State of the State Health IT

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1 State of the State Health IT Susan Otter Director of Health Information Technology November 10, 2015

2 HIT: Opportunity and Challenges HIT impacts nearly every aspect of coordinated care New tools are needed to share information; aggregate data effectively; support telehealth; provide patients with tools and data HIT and EHR investments in Oregon abound Top tier of states for EHR adoption, but not working well or interoperable in many cases Health information exchange advancing in many regions Connecting all members of the care team is important Sharing critical hospital event information Barriers to participating in HIT for non-physical health providers Digital Divide OHA and others are investing in state-level HIT We are making progress and tracking to ensure we are delivering value for the investment

3 Vision of an HIT-Optimized Health Care System The vision for the State is a transformed health system where statewide HIT/HIE efforts ensures that the care Oregonians receive is optimized by Health IT. Oregon HIT Business Plan Framework ( ): iness%20plan%20framework.pdf

4 Goals of HIT-Optimized Health Care 1. Sharing Patient Information Across the Care Team Providers have access to meaningful, timely, relevant and actionable patient information to coordinate and deliver whole person care. 2. Using Aggregated Data for System Improvement Systems (health systems, CCOs, health plans) effectively and efficiently collect and use aggregated clinical data for quality improvement, population management and incentivizing health and prevention. 3. Patient Access to Their Own Health Information Individuals and their families access their clinical information and use it as a tool to improve their health and engage with their providers.

5 Health IT: Supporting CCOs and the Coordinated Care Model Selected characteristics of the coordinated care model: Care coordination, population management throughout the system Integration of physical, behavioral, oral health Accountability, quality improvement and metrics Alternative payment methodologies Patient engagement Coordinated care model relies on access to patient information and the Health IT infrastructure to share and analyze data

6 EHR Adoption and Meaningful Use in Oregon Oregon providers have been early adopters of EHR technology Currently, Oregon is in the top tier of states for providers receiving EHR incentive payments (as of September 2015: $391.6 million paid to Oregon providers Medicaid EHR incentives: $126.9 million Medicare EHR incentives: $264.7 million However, 135 unique EHRs are in use in Oregon

7 EHR Vendor Systems in use by Oregon Hospitals (n = 60) Peacehealth 7% Healthcare Management Systems 2% Meditech 12% Cerner 13% CPSI 5% McKesson 12% Healthland 8% EPIC 41% * Based on most recent EHR Incentive Payment data for a hospital from the Medicare or Medicaid EHR Incentive programs June 2015

8 Top 10 EHR Vendor Systems Purchased by Oregon Eligible Professionals (n=5,589 out of 6,886) eclinicalworks LLC 4% All of the top 10 systems have 2014 CEHRT versions available athenahealth 2% McKesson 3% Greenway Health LLC 6% Allscripts 8% NextGen Healthcare 9% Cerner Corporation 2% GE Healthcare 16% Epic 49% Practice Fusion 1% * Based on most recent EHR Incentive Payment data for a hospital from the Medicare or Medicaid EHR Incentive programs 2011-June 2015

9 Health Information Exchange Efforts in Oregon Regional HIEs Emergency Department Information Exchange Direct secure messaging within EHRs, between HIEs CareAccord, Oregon s statewide HIE Vendor-driven solutions: Epic Care Everywhere, CommonWell Federal Network (the Sequoia Project) Connection to federal agencies: SSA, CMS, VA, etc. Other organizational efforts: by CCOs, health plans, health systems, independent physician associations, and others Including private HIEs, point-to-point interfaces, HIT tools, hosted EHRs, etc. that support sharing information across users

10 Information Sharing with Direct Secure Messaging Statewide Direct secure messaging as baseline for health information exchange: HIPAA-compliant way to encrypt and send any attachment of protected patient information electronically; OHA administers CareAccord, offering web-portal based Direct secure messaging For providers, plans, CCOs, and other care team members and state programs who don t have EHRs, or face barriers to exchanging information

11 Statewide Sharing of Electronic Health Information: Direct Secure Messaging Physical health providers and hospitals moving to Direct secure messaging in 2014/2015: Providers seeking EHR Incentive payments must adopt 2014-certified EHR technology, which must include Direct secure messaging National accreditation is helping to ensure interoperability between Direct secure messaging providers (HISPs) Accreditation means connection statewide to care team CareAccord first statewide HIE to become accredited

12 Regional HIEs by County

13 Sharing Hospital Event Data The Emergency Department Information Exchange (EDIE) Utility Collaborative effort led by the Oregon Health Leadership Council with OHA and other partners Connects hospital event data from OR, WA Notifies ED of high utilizers provides critical information for ED PreManage Provides real-time notifications to subscribers when their patient/member has a hospital event Dashboards provide real-time population-level view of ED visits Care guidelines Subscribers can add key care coordination information into PreManage, viewable by other users

14 Hospital Event Data by County CCOs (PreManage), Hospitals (EDIE)

15 User Experience and Impact Encouraging outcomes around early use of EDIE and PreManage: Improved communication and coordination of care Real-time interventions on high-risk patients Reducing rehospitalizations Work flows changing through use of PreManage Physical health hospitalization information helpful to behavioral health teams Mechanism for more comprehensive care planning for high-risk patients

16 Summary of CCO HIT Investments # of CCOs Health Information Exchange 14 Case Management and Care Coordination Population Management, Metrics Tracking, Data Analytics EHR Hosting via Affiliated IPA Overview 1 active HIEs (5 CCOs) 2 HIEs in development (2 CCOs) 1 Community-wide EHR (1 CCO) PreManage Hospital Notifications (9 CCOs) 1 Social Services focused tool (2 CCOs) Case Management Tools (9 CCOs) Population Management tools (9 CCOs) Business Intelligence (BI) tools (6 CCOs) Health Analytics tools (11 CCOs) Full CCO HIT Efforts Report (2015):

17 HIT/HIE Exists in Oregon, but Gaps Remain Many providers, plans, and patients do not have the HIT/HIE tools available to support a transformed health care system, including new expectations for care coordination, accountability, quality improvement, and new models of payment.

18 The Role of the State in Health IT SUPPORT Community and Organizational HIT/HIE Efforts STANDARDIZE & ALIGN PROVIDE

19 OHA Office of Health IT Mission The Office of Health Information Technology develops and supports effective health IT policies, programs, and partnerships to enable improved health for all Oregonians. Policy/ Program Development Strategy Implementation HIT Programs Federal & state policy analysis Funding and grants Program development, initiatives and pilots: Telehealth Behavioral Health Information Sharing HIT Oversight Council (HITOC) & related committees HIT data, environmental scan & metrics Partnerships & collaboratives EDIE Utility Common Credentialing Provider Directory Clinical Quality Metrics Registry Technical Assistance to Medicaid Practices Medicaid EHR Incentive Program CareAccord Program Flat File Directory (Direct secure messaging addresses)

20 Foundational HIT Services Clinical Quality Metrics Registry Clinical Quality Metrics and CCOs: CCO quality incentives include three clinical metrics: Optimal diabetes care, Controlling hypertension, Depression screening and follow-up following the Meaningful Use specifications can be collected from EHRs By 2017, OHA registry will capture clinical metrics electronically From providers, CCOs or other third parties 2014 requirements for EHRs enable automated reporting of Meaningful Use clinical metrics (using QRDA I and QRDA III formats) Allows new insight into clinical outcomes through more efficient and aligned reporting

21 Foundational HIT Services Common Credentialing Program Mandatory common credentialing solution, coming in 2017: Establish a credentialing program and database for All health care practitioners All credentialing organizations (hospitals, health plans, CCOs, etc.) Simplify the credentialing process for providers, CCOs, health plans and hospitals Provide up-to-date, accurate practitioner information Increase system efficiencies - reduce costs and redundancies Developing rules on application and submittal requirements, the process of verification, and fees

22 Foundational HIT Services Provider Directory Coming in 2017: Offers providers a one-stop option to find who, where, and how to contact other providers and care team members. Support analytics used by OHA, health providers and systems, CCOs and health plans that rely on attributing providers to practice settings Enable the exchange of patient health information across different organizations and technologies by providing HIE addresses to those exchanging information Provide efficiencies for operations, oversight, and quality reporting Leverage common credentialing efforts and emerging provider directory standards

23 Get Involved in Health IT Follow OHA s HIT efforts subscribe to our list Volunteer for a committee Follow HIT Oversight Council (HITOC): Monitor and regularly report on progress of state and local HIT efforts Make recommendations on HIT efforts needed to achieve goals of health system transformation Interoperability, behavioral health information sharing

24 Learn more about Oregon s HIT/HIE developments and Subscribe to our list! CCO Health IT Profile Report (Click Resources ) Health Information Technology Oversight Council (HITOC) Susan Otter Director of Health Information Technology

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