Kevin W. Ryan JD, MA

1
Rural TeleCon 0610th Annual Conference of the
Rural Telecommunications Congress

• Kevin W. Ryan JD, MA
• Associate Director ACHI
• Assistant Professor UAMS COPH

2
The coming tsunami of electronic health
information exchange important dates

• 2014 - EHR to be widespread
• 2009 e-prescribing required by MMA
• 2006 ?

3
Where are we today in 2006?

• EHR usage study shows slow progress toward Bushs
  2014 goal Healthcare IT News
• lt10 of physicians employee an EHR system that
  benefits patient care
• lt5 of hospitals use computerized physician order
  entry
• Reasons for slow progress
• Lack of interconnectivity / interoperability
• Costs
• Fear of legal burdens
• Uncertain tech support
• Concerns about rapid obsolescence
• Rural area providers least likely to adopt EHR

4
Rationale for an interoperable EHR

• Cost savings
• Decreased medical errors
• Improved public health surveillance

5
General issues with EHR

• Verification of patient consent for release of
  medical records information.
• Forwarding patient information without a signed
  release form.
• Perceived need to obtain IRB approval for release
  of identified patient data.

6
General barriers to obtaining an interoperable EHR

• The way we have always done it mentality
• Ownership of responsibility
• Discrepancy in application and interpretation of
  HIPAA
• State law regarding mandated reporting / privacy
  of communicable diseases
• Just say no!

7
Interoperability issues

• Lack of common platform
• Legal / regulatory / policy impediments to
  information exchange
• Bandwidth

8
US DHHS Health Information Exchange Plan

• Harmonize standards
• Create certification criteria for EHR products /
  technology
• Develop prototype network architecture
• Identify / address variations in state laws /
  business policies affecting privacy and security
  that impedes / facilitates exchange of health
  information

9
Health Information Security and Privacy
Collaboration - HISPC

• Funded by DHS Agency for Healthcare Quality and
  Research
• Managed by NGA / RTI
• 33 states and Puerto Rico

10
Mission

• Bring together broad range of stakeholders
• Identify legal / policy / practice barriers to
  electronic exchange of health information
• Develop through a consensus process recommended
  solutions
• Create state level report to Federal government
• Cooperate in establishment of NHIN

11
Arkansas HISPC Project

• The Arkansas HISPC project management team
  consists of various partners within the state
  with interest or expertise in the areas of Health
  Information Technology, HIPPA and Law.
• AR Center for Health Improvement
• AR Department of Health and Human Services
• AR Foundation for Medical Care
• The Brock-Chad Group (Legal Consultants)
• Stakeholders / interested parties

12
Present Arkansas Health Information Exchange
Initiatives

• Arkansas Hospital Association Investigation of
  statewide EHR
• Employee Benefits Division (EBD), Quality
  Sub-Committee Quality of care measurement
  standards link with EHR
• Arkansas Blue Cross/Blue Shield Convening
  quality initiative stakeholders
• Arkansas Foundation for Medical Care Aligning
  forces for regional quality healthcare
  improvement.
• Arkansas Center for Health Improvement VISTA
  feasibility study. Assisting EBD with quality
  sub-committee.
• Arkansas Public Health Bioterrorism System
  Statewide public health agency system
  implementation
• ANGELS Project
• Telemedicine

13
Arkansas HISPC Project

• Evaluation of legal issues regarding information
  sharing.
• Community buy-in regarding the need and
  mechanisms for application.
• Formation of collaborative partners in the
  activities around health information exchange.
• Access to information and issues experienced by
  other states, who can serve as a resource as
  Arkansass activities develop.

14
Stakeholder Representation and Outreach

• Hospitals
• Pharmacy
• Payers
• Professional association / societies
• Public health agencies
• Community clinics / health centers
• Legal representatives
• Consumers
• Industry

15
Data Collection Process

• Facilitated face-to-face meetings discussing
  health information exchange scenarios.
• E-group input

16
Challenges

• Convening sufficiently diverse groups
• Perceived lack of need
• Perceived inability to address issue

17
Deliverables

• Establishment of a sustainable state level
  initiative
• Linked activities with regional / national
  efforts
• Reports
• Interim
• Final

18
Your participation in this project is welcomed.

• Kevin W. Ryan JD, MA
• 501.526.2244
• ryankevinw_at_uams.edu
• Shirley Tyson HISPC Project Director
• 501.526.2257
• tysonshirley_at_uams.edu