Vermont s Roadmap for Health Information Technology to Support Health Care Reform

Transcription

1 VERMONT INFORMATION TECHNOLOGY LEADERS Vermont s Roadmap for Health Information Technology to Support Health Care Reform State Alliance for E-Health State Learning Forum September 25-26, 2008 Paul Forlenza, V.P. Policy and Special Projects x103 Agenda Health Care Reform in VT and Role of IT VT Health Information Technology Plan Principles, Core Objectives, Project Scope Privacy and Security Interoperability Standards and Architecture Investment Strategy Health IT-Fund Clinical Transformation Health Information Exchange Funding Request 2/13/

2 Health Care Reform Goal: Improved Health Outcomes Increase Access to affordable coverage Enhance Private Insurance Coverage Assist with Affordability Improve Outreach to Uninsured Contain Costs Increase Access to Coverage and Care Improve Quality of Health Care Simplify Health Care Administration Decrease Cost Shift Change Provider Financial Incentives Improve Quality of Care Promote Wellness Enhance Chronic Care Management Focus on transparency Increase provider availability Source: Susan Besio 2/13/ Goal: Improved Health Outcomes Increase Access to affordable coverage Enhance Private Insurance Coverage Assist with Affordability Improve Outreach to Uninsured Promote Health Information Technology VT Information Technology Leaders (VITL) - statewide RHIO & Health IT Plan Health IT Reinvestment Fund Electronic Health Record Projects Blueprint Clinical Tracking Tool E-Prescribing Study Master Patient/Provider Index Contain Costs Increase Access to Coverage and Care Improve Quality of Health Care Simplify Health Care Administration Decrease Cost Shift Source: Susan Besio Improve Quality of Care Promote Wellness Enhance Chronic Care Management Focus on transparency Increase provider availability Change Provider Financial Incentives 2/13/

3 VT Health Information Technology Plan 2005: VITL established as non-profit with funding from state government and VT s hospital association 2006: VITL required to develop Vermont Health Information Technology Plan (VHITP) as roadmap 2007: VHITP published and widely circulated in VT with significant interest outside VT ( 2008: VHITP approved by legislature with request to update annually with attention to interoperability standards, and privacy and security issues 2/13/ It s here somewhere 2/13/

4 Plan Principles 1. Health care information is secure and private and accessed appropriately 2. Care will be improved by making health information available where and when it is needed 3. Shared health care data is a key component of an improved health care system. Data interoperability is vital 4. Infrastructure will be created using best practices and standards, and leverage past investments 5. Stakeholders will act in a collaborative, cooperative fashion to advance steady progress towards the vision for an improved health care system 2/13/ Core Objectives - Vermont HIT Plan 1. Encourage and enable the deployment and use of EHR systems within the state to increase the amount of health information that exists in electronic form. 2. Establish and operate the infrastructure necessary to promote secure electronic health information exchange to achieve the plan s vision. 3. Empower consumers to take an active role in electronic health information initiatives in Vermont. 4. Enable public health agencies to leverage HIT/HIE investments to monitor and ensure the public s health more transparently and quickly. 2/13/

5 Project Scope 2/13/ Privacy & Security: Survey of Vermonters * A majority of Vermonters feel putting health care information into electronic form and exchanging data between health care organizations is generally a good idea. A sizeable number also have some concerns about electronic health records, including: security of electronic records possibility of data lost information being misused or unauthorized people gaining access to private information. * Survey conducted by Market Decisions, Maine, April 2007 Source: VITL survey of 500 Vermonters, April /13/

6 Privacy & Security Framework * 1. Data must be safe from harm and accessible only to those with a need to know 2. Privacy shall be maintained through policies involving disclosure, consent, and sharing 3. Consumer privacy, security, and confidentiality shall be considered paramount 4. Access rights should be traceable and verifiable 5. Data stewards across all settings shall serve as custodians for data 6. Data used in health information exchange must be used ethically 7. Creator of data is the owner, Vermont and federal law establish access rights for patients. * Updated Privacy and Security Policies will be available January, /13/ Standards Balance between organizations subject to CON* process and others Distinguish between statewide HIEN and HIT applications within organization * Certificate of Need Cost of interfaces will influence use of standards 2/13/

7 Technical Standards for HIE Core Technical Standards Network connectivity Web applications Transport encryption Authentication Messaging Standards Message formats Message transport Clinical document construction Core Semantic Standards Terminology and Coding Standards 2/13/ HIT Infrastructure and Applications Application Architecture Clinical Context Management Database Access Web Applications Directory Services Authentication CCHIT certified EHR-S 2/13/

8 Architecture 2/13/ Continuing Investments Financial Support Access Data 2/13/

9 Recent Activity Work with Administration and General Assembly to fund EHR deployment and HIE operations 2007: EHR Pilot funded with voluntary contributions 2008: VITL developed GAP analysis to identify funding need Legislature & administration established HIT Fund Fee (0.19%)* on health claims paid by payers Estimated to generate $32m over 7 yrs Requires application to administration and review by legislature * less than 2/10 of 1 percent 2/13/ Vermont Information Technology Leaders, Inc. Original presentation developed by Angela Barnett, Director of Clinical Outcomes and updated by Paul Forlenza, V.P. Policy 2/13/

10 Strategy to Promote HIT/HIE Geography Assist practices with EHR adoption in areas of activity low EHR Encourage exchange in areas with high EHR adoption rates by connecting hospitals, primary care and specialists to the HIEN Chronology Bring users onto the exchange in a sequence that allows maximum perceived (and actual) benefit Complexity Introduce exchange in such a way that it does not overwhelm users 2/13/ Strategic Deployment of Health Information Technology Primary Care Practices Specialists Hospitals Communities (FQHCs) Blueprint for Health 2/13/

11 HIT Fund Proposed Projects Clinical Transformation of Primary Care Clinical Process Improvement EHR System Grants Connectivity to the HIE Promoting Health Information Exchange Hospital Connectivity Specialist Assessment and Connectivity Medication History Subsidy VDH Immunization Registry Patient Outreach and Education 2/13/ Clinical Transformation Project: Goals Provide clinical process improvement education to all EHR grant sites Provide financial and technical assistance to 6-8 primary care practices (up to 28 FTEs) during FY 2009 for EHR system selection, deployment, and optimization 2/13/

12 Clinical Transformation Project: Outcomes EHR systems that are efficiently and effectively deployed and used to their maximum potential Empowered staff, providers, and patients that gain measurable benefit from health information technology and data exchange Processes adopted within the practices that contribute positively to local, state and federal reform efforts Best practice implementation models customized to Vermont practices End-user network that will serve as a resource for future practices 2/13/ Clinical Transformation Project: Evaluating Success Each practice will be evaluated using five core categories of measures: clinical outcomes, functionality, financial, satisfaction, and patientcenteredness Practice measures will be aggregated to provide overall project success VITL foresees a long range goal of evaluating the impact of HIT utilization on health care 2/13/

13 Clinical Transformation Project: EHR Adoption Timeline EHR Roll-Out Cumulative Totals (including pilots) % of total providers 11% 24% 38% 52% 68% 85% 100% 2/13/ Promoting Health Information Exchange Goal: To establish a health information exchange that supports delivery of the right data to the right person at the right time Projects Connectivity and Data Mapping to the HIE Hospitals, Specialists, Primary Care, FQHCs VT Dept. Health Immunization Registry Medication History Subsidy Patient Outreach and Education 2/13/

14 Four Elements for Successful Health Information Exchange Hardware & Software Connectivity Robust Data Exchange Network Activated Patients and Providers 2/13/ Request for HIT Funds FY2009 Project Request Entities Served Clinical Transformation $ 1.4 m Primary Care Connectivity and HIE Operations Applications and Outreach Total $ 1.1 m $ 0.3 m $ 2.8 m Primary Care, Specialists, Hospitals, FQHCs Providers and Patients 2/13/

15 Putting information technology in the hands of providers and patients.. 2/13/ Contact Information Governor s Office Susan Besio, Director of Health Care Reform Implementation VITL Angela Barnett, Director of Clinical Outcomes Paul Forlenza, V.P. Policy and Special Projects Next set of slides has additional details: Health Care Reform Initiatives in Vermont Interoperability Standards 2/13/

16 Goal: Increase Access to Affordable Health Care Coverage Assist with Affordability Catamount Premium Assistance ESI Premium Assistance Reduction in VHAP, Dr. Dynasaur Premiums Catamount Eligibility for High Deductible Individual Plans Catamount Pre-existing Condition Amnesty Period CMS 1115 Waiver Amendments Enhance Private Insurance Coverage New Catamount Health Plans for the Uninsured Promotion of Employer-Sponsored Insurance Exploration of Private Insurance Market Reform Small Group Market 75% Rule Adjustment Healthy Lifestyles Insurance Discounts (premiums and cost-sharing) Local Health Care Coverage Planning Grant Possible Individual Insurance Mandate in Future Improve Outreach to Uninsured Bi-State Outreach & Enrollment Study (2006) Comprehensive Marketing, Outreach Public Private Partnership New Enrollment Web-site number Bi-state Enrollment Tracking / Outreach System Eligibility Systems Re-designs: Medicaid Eligibility IT System (MOVE) Public Benefits Eligibility Process Modernization Project VT Household Health Insurance Surveys (2005, 2008, 2009) Source: Susan Besio 2/13/ Goal: Improve Quality of Care Promote Wellness Immunizations Programs and Registry Healthy Lifestyles Insurance Discounts Community Wellness & Healthy Living Plans Community Health & Wellness (CHAMPPS) Grants Healthy Community Environmental & Policy Strategies Healthy Worksite Best Practices Promotion Nutrition Guidelines for Schools Healthy Choices & Trans Fats Labeling in Restaurants Elimination of Artificial Trans Fats in Prepared Foods by 2011 Healthy Weight thru Primary Care (Pilots & Best Practices) Blueprint for Health Prevention Activities Catamount Health Plans (no cost-sharing) Enhance Chronic Care Management Blueprint for Health Statewide Chronic Care Initiatives Blueprint Multi-payer Integrated Medical Home Pilot Programs OVHA Chronic Care Management / Care Coordination Programs State Employee Health Plan Alignment, Provider Satisfaction Source: Susan Besio Catamount Health Plans (no cost-sharing) 2/13/

17 Goal: Improve Quality of Care, cont. Focus on Transparency / Quality Improvement Consumer Health Care Price & Quality System VT Hospital Patient Safety & Surveillance System Never Events Payment Reform Hospital-Acquired Infections Reporting Hospital Safe Staffing Reporting Advanced Directives Multi-payer Database (VCHURES) Academic Detailing Program Promote Health Information Technology VT Information Technology Leaders (VITL) - statewide RHIO & Health IT Plan Health IT Reinvestment Fund Electronic Medical Record Projects Blueprint Clinical Tracking Tool E-Prescribing Study Master Provider Index Increase Provider Availability Loan Repayment Program Loan Forgiveness Program FQHC / VT Rural Health Alliance Funding Dental Dozen Initiative Tele-psychiatry Pilot Fair Standards for Provider Contracting with Insurers Restrictive Covenants Study Provider Reimbursement Surveys Nurse Authority Study Source: Susan Besio 2/13/ Contain Costs Increase Access to Coverage and Care (Prevention, Appropriate Care, Less Uncompensated Care) Improve Quality of Health Care (Prevention, Appropriate Care, Better Information) Simplify Health Care Administration Vermont Claims Administration Collaborative - Developing uniform standards for claims administration: Claims Forms Use of Payment Codes Claims Submission & Processing Procedures (including electronic data interchange) Prior Authorization Process Member Identification Cards Patient invoices & Explanation of Benefits Forms Uniform Provider Credentialing Form Workers Compensation Claims Process & Payment Study Decrease Cost Shift Increase Medicaid Provider Rates Cost Shift Task Force Standardized Policy for Hospital Uncompensated Care and Bad Debt Employer Health Care Contribution Fund Change Provider Financial Incentives Blueprint For Health Payment Reform Accountable Care Organization Study Source: Susan Besio 2/13/

18 Technical Standards for HIE Core Technical Standards Network connectivity (TCP/IP) Web applications (HTTP) Transport encryption (Secure Socket Layer) Authentication (Username/Strong Password PKI) Messaging Standards Message formats (HL7, IHE, SCRIPT) Message transport (PHIN, SOAP, XML) Clinical document construction (CDA/CDA R2) Core Semantic Standards HCPCS/CPT, CDC, ICD-10 CM, LOINC, NLM UMLS, NDC 2/13/ HIT Infrastructure and Applications Application Architecture (Service-oriented Architecture) Clinical Context Management (HL7 CCOW) Database Access (SQL) Web Applications (Rehabilitation Act 1973, Sec. 508) Directory Services (LDAP) Authentication (Single Sign-on) CCHIT certified EHR-S 2/13/