NATIONAL HEALTH POLICY FORUM. January 2010

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1 NATIONAL HEALTH POLICY FORUM January 2010

2 TAKE 1: OVERY ACT FUNDING FLOWS Funding Source Program Distribution Agency Funding Use Fund Recipients / Beneficiaries Entitlement Funds Appropriated Funds Medicare Payment Incentives ~$20B Medicaid Payment Incentives ~$14B HIE Planning & Development (at least $300M) EHR Adoption Loan Program Health IT Extension Program Workforce Training Grants CMS CMS ONC ONC HHS Agency TBD HHS, NSF Medicare Carriers & Contractors State Medicaid Agencies Requires 30% share of Medicaid (except Children s Hospitals) Planning Grants Implementation Grants Loan Funds for States Loan Funds for Indian Tribes Health IT Research Center Regional Extension Centers Medical Health Informatics EHR in Med School Curricula Designated State Entity State Gov t Indian Tribes Non-profit Consulting Vendors Loans Services Acute care hospital Children s hospitals Physicians Nurse Practitioner Midwife Federally Qualified Health Centers Non-profit Consulting Vendors Provider Organizations Least Advantaged Providers Requires Meaningful use of EHR New Technology R&D Grants NST, NSF Health Care Information Enterprise Integration Research Centers Higher Education Medical School Graduate schools Federal Gov t Labs 1-1-

3 TAKE 2: OVERY ACT FUNDING FLOWS Office of Civil Rights HIT policy & stds Policy Policy Privacy & Security Regulations & enforcement HIT Policy Committee Payoff: Safer, higher quality care Cost savings Privacy protection Healthier people EHR/MU Standards HHS Office of the National Coordinator HIT Standards Committee EHR Standards NIST Certifier Accreditation Meaningful Use Measures EHR Standards Nationwide Health Information Exchange (NHIN) Premiums / Eligibility CMS (largest payer) Meaningful Use Measures EHR Product Certifiers Claims/MU Product Certification EHR Product Vendors SSA Reimbursement Private Providers EHR Products Private HIEs Military Health System EHR Products VA-DOD Health Info Exchange (largest HIE) Veterans Health (largest provider) EHR Products Massachusetts ehealth 2 Collaborative -2-

4 TAKE 3: OVER ACT FUNDING FLOWS $47B $2B Various studies and reports Health information exchanges Regional health IT resource center Regional health IT extension centers State implementation and planning grants EHR loan funds NIST certication infrastructure $45B Direct payments to individual providers -3-

5 -4-

6 FEDERAL REQUIREMENTS PROCESS OVERVIEW New technology certification regime Meaningful Use Certification Requirements Meaningful Use Incentive Rules New technology certification State Medicaid regime Meaningful Use CMS National Coordinator State Medicaid Orgs HIT Policy Committee Meaningful use EHR certification Health exchange HIT Standards Committee Clinical quality Clinical operations Privacy & Security HITSP enabling healthcare interoperability Slide -5-

7 MEANINGFUL USE REQUIREMENTS AND HIE Meaningful Use objectives requiring health exchange Lab results delivery Prescribing Claims and eligibility checking Quality & immunization reporting, if available Registry reporting and reporting to public health Electronic ordering Health summaries for continuity of care Receive public health alerts Home monitoring Populate PHRs Access comprehensive data from all available sources Experience of care reporting Medical device interoperability Increases volume of transactions that are most commonly happening today Lab to provider Provider to pharmacy Substantially steps up exchange Provider to lab Pharmacy to provider Office to hospital & vice versa Office to office Hospital/office to public health & vice versa Hospital to patient Office to patient & vice versa Hospital/office to reporting entities Starts to envision routine availability of relatively rich exchange transactions Anyone to anyone Patient to reporting entities

8 Deletions NPRM changes from HITPC Recommendations Record advance directives Document a progress note for each encounter Provide access to patient-specific education resources Additions Provide summary care record for each transition of care and referral Changes Adding DOB to record demographics and cause and date of death for hospitals Adding growth charts to record vital signs Limiting smoking status to age 13+ Increasing CDS rules from 1 to 5 Removed where possible from insurance eligibility checks Changed the provision of clinical summaries from each encounter to each office visit Changed compliance with HIPAA to Protect electronic health information maintained by certified EHR technology -7-

9 NPRM changes from the HITPC Recommendations Measures Ensured every objective is matched to a measure Added a % threshold to measures recommended as % of Calculated some % based on unique patients seen as not every action would be taken for every office visit Narrowed lab results to those whose results are in a positive/negative or numeric format For exchange of information changed implemented ability to Performed at least one test Clinical quality measures were greatly expanded to accommodate the diversity of specialists meeting the definition of an eligible professional 8-8-

10 NATIONAL REGIONAL HIT EXTENSION CENTER PROGRAM HIT Research Center (HITRC) -9-

11 ESTIMATED STATE-LEVEL HIE FUNDING ALLOCATIONS $ millions -10-

12 An evolving definition of the NHIN What is the Workgroup s definition of the NHIN? A set of policies, standards and services that enable the Internet to be used for secure and meaningful exchange of health information to improve health and health care. -11-

13 Key Findings Key elements that need to be in place to facilitate and encourage the broadest range of providers (individuals and organizations) to be able to achieve meaningful use in 2011: Secure Internet transport. Directories to allow parties to locate those to whom information is transferred. Means to authenticate/validate identity of parties involved in information exchange. Trust fabric that provides parties with sufficient confidence that the exchange can be accomplished successfully

14 Findings: Trust Fabric Information exchange depends on common trust elements, including: Rules for interaction. Pre-existing personal and business relationships. Understanding and clear expectation of how data will be used. Assurance that the exchange takes place as expected (including the identity of those exchanging data). Oversight and accountability for compliance. Implementation of the trust elements will differ based on the nature of the parties to the exchange and the information being exchanged. The absence of a mature policy and technical trust framework is an impediment to information exchange

15 HHS Authorized HSP HHS Authorized Certifiers HSP Authorized Certifiers HSP Certifiers One Possible NHIN Strawcase NHIN Certificate Authority NHIN Root Certificate Authority NHIN Certificate Authority NHIN CA issues certificate to HSP if it an Authorized HSP Certifier validates that the HSP conforms to standards for HSP operations (identity proofing, authentication, authorization, etc.) NHIN Node Directory (HSPs, other nodes) Health Information Exchange Service Providers (HSPs) identity proof, authenticate, and represent providers in information exchange. HSPs can be HIOs, EHR vendors, transactions companies, health systems, IPAs, govt agencies, etc. HSPs maintain local directories of providers they serve + their health info exchange addresses HSP HSPs manage secure delivery of health info packages (e.g., care summaries) via the Internet to and from providers via other HSPs and to and from other NHIN nodes (e.g., PHRs) HSP NOTE: Different HSPs and other NHIN nodes (e.g., PHRs) can support different levels and types of health info exchange (simple to more sophisticated) Provider s certified EHR generates health info package in compliance with applicable vocabulary, document, and message standards (e.g., care summary) Provider A 14 Provider B -14- PHR

16 WHAT GOES AROUND, COMES AROUND Verb Noun Primordial soup Primordial soup -15-

17 Micky Tripathi, PhD MPP President & CEO

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