Using e-health: EHRs, HIE and the Minnesota Accountable Health Model

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1 Using e-health: EHRs, HIE and the Minnesota Accountable Health Model Minnesota Rural Health Conference June 24, 2014 Duluth, MN Karen Soderberg and Anne Schloegel Office of Health Information Technology (OHIT) Minnesota Department of Health 1

2 Overview What is e-health? e-health drivers E-health status of providers in Minnesota Health information exchange (HIE) Minnesota Accountable Health Model Opportunities and Resources 2

3 Acknowledgements MDH Office of Health Information Technology Marty LaVenture Jennifer Fritz Kari Guida Bob Johnson Rebecca Johnson Lisa Moon Priya Rajamani Susie Veness Minnesota e-health Initiative 3

4 What is e-health? Adoption of electronic health record (EHR) systems Effective (i.e., meaningful) use of EHRs Interoperability Continuum of EHR Adoption the secure and standardized exchange of health information among providers/organizations Adopt The Minnesota Model Utilize Exchange Assess Plan Select Implement Effective Use Readiness Interoperate 4

5 e-health in Minnesota E-health is the adoption and effective use of electronic health record (EHR) systems and other health information technology (HIT) including health information exchange (HIE) to: Improve health care quality Increase patient safety Reduce health care costs Enable individuals and communities to make the best possible health decisions 5

6 Minnesota e-health Initiative A public-private collaboration established in 2004 Legislatively chartered Coordinates and recommends statewide policy on e-health Develops and acts on statewide e- health priorities Reflects the health community s strong commitment to act in a coordinated, systematic and focused way Vision: accelerate the adoption and effective use of Health Information Technology to improve healthcare quality, increase patient safety, reduce healthcare costs, and enable individuals and communities to make the best possible health decisions. 6

7 e-health Drivers Triple Aim Improved consumer experience Improved population health Lower per capita health care costs Federal Activities Meaningful Use Incentive Program State Innovation Model (SIM) Grants State Activities Minnesota 2015 Interoperable EHR Mandate Minnesota Accountable Health Model 7

8 Minnesota 2015 Interoperable The 2007 Minnesota Legislature mandated in Minnesota Statute 62J.495 (Electronic Health Record Technology), that: EHR Mandate By January 1, 2015, all hospitals and health care providers must have in place an interoperable electronic health records system within their hospital system or clinical practice setting. 8

9 The Continuum of Care Adult Day Services Behavioral Health (Mental & Chemical) Birth Centers Chiropractic Offices Primary Care Clinics Specialty Care Clinics Complementary/ Integrative Care Dental Practices Government Agencies (City/County & State) Habilitation Therapy Home Care Agencies Hospice Hospitals Laboratories Long Term Care Facilities Pharmacies Surgical Centers 9

10 Minnesota Model for Adopting Interoperable Electronic Health Records Developed by the Minnesota e-health Initiative to: Provide guidance and tools for providers to achieve the Minnesota mandates and improve care Assess progress and barriers 10

11 Minnesota Adoption of EHRs Hospitals (2013) Local Public Health~ (2013) Clinical Labs* (2013) Clinics (2014) 99% 97% 97% 93% Nursing Homes (2011) 69% Chiropractic Offices (2011) 25% 0% 20% 40% 60% 80% 100% Percent of organizations with EHRs or similar systems ~ Community Health Boards, some of which have >1 local health department * Clinical Labs use lab information systems rather than EHRs Source: Minnesota Department of Health, Office of Health Information Technology 11

12 Trends in Adoption 100% 80% 86% 80% 99% 95% 93% 60% 67% 40% 57% MN Hospitals with EHRs 20% 0% MN Clinics with EHRs 17% MN Pharmacies e-prescribing* 9% Mid-2000's *Excludes pharmacies with the pharmacy class of medical device manufacturer Source: Minnesota Department of Health, Office of Health Information Technology, ; Office of the National Coordinator, Surescripts 12

13 Adoption of EHRs in Rural Minnesota Rural/CAH Urban/Non-CAH Hospitals (N=140) 99% 100% Clinics (N=1,206) 91% 93% Nursing Homes (N=316) 64% 74% 0% 20% 40% 60% 80% 100% Percent of provider settings with EHRs Installed Source: Minnesota Department of Health, Office of Health Information Technology, Clinic HIT survey (2014), Hospital HIT survey (2013), Nursing Home HIT survey (2011) 13

14 Clinic EHR Adoption by Geography Percent of Clinics with EHRs 93% 91% 96% 88% Map Source: MDH Office of Rural Health and Primary Care 14

15 Effective Use of EHRs E-prescribing Clinical decision support (CDS) tools Medication guides/alerts (e.g., interactions, allergies) Preventive care reminders Clinical guidelines Computerized provider order entry (CPOE) Lab and radiology orders Transfer of care 15

16 MN Nursing Homes (N=217) MN Clinics (N=1,116) MN Hospitals (N=139) Use of Clinical Decision Support Tools Rural/CAH Urban/Non-CAH Medication guides or alerts Clinical services reminders/alerts Clinical guidelines Medication guides or alerts Preventive care services reminders/ alerts Clinical guidelines Medication guides or alerts Preventive care services reminders/alerts Clinical guidelines 49% 41% 43% 51% 41% 45% 64% 60% 64% 77% 73% 72% 76% 76% 77% 71% 94% 95% Source: Minnesota e-health Profile, MDH Office of Health IT, 2011 (nursing homes), 2013 (hospitals) and 2014 (clinics) 0% 20% 40% 60% 80% 100% Percent Using CDS Tools 16

17 Use of Computerized Provider Order Entry (CPOE) Rural/CAH Urban/Non-CAH MN Hospitals fully implemented for CPOE 52% 72% MN Hospitals partially implemented for CPOE 16% 29% MN Clinics' use of CPOE for 80% or more of orders 78% 83% MN Nursing Homes Using CPOE for medication orders 22% 28% 0% 20% 40% 60% 80% 100% Percent of Minnesota Provider Settings Using CPOE 17

18 MN Clinics: Impact of EHRs on Practice Agree Agree Somewhat Be alerted to potential medication errors Enhance patient care in your clinic Order more on-formulary drugs Be alerted to critical lab values Be reminded to provide preventive care Provide care that meets clinical guidelines for patients with chronic disease Identify needed lab tests Order fewer tests due to better availability of other lab results 69% 66% 62% 61% 56% 52% 46% 38% 23% 30% 23% 27% 20% 28% 34% 37% 0% 20% 40% 60% 80% 100% Percent of Clinics with EHRs (N= 1,116) Source: Minnesota e-health Profile, MDH Office of Health IT,

19 Impact of EHRs by Geography Be alerted to potential medication errors Enhance patient care in your clinic Order more on-formulary drugs Be alerted to critical lab values Be reminded to provide preventive care Provide care that meets clinical guidelines for patients with chronic disease Identify needed lab tests Order fewer tests due to better availability of other lab results Rural/CAH 23% Urban/Non-CAH 65% 70% 65% 66% 59% 62% 69% 59% 68% 54% 50% 53% 46% 46% 41% 0% 20% 40% 60% 80% 100% Percent Agree strongly 19

20 E-Prescribing by Rural, Urban and Setting Rural/CAH Urban/Non-CAH Hospitals (N=140) 61% 70% Clinics* (N=1,206) 88% 87% Nursing Homes~ (N=316) 36% 48% Pharmacies (N=1,079) 94% 96% 0% 20% 40% 60% 80% 100% Percent of Minnesota Provider Settings e-prescribing * Clinic data includes those that do not have an EHR installed and instead are using a non-ehr e-prescribing service. 20 ~ Includes nursing homes that planned to e-prescribe by mid-2013.

21 Electronic Exchange of Health Information Among Partners Rural/CAH Urban/Non-CAH Hospitals exchanging with any setting Hospitals exchanging with unaffiliated settings 48% 66% 72% 75% Clinics exchanging with any setting 73% 83% Clinics exchanging with unaffiliated settings Nursing homes able to exchange (2011) 46% 39% 35% 40% 0% 20% 40% 60% 80% 100% Percent of Minnesota Provider Settings Exchanging Health Information Source: Minnesota Department of Health, Office of Health Information Technology,

22 Minnesota Model Guides Guide 1: Addressing Barriers to EHR Adoption Guide 2: Recommended Standards Guide 3: e-prescribing Guide 4: Effective Use of EHRs Guide 5: Health Information Exchange 22

23 e-health/hit Toolkits Stratis Health ( developed setting specific toolkits with partners (e.g. associations and Minnesota Department of Health) OVERVIEW, assess, plan, select, implement, maintain, and optimize Free, actionable tools and resources to assist providers in planning for and optimizing e-health and HIT Behavioral health* Chiropractic offices Physician offices Critical access and small hospitals Home health agencies* Local public health* Nursing homes Social services* *Developed in and still improving 23

24 Minnesota Approach to HIE Market-based to Encourage Innovation and Allow Choice Government Role is Provision of HIE Oversight Statewide Shared Services Collaborative 24

25 Minnesota Approach: State Certification and Oversight of HIE Established oversight by Commissioner of Health to protect providers and consumers Market-based approach for HIE services Requires State Certificate of Authority to operate Uses transparent and public participation process Statewide Shared Services Collaborative supports interoperability among State-Certified HIE Service Providers 25

26 Types of HIE Service Providers Health Information Organization (HIO) oversees, governs, and/or facilitates the exchange of health-related information according to nationally recognized standards. Health Data Intermediary (HDI) provide infrastructure necessary to connect computer systems or other electronic devices utilized by health care providers, laboratories, pharmacies, health plans, thirdparty administrators or pharmacy benefit managers to facilitate secure transmission of health information, such as Pharmaceutical electronic data intermediaries, and Health Information Service Providers (HISP), as defined by the Nationwide Health Information Network (NwHIN) Direct Project 26

27 Key Types of HIE Mechanisms in Minnesota Peer to Peer Interstate and National HIE Health Data Intermediary (HDI) Health Information Organization (HIO) Statewide Shared Services Infrastructure Statewide Shared Services Participant Minnesota HIE Oversight Program Integrated Delivery Network & ACO EHR Vendor Mediated 27

28 Statewide Activities to Support Health Information Exchange 2012 & 2013 Statewide Shared Services Collaborative to support interoperability among State-Certified HIE Service Providers Incentive programs for HIE Service Providers HIE Connectivity Grant Program for health and health care providers and pharmacies 28

29 Minnesota e-health Connectivity Grant Program for HIE Program Goals to increase: Connections to State-Certified HIE Service Providers Exchange within broad-based community collaboratives for meaningful use transactions including exchange of care summaries Number of pharmacies connected for e-prescribing 29

30 map 30

31 e-health Connectivity Grants (2011) 35 grants to 65 community partners ($451,998) Grants of up to $10,000 awarded for: - establish connectivity with a State-Certified Health Information Exchange Service Provider. - upgrade pharamcy hardware or software and up to one year of transaction costs 16 grants partially or fully completed; $180,820 (44%) of funds distributed 31

32 e-health Connectivity Grants (2012) 16 grants- over 180 partners ($2.4 million) Grants ranged from $4,000 to $267,165 to: Expand community-based collaborative HIE efforts Assist with meeting meaningful use requirements Expand HIE capability to support care & public health Increase number of pharmacies e-prescribing 14 grants partially or fully completed; $1,862,659; (75%) of funds distributed. 32

33 e-health Connectivity Grant Program Results Increased connections to State-Certified HIE Service Providers 68 providers/facilities across the state are now connected to a State-Certified HIE Service Provider Hospitals, primary care and specialty clinics, behavioral health providers, nursing homes, home health and local public health Direct (push/pull) and Query (push/pull/query) 33

34 e-health Connectivity Grant Program Results Increased number of pharmacies e-prescribing Eight retail pharmacies and five hospital pharmacies; all but one is now e-prescribing 93% now e-prescribing; up from 91% in 2011 Average between 60 and 90% of local prescribers (e.g., clinics, hospitals, dental offices) are sending prescriptions electronically. 34

35 e-health Connectivity Grant Program Results Increased exchange within community collaboratives A - nursing home and large hospital system - CCD exchange- using peer to peer connection that can be replicated with others using the same EHR B Local Public Health led project included all interested parties in city-based community (primary care, specialty and mental health providers/clinics, hospital, behavioral health hospital, long-term care facilities and social services). All participants connected to HIE service provider and exchanging health information. C Four Regional Projects led by Public Health Departments with shared EHR vendor and other hospitals, clinics and long-term care. (Northwest-9 counties, West Central- 5 counties, Southwest -16 counties, East Central -8 counties) 40 grant partners evaluated-best HIE solution(s) identified for their organization Secure using the DIRECT protocol standards Linking vendor to vendor application (peer-to-peer) Accessing a Health Information Exchange (HIE) using CONNECT protocol standards 35

36 What is the Minnesota Accountable Health Model? $45 million State Innovation Model (SIM) testing grant awarded by the Center for Medicare & Medicaid Innovation Lead in partnership by the Minnesota Department of Health and Minnesota Department of Human Services. Purpose: provide Minnesotans with better value in health care through integrated, accountable care using innovative payment and care delivery models that are responsive to local health needs. 36

37 What is the Minnesota Accountable Health Model Vision? A framework for driving health reform toward these aims: Most Minnesotans receive care that is patient-centered and coordinated across settings Most providers of care and services are participating in an ACO or similar model that holds them accountable for costs and quality Financial incentives across private and public payers that encourage Triple Aim, coordination, partnership, prevention, value and health promotion Communities, providers and payers collaborate to improve clinical care and population health 37

38 Minnesota Accountable Health Model Key Investments Key investments in five Drivers that are necessary for accountable care models to be successful: Driver-1 Providers have the ability to exchange clinical data for treatment, care coordination, and quality improvement--hit/hie Driver-2 Providers have analytic tools to manage cost/risk and improve quality--data Analytics Driver-3 Expanded numbers of patients are served by team-based integrated/coordinated care--practice Transformation Driver-4 Provider organizations partner with communities and engage consumers, to identify health and cost goals, and take on accountability for population health ACH Driver-5 ACO performance measurement, competencies, and payment methodologies are standardized, and focus on complex populations-- ACO Alignment 38

39 Leveraging for e-health The Minnesota Department of Health e-health RPFs for the SIM-Minnesota funding: Minnesota Accountable Health Model e-health Grant Program (closed) Minnesota e-health Roadmaps to Advance the Minnesota Accountable Health Model (closed) Privacy, Security and Consent Management for Electronic Health Information Exchange (pending) 39

40 Become Involved Collaborate with associations, organizations and other health care settings Participate in e-health training & education Use, adapt and share e-health tools MN e-health Guides Stratis Health Toolkits Join / Participate in the Minnesota e-health Initiative Subscribe to e-health updates Participate in e-health Initiative workgroups 40

41 ICD-10 resources AUC homepage: ICD -10 resources

42 ICD-10 resources (cont.)

43 Contact Information Karen Soderberg Phone: (651) Anne Schloegel Phone: (651)

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