• Frustration
• Changing technology

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Practical Considerations

• Plan, Plan, Plan
• Establish close relationship with vendor
• Educate staff
• Anticipate provider reaction and work with them
• Plan, implement, adjust
• Patience, persistence, commitment

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