HIE Strategy in California and Stage 2 Meaningful Use
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1 HIE Strategy in California and Stage 2 Meaningful Use Robert M. Cothren, PhD Technical Director, California Health equality Institute for Population Health Improvement, UC Davis Health System Patient-Centered Health Home & Health Information Technology Conference 26 June 2013
2 Agenda Context California s Strategy for HIE Impact on Meaningful Use What this all means to you 2
3 In the beginning 2004 Presidential order: an electronic health record for every American that wants one by Created the Office of the National Coordinator for Health Information Technology. Started the Nationwide Health Information Network. 3
4 and then along came HITECH American Recovery and Reinvestment Act of 2009 Establishes ONC permanently. Creates incentive program (~$18B) for adoption and meaningful use of EHR technology for eligible providers and hospitals. Creates statewide HIE initiatives (~$500M). Other stuff (RECs, workforce, Beacons). 4
5 Meaningful Use Meaningful Use and EHR certification are driving the industry today. Driving common functionality in EHR systems. Increasing adoption through incentives. Creating the electronic information for HIE to exchange. 5
6 Meaningful Use Stage 1 capture structured information in EHRs Stage 2 exchange structured information among providers and patients Stage 3 improve outcomes through analytics 6
7 PIN Priorities Instruction from ONC e-prescribing Electronic lab results delivery Care summary exchange and for Public health reporting Immunizations Reportable conditions Syndromic surveillance As appropriate on a per-state basis 7
8 So what about California? 8
9 California s strategy Promote community / enterprise activities. Promote exchange among communities / enterprises. Make centralized infrastructure as lightweight as possible. Support access to government systems. Support access to national networks. 9
10 Emerging models for HIE Directed Direct (secure ) Results Delivery (HL7 messages) Lab Radiology Hub(s) Hub For the provider that has nothing For the provider with an EHR Longitudinal Record Centralized (community record) Federated (virtual record) Lab Radiology Lab Radiology Data Data Data RLS?? For providers in a community For providers that want to own the infrastructure 10
11 Emerging shift in service delivery From HIOs which provide governance for exchange activities and technology to accomplish exchange. to a mix of HIOs that may or may not provide technology, and HIE Service s that provide the technology alone. 11
12 The real requirements for Meaningful Use 1. Computerized provider order entry 2. e-prescribing 3. Record demographics 4. Record vitals 5. Record smoking status 6. Use clinical decision support 7. Patients view, download, transmit 8. Clinical summaries to patients 9. Protect electronic health information 10. Incorporate lab results 11. Generate patient lists 12. Reminders for follow-up care 13. Patient educational resources 14. Medication reconciliation 15. Transmit care summaries for transitions of care 16. Report immunizations 17. Secure messaging with patients plus menu items 18. Report syndromic data 19. Record electronic notes 20. Imaging results 21. Record family history 22. Report cancer cases 23. Report other registry cases 12
13 The real HIE requirements for Meaningful Use 1. Computerized provider order entry 2. e-prescribing 3. Record demographics 4. Record vitals 5. Record smoking status 6. Use clinical decision support 7. Patients view, download, transmit 8. Clinical summaries to patients 9. Protect electronic health information 10. Incorporate lab results 11. Generate patient lists 12. Reminders for follow-up care 13. Patient educational resources 14. Medication reconciliation 15. Transmit care summaries for transitions of care 16. Report immunizations 17. Secure messaging with patients plus menu items 18. Report syndromic data 19. Record electronic notes 20. Imaging results 21. Record family history 22. Report cancer cases 23. Report other registry cases 13
14 The Meaningful Use cases for HIE Electronic ordering and results delivery Care coordination and transitions of care Public health and other reporting Electronic information for patients 14
15 Our Programs 15
16 Expansion and Acceleration Creating HIE options for providers. Planning for new HIOs Expansion of existing HIE infrastructure New interfaces to labs, radiology, etc. Conversion of lab data to LOINC terminology New interfaces for public health reporting New services for rural providers 16
17 Trust Framework Breaking down the walls between systems. Reducing the cost to join. Supporting development of model agreements Creating communities of trust Creating provider directories 17
18 Expanding Public Health Capacity Reading public health for Meaningful Use. Making public health data accessible. Improving population health. Creating gateways to register, validate, and submit public health data Creating a home for data on high-impact conditions, special populations 18
19 So what does this mean for you? 19
20 1. Veterans Affairs There are options 20
21 2. HIE Ready There are EHRs that are better prepared for HIE. It is easier to determine which EHRs support HIE. It is easier to order interoperability. See for more information. 21
22 3. Immunization Gateway Service The California Immunization Registry is ready to receive your data. You can now register and send data compliant with MU. See for more information. 22
23 4. Rural Incentive Program Directed Direct (secure ) Results Delivery (HL7 messages) Lab Radiology Hub(s) Hub For the provider that has nothing For the provider with an EHR There are now options for providers in rural California. Longitudinal Record Centralized (community record) Federated (virtual record) Lab Radiology Lab Radiology Data Data Data RLS?? For providers in a community For providers that want to own the infrastructure Identified 5 service providers with varying offerings. Subsidizing 65% of the cost of getting connected. See for more information. 23
24 Questions 24
25 Contact Information Robert M. Cothren, PhD Technical Director, California Health equality Institute for Population Health Improvement UC Davis Health System p e robert.cothren@ucdmc.ucdavis.edu w 25
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