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Review of Alabama HIE Operational Plan. 06/24/2010 at 08:30 AM Central Time Link: https://alabamamedicaid1.ilinc.com/join/fjcvbzm/pykxmfc Primary Dial-In: 1-800-915-8704 Passcode: *1273929*. Agenda. Update on RFP Process – Gary Parker
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Review of Alabama HIE Operational Plan 06/24/2010 at 08:30 AM Central Time Link: https://alabamamedicaid1.ilinc.com/join/fjcvbzm/pykxmfc Primary Dial-In: 1-800-915-8704 Passcode: *1273929*
Agenda • Update on RFP Process – Gary Parker • Review of Operation Plan Key Points – Patricia MacTaggart • Review Master Issue List - KBDA • Review of Project Plan within the Op Plan – Richard Jensen • Next Step – Review of Document by Work Groups and then Submission to Full Commission
Environmental Scan: Consent Potential Issue: potential need for focus effort related to e-consent implications
Scan: Percentage of Physicians Who Qualify for Medicaid Adoptive Incentive • Potential Issues: • Small number of respondents • Small % of family practitioners eligible for incentives
Scan: Percentage of Practice Specialties that Qualify for Medicaid Adoptive Incentive Potential Issue: How can FQHC numbers be so low?
REC Readiness Assessment of Providers:Additional Information • The assessment is scheduled to be released by the end of July 2010. • The assessment will determine provider interest in obtaining REC services as well as gather information about existing HIE services including EMR and EHR usage. • The information will serve as an enrollment process for providers. • The assessment will be distributed to all providers and will be used to help identify priority primary care providers.
Timeline for CriticalImplementation Milestone Action StepsFY10 6/15/10 07/10 8/1/10 9/1/10 9/30/10 HIT Coordinator In Place HIT Staffing in Place Exchange Participation Operating Rules (DURSA/QSO) Draft Leg. to Establish Board including appointment process Operating Policies & Procedures Enforcement Authority Fed. Law Comparison
Interim Statewide HIE Advisory Commission • Until authority for a permanent governance structure is in place, the Advisory Commission will continue to operate, along with its workgroups as it has through the Strategic and Operational Planning and implementation phases with the Medicaid Agency providing ongoing staff support to the Advisory Commission. • The Advisory Commission will create an initial set of exchange rules that are expected to mirror the rules for connecting with the statewide exchange. Many of the rules are being decided by the CMS certification requirements and/or existing regulations (e.g., HIPAA). • Additional rules, including the upfront licensing including who has to be licensed, of entities exchanging health information, will be promulgated through the administrative rule making process. • It was decided that it was not necessary to incur additional expenses to have a regulatory board at this juncture for an industry that is very limited and as the industry potentially grows many of the rules and regulations will be governed at the national level and easily adaptable
Legislation for AHIE Operating Commission will Address • Commission Membership • Membership of commission and how members are selected • Clarify that selection of members is an open process and consumer are included. • Duties/responsibilities of a commission member • Reporting Requirements for the HIT Office will be delineated. The HIT Office will be required to provide a formal report at each commission meeting that a minimum will include the following regarding each of the units within the office: • Project status • Budget/financing • Progress on operational plan • Explanation of how Operational Commission and HIT Office will oversee HIO in the state. • Enforcement Agency – Specify the state agency that will be the Enforcement Agency for the HIE.
Longer Term AHIE Operating Commission • In the long term, transition to the Operating Commission, which will be a public-private membership as a 501(c)(3) non-profit organization or other formal type of government governing board, will occur when deemed necessary by factors such as, but not limited to, when HIE is funded by less than a pre-determined amount of public funds, and/or when the product and process is stabilized, or when necessary to mitigate risks to the federal and/or state government. If the model becomes a 501(c)(3), authority will be designed that assures compliance with all federal and state laws and assuring Medicaid retains a leadership role. • The State HIT Coordinator and staff, as state employees, will administratively report to the Governor but will functionally report directly to the Operating Commission.
Timeline for Technical InfrastructureAction Steps 6/10 07/10 8/10 9/10 3/11 HIE System Features & Design Finalized HIE ITB/RFP Released HIE Bids Due Beta Sites Identified and Contracted HIE Evaluations Complete HIE Contract Review Committee HIE Contract Begins HIE Operational Level One (RLS, MPI, Provider Index, Messaging)
Gateway Birmingham AHIE Stakeholders Communicating via the NHINArchitecture Gateway Auburn Medicaid Gateway • AL-HIE Stakeholders • Primary Provider • Pharmacy • EMT • Hospital/Clinic • Health Organization/Center • Payor • Wellness Community • Personal Health Records • … Gateway Stakeholder Mobile
Authorization Consumer Preferences Document Query & Retrieval Data Transform Service Discovery Message Platform Adaptor Web Service Subject Identity Audit Log Master Subject Index Data Store NHIN Service Registry NHIN Gateway Alabama As NHIOs Enterprise Service Bus Other NHIOs Authorization Engine
CMS FED TN Medicaid Gateway Gateway Gateway Birmingham GA Medicaid Gateway Gateway Auburn Medicaid Gateway Gateway MS Medicaid Gateway Mobile AL–HIE Stakeholders Exchanging Health Information viaNHIN Gateways to the NHIN
AL-HIE Leveraging the NHINImproved Health Care Value Through eHealth Collaboration CMS FED TN Medicaid LHIO Driven by Local Needs GA Medicaid Birmingham Standard Interface & Technology Auburn MS Medicaid AL Medicaid NHIN Community NHIN Enterprise Reference Architecture Kevin Puscas Mobile
Policy Framework for NHIN “Chain of Trust” Gateway Shared Services Access Consent Policies Authorization Framework Document Query Retrieve Documents Health Event Messaging Messaging Platform Patient Discovery Web services Registry Etc. Community HIE(s) State-level HIE Domain-specific or Non-geographic HIE PublicHealth IDN FQHC Affinity-grouped Providers Medicaid or State Health Plan National Health Plans IDN State-Level DURSA IOA DURSA 22
Business and Technical Operations • Success Factors/Metrics: • Achieve a 20% response rate on the annual after first year environmental scan of physicians and 40% rate on hospital scan. • Alabama’s HIE passes pilot testing with minimal problems and is ready for utilization by all providers by March 2011. • 25% of providers register with the AHIE before Sept. 2011. • 20% of all providers achieve meaningful use by Sept. 2011, notwithstanding any major vendor issues. • 40% of all providers achieve meaningful use by Sept. 2012, notwithstanding any major vendor issues.
Legal and Policy ProcessLegal Research Team (LRT) • LRT to aid in the process of sourcing and analyzing legal information related to privacy and security, interoperability, Medicare and Medicaid, and the development of relevant policies and procedures. • LRT will identify and determine whether the laws or standards conflict with one another, conflict with federal law or regulations or hinder the mission of Alabama’s HIE. • LRT tasked with gaining an understanding of other state policies regarding HIE, including conducting a survey of Alabama’s border states (FL, GA, MS and TN) to determine where common ground exists and to identify where Alabama policy changes may need to be pursued. • Existing Legal and Policy Workgroup continues to function as an advisory body. Potential Issue: Staffing all the work
Legal and Policy: Current State Assessment • Potential Issues: • Detail work is tremendous • Timeline is demanding • Staffing to support
Policy and Procedure Development Key Point:Identified issues but actual work is significant
Finance: Year 1 Budget Key Points: Retaining original budget for now – will update later -- Added Medicaid (federal/state)
Finance: Year 2 Budget Key Points: Retaining original budget for now – will update later -- Added Medicaid (federal/state)
Finance: Year 4 Budget Key Points: Retaining original budget for now – will update later --- Added Medicaid (federal/state)
Audiences Hospitals Physicians Laboratory/X-ray Pharmacy/ Ancillary Services Other Providers Rural Health Clinics Patients/Consumers Payers Purchasers State Agencies Health Professional Schools General Public Government Timeline Year 1 (through 9/30/10) – Preparation for HIE Implementation Year 2 (FY11) – Implementation Year 3 (FY12) – Adoption and Use Year 4 (FY13) – Transition to Long-Term Sustainability Communication/Marketing Plan Core Messaging • Success Factors/Metrics • HIE Commission partners committed to project success • Clearly articulated benefits, ROI • Consistent, clear and honest communications about issues that directly impact consumers (Transparency, privacy and security of data) • Stakeholder/Target Audience understanding /acceptance of role in HIE adoption • Meaningful, real opportunities for all target audiences to contribute ideas
Core Messages One Health Record means that a basic set of health information on a patient will be available, safe and secure, when and where it is needed to provide quality care for that patient. The needs of patients/consumers are at the center of Alabama’s HIE. OHR will lead to improved information sharing and communication between providers and patients and help create a “medical neighborhood” for each patient. The availability of health information via AHIE will empower consumers to understand & access personalized health information in order to better manage Alabama’s HIE is being developed as an independent, transparent, secure, evidence-based system by Alabamians. Federally-funded, state-run Regional Extension Center is available to assist in HIE adoption / meaningful use by providers. The secure exchange of health care data is an essential part of a reformed health care system, providing information to reduce duplication, increase efficiency, improve patient health outcomes, prevent fraud/abuse, and lower health care costs.
Core Messages Availability of health data through Alabama’s HIE will improve public health services by making it possible to monitor – and potentially prevent – public health emergencies by timely reporting of information about illness outbreaks; and by providing information about prevalence of chronic illness so disease interventions can be more effective. HIE will make it possible for vital health information to be securely shared with health care providers during times of public emergency. (e.g. hurricanes) Adoption and use of HIE in Alabama will provide information and resources to expand health care services to rural and underserved populations. Alabama has been on leading edge – we have the foundation for success due to Medicaid’s Together for Quality project; lessons learned from that initiative will enable state to build on successes, to “get it right.” The HIE system in Alabama is designed to be a long-term, self-sustaining entity that will not increase the cost of health care, but instead support better care at a lower cost. Unprecedented opportunity for funding to do something substantive to get better health care at a lower cost; to move past the “silos” to create a system that provides doctors and patients with better information.
