ARRA Implications for SLHIE Governance Definitions, Plans

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ARRA Implications for SLHIE GovernanceDefinitions
, Plans State-level Readiness

• State Level HIE Leadership Forum Webinar
• SLHIE Consensus Project
• March 27, 2009

2
Agenda

• Update on ARRA (10 min)
• Highlight funding, timing, and key considerations
• Defining Meaningful Use Information
  Exchange (30 min)
• Describe statutory definitions
• Examine operational definitions
• Discuss implications
• Developing Plans and Advancing Implementation (30
  min)
• Identify the key issues
• Discuss states approaches to key issues
• Share best practices and suggestions for moving
  forward
• Next Steps and Wrap up (10 min)

3
Faculty

• Presenters
• Lynn Dierker, Project Director, State-level HIE
  Consensus Project
• Lammot du Pont, Senior Manager, Manatt Health
  Solutions
• State-level HIE Discussants
• Rachel Block, Executive Director, New York
  eHealth Collaborative
• Melissa Hargiss, Director of eHealth Initiatives,
  State of Tennessee
• Brad Tritle, Executive Director, Arizona Health-e
  Connection

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ARRA FundingMany Sources, Many Purposes
Appropriations for Health IT
New Incentives for Adoption

• 2 billion for loans, grants technical
  assistance for
• National Resource Center and Regional Extension
  Centers
• EHR State Loan Fund
• Workforce Training
• Research and Demonstrations

• New Medicare and Medicaid payment incentives for
  HIT adoption
• 20 billion in expected payments through Medicare
  to hospitals physicians
• 14 billion in expected payments through Medicaid
• 34 billion expected outlays, 2011-2016

Appropriations for HIE
Community Health Centers
1.5 billion in grants through HRSA for
construction, renovation and equipment, including
acquisition of HIT systems

• At least 300 million of the total at HHS
  Secretarys discretion for HIE development
• Funneled largely through States or qualified
  State-designated entities
• For planning and/or implementation

Broadband and Telehealth
4.3 billion for broadband 2.5 billion for
distance learning/ telehealth grants
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ARRA FundingStates as the Focal Point
Dept of Commerce
CMS Medicare
CMS Medicaid
ONC
AHRQ
HRSA
Nat Science Foundation
Dept of Agriculture
Regional Extension Centers
Telehealth Consortia
Local HIEs
3rd Parties Promoting EHR Adoption
Academia
Physicians Community
Clinics Hospitals
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ARRA FundingTiming....Planning Begins Now
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ARRAMeaningful Use and Information Exchange

• To receive incentives, providers must
  meaningfully use a certified EHR
• Use electronic prescribing
• Be connected in a manner that provides for the
  electronic exchange of health information to
  improve the quality of health care, such as
  promoting care coordination
• Submit information on clinical quality measures

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Defining Information Exchange Characteristics

• Information Exchange Could Be Defined By...
• Functionality Connectivity to specific networks
  (e.g., Surescripts Labcorps/Quest)
• Data types Clinical results, medication history,
  Continuity of Care Documents
• Relationship of participants Inter- vs.
  intra-organizational
• Range of stakeholders Multiple providers of care
• Use cases Medication management, population
  health, consumer empowerment, etc.
• Type of network CCHIT-certified, aligned with
  federal and state plans, accredited

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Defining Information Exchange Whats At Stake

• 1. Low vs. High Threshold for Information
  Exchange
• Low threshold More networks will qualify,
  leading to quicker rate of EHR adoption.
• High threshold Optimum framework for achieving
  healthcare goals, but information exchanges may
  have a challenge in meeting the criteria
• 2. Increasing Stringency
• Secretary shall seek to improve the use of EHRs
  and health care quality over time by requiring
  more stringent measures of meaningful use.
• What is initial threshold?
• How fast will threshold be increased?

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Defining Information ExchangeWhat Weve Learned

• Preliminary Findings on Information Exchange
• Prevalence of inter-organizational requirement.
• Preference to define through higher value use
  cases.
• Other suggestions (1) implement in the context
  of technical and policy architecture (2)
  consider consumer access
• Preliminary Findings on Meaningful Use
• Meaningful Use as a Floor. Definition should
  include requirements for effective use (e.g.,
  clinical decision support)
• Meaningful Use and HIE Sustainability.
  Recommendation that portion of incentives for
  meaningful use of EHRs be required to support the
  HIE.

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Planning Advancing Implementation

• Developing a Comprehensive Plan
• Components and Factors to Consider
• Threshold Issues
• Challenges

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Developing A Comprehensive PlanComponents and
Factors to Consider

• Vision and Objectives
• Tie to goals for sustainable health system
  improvement
• Define and prioritize use cases
• Execute
• Establish sequence build incrementally
• Measuring Progress
• Define measures
• Create mechanisms to track activities

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Developing A Comprehensive PlanThreshold Issues

• Governance and Accountability
• Defining roles, responsibilities
• Building an effective public-private framework
• Privacy and Security
• Implications of ARRA privacy and security
  provisions
• Building and sustaining a capacity for statewide
  policy framework
• Technical Approach
• Defining common requirements
• Identify opportunities for shared services
• Financing
• Developing a framework beyond a business plan for
  the HIE
• Defining sustainability
• Aligning reimbursement approaches to maintain
  capacity
• Health IT Adoption
• Aligning Medicare, Medicaid, and private payers
  incentives

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Developing A Comprehensive PlanGovernance
Challenges

• Coordination within State government
• Coordination across public-private sectors
• Building consensus
• Expanding capabilities to meet new obligations

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State-level HIE Consensus ProjectForum Next Steps

• New Reports to Advance Governance Activities
• Compilation of State-level HIE Approaches
• Considerations of Key Definitions
• Medicaid and State-level HIE
• State Legislature and State-level HIE
• Opportunities to Mobilize Forum Voice
• Webinars
• Project staff and network of experts
• Additional Resources
• State profiles
• Presentations
• Matrix of ARRA and ONC Strategic Plan
• Inventory of State-level HIE Plans