South Dakota State Medical Association 2009 Annual Meeting

2. Overview Health IT 101 Privacy / Security Federal Initiatives State Work

3. Health Information Technology

4. Mechanics of Health IT EMR / EHR can be used interchangeably EMR � Single practice setting � Physician Office EHR � More comprehensive � Hospital or Health System may use May include more health information to make it more comprehensive HIE is the movement electronic health information across organizations not affiliated NHIN is the federal level initiative that will work to tie Statewide HIE�s together EMR / EHR can be used interchangeably EMR � Single practice setting � Physician Office EHR � More comprehensive � Hospital or Health System may use May include more health information to make it more comprehensive HIE is the movement electronic health information across organizations not affiliated NHIN is the federal level initiative that will work to tie Statewide HIE�s together

5. How do they fit? Ripple effect CORE � EMR/EHR � This must be in place before you can have HIE or NHIN Each layer becomes more comprehensiveRipple effect CORE � EMR/EHR � This must be in place before you can have HIE or NHIN Each layer becomes more comprehensive

6. What do we have now? Currently we have multiple silos of information Great information is contained within these Silos HIE will serve as the connecting point Provide more accurate, complete, up-to-date info about patientsCurrently we have multiple silos of information Great information is contained within these Silos HIE will serve as the connecting point Provide more accurate, complete, up-to-date info about patients

7. In real life, how do silos affect workflow?In real life, how do silos affect workflow?

8. What would be ideal?

9. Institute of Medicine �To Err is Human� 1999 As many as 98,000 people die from preventable medical errors each year Some of these are attributed to illegible handwriting 7,000 deaths occur annually due to medication errors Additional 1.5 Million people are injured each year from medication errors 4 of 5 adults take on medication every day (Pres or OTC) Paper Kills Safety and Quality of care for patients is the catalyst to adopt health ITInstitute of Medicine �To Err is Human� 1999 As many as 98,000 people die from preventable medical errors each year Some of these are attributed to illegible handwriting 7,000 deaths occur annually due to medication errors Additional 1.5 Million people are injured each year from medication errors 4 of 5 adults take on medication every day (Pres or OTC) Paper Kills Safety and Quality of care for patients is the catalyst to adopt health IT

10. Barriers to overcome Most cite Capital and Funding as the greatest barrier Most cite Capital and Funding as the greatest barrier

11. Is there good news? Actually yes. Physicians that have adopted are seeing the value in patient safety, operational effectiveness and cost Improves quality of clinical decisions Improves communication with patients Greatly increases preventive care and chronic-illness care Actually yes. Physicians that have adopted are seeing the value in patient safety, operational effectiveness and cost Improves quality of clinical decisions Improves communication with patients Greatly increases preventive care and chronic-illness care

12. Where is the workforce? ONC Strategic Health IT Plan lists developing workforce for health IT development and use Health IT folks run the servers and install software Health Informatics Specialists interpret and analyze information and work with clinical staff. Many are clinicians ( Dr, RN, Rx) Many start as programmers how have a clinical knowledge base Many act as diplomats � merging clinical and technical people. ONC Strategic Health IT Plan lists developing workforce for health IT development and use Health IT folks run the servers and install software Health Informatics Specialists interpret and analyze information and work with clinical staff. Many are clinicians ( Dr, RN, Rx) Many start as programmers how have a clinical knowledge base Many act as diplomats � merging clinical and technical people.

13. Is it Private & Secure? Pass around Charts and CD�s Issues surround access to records Who should see it When should they see it Who else should have access As you can see from example: ANY layer of electronic capability can provide privacy and security beyond what a paper chart can Pass around Charts and CD�s Issues surround access to records Who should see it When should they see it Who else should have access As you can see from example: ANY layer of electronic capability can provide privacy and security beyond what a paper chart can

14. Access vs. Risk Patient Focus Educate Consumers Risk of breach vs. timely access to critical info Encourage consumer to take an active role in their healthcare Personal Health Records Timely access to information = cost savings Reduced duplicate tests, procedures Reduced medication errors Consumer View (Risk exists by outweighed by benefits) Information is readily available Reduce duplicate tests Reduce medication errors Access to pertinent information for an emergency situation We only hear bad examples Lost / Stolen laptops Medical records thrown in trash bins We don�t hear the positive Consumer no longer needs to carry volumes of records Care is immediate, current, and efficient Consumer View (Risk exists by outweighed by benefits) Information is readily available Reduce duplicate tests Reduce medication errors Access to pertinent information for an emergency situation We only hear bad examples Lost / Stolen laptops Medical records thrown in trash bins We don�t hear the positive Consumer no longer needs to carry volumes of records Care is immediate, current, and efficient

15. Relevance today� What relevance to today�s headlines is there? EMR�s play a pivotal role in disease tracking and surveillance 2001 Severe Acute Respiratory Syndrome (push slowed after threat passed) Again recommending fusing public health IT goals with broader EHR agendas What relevance to today�s headlines is there? EMR�s play a pivotal role in disease tracking and surveillance 2001 Severe Acute Respiratory Syndrome (push slowed after threat passed) Again recommending fusing public health IT goals with broader EHR agendas

16. National View In the next few slides I�ll give you a national view of what is happeningIn the next few slides I�ll give you a national view of what is happening

17. New Leadership� Renewed Vision� So�. Where do we stand now? Under new leadership and vision we stand at a unique point in time. SD is well positioned to catapult our state efforts Awaiting confirmation of Kathleen Sebelius as Secretary of HHS Recently appointed Dr. David Blumenthal as National Coordinator So�. Where do we stand now? Under new leadership and vision we stand at a unique point in time. SD is well positioned to catapult our state efforts Awaiting confirmation of Kathleen Sebelius as Secretary of HHS Recently appointed Dr. David Blumenthal as National Coordinator

18. The Game Changer American Recovery and Reinvestment Act � ARRA Title IV � Medicare / Medicaid incentives for Health IT Title VIII � Health and Human Services Title XIII � Health Information Technology for Economic and Clinical Health (HITECH) Act American Recovery and Reinvestment Act � ARRA Title IV � Medicare / Medicaid incentives for Health IT Title VIII � Health and Human Services Title XIII � Health Information Technology for Economic and Clinical Health (HITECH) Act

19. ARRA Office of National Coordinator $2 billion $598 million for Regional Extension Centers $564 million for State HIE Cooperative Agreements Centers for Medicare / Medicaid Services $20 billion Community Health Centers $1.5 billion Federal Communications Commission $4.3 billion $2 Billion to ONC for loans, grants, technical assistance, and HIE Planning and Implementation Expecting strategic plan from ONC to congress May 15 $20 Billion in expected Medicare / Medicaid Incentive payments (2011) Incentive to adopt of up to $44,000 over 5 years 2016 CMS incentives give way to penalties for failing to adopt Health IT $1.5 Billion to Community Health Centers for construction, equipment and acquisition of Health IT systems $4.3 Billion for broadband infrastructure through Federal Communications Commission (FCC)$2 Billion to ONC for loans, grants, technical assistance, and HIE Planning and Implementation Expecting strategic plan from ONC to congress May 15 $20 Billion in expected Medicare / Medicaid Incentive payments (2011) Incentive to adopt of up to $44,000 over 5 years 2016 CMS incentives give way to penalties for failing to adopt Health IT $1.5 Billion to Community Health Centers for construction, equipment and acquisition of Health IT systems $4.3 Billion for broadband infrastructure through Federal Communications Commission (FCC)

20. Regional ExtensionCenters Offer direct, individualized, and on-site technical assistance to providers Physicians, PAs, NP 70 across the US One application for SD (round 2) Center for Advancement of Health IT Dakota State University, USD, SDSU, other partners

21. State HIE Cooperative Agreements Supports sustainable statewide HIE Through meaningful use of EHR adoption Requires State Health IT Coordinator Coordinates public / private efforts State strategic and operational plans Approved by ONC 5 key domains Governance, Finance, Technical Infrastructure, Legal/Policy, Business Operations Due October 16 � Awarded by mid January 2010 Requires matching funds in FY11 (October 1, 2010)

22. Medicare / MedicaidIncentives Medicare / Medicaid Incentives for Eligible Professionals Begin in January 2011 end 2015 Meaningful EHR User (meaningful use matrix) Improve quality, safety, and efficiency Engage patients and families Improve care coordination Improve population and public health Ensure privacy & security protections for PHI

23. Medicare Maximum incentive - $44,000 $18,000; $12,000; $8,000; $4,000; $2,000 Meaningful use of certified EHR ePrescribing Electronic exchange of health information Electronic reporting on clinical quality and other measures Reduced payments in 2015 for those who are not meaningful users 1%, 2%, 3% (between 3-5% after 2017) www.cms.hhs.gov/Recovery/

24. Medicaid Maximum incentive - $64,000 Meaningful use requirements will be determined by Medicaid programs Must meet minimum Medicaid patient volume 30% Physicians, dentists, certified nurse-midwives, nurse practitioners, and physician assistants Can start as late as 2016 (ends in 2021) No penalty imposed

25. ARRA Office of National Coordinator Privacy and Security Provisions Nationwide Health Information Network Federal Advisory Committees Not only dollars but significant policy restructuring ONC Codifies ONC�s role in HHS and requires numerous reports/analysis Empowers ONC to endorse standards, specifications, & certification criteria Creates Chief Privacy Officer Privacy / Security Extends HIPAA to a broader range of organizations Notification to individuals of breaches Toughens HIPAA�s civil penalties NHIN Directions Coordinator to establish a governance mechanism for the NHIN Advisory Committees Health IT Policy Committee Health IT Standards Committee These will direct many facets of Health ITNot only dollars but significant policy restructuring ONC Codifies ONC�s role in HHS and requires numerous reports/analysis Empowers ONC to endorse standards, specifications, & certification criteria Creates Chief Privacy Officer Privacy / Security Extends HIPAA to a broader range of organizations Notification to individuals of breaches Toughens HIPAA�s civil penalties NHIN Directions Coordinator to establish a governance mechanism for the NHIN Advisory Committees Health IT Policy Committee Health IT Standards Committee These will direct many facets of Health IT

26. Federal Initiatives National Governor�s Association State Level Health Information Exchange Certification Commission for Health IT National Conference of State Legislatures National eHealth Collaborative eHealth Initiative Health Information Technology Standards Panel Nationwide Health Information Network Others NGA State Alliance for eHealth Taskforce on Privacy/Security and Governance of HIE�s SLHIE Forum membership that coordinates HIE efforts across the states CCHIT Certification body that ensures Health IT products are interoperable Inpatient and Ambulatory EMR�s NCSL Guidance on legislative issues across the states HITSP Promotes standardization and harmonizes HL7 standards NHIN �Network of Networks� testing national exchange across statesNGA State Alliance for eHealth Taskforce on Privacy/Security and Governance of HIE�s SLHIE Forum membership that coordinates HIE efforts across the states CCHIT Certification body that ensures Health IT products are interoperable Inpatient and Ambulatory EMR�s NCSL Guidance on legislative issues across the states HITSP Promotes standardization and harmonizes HL7 standards NHIN �Network of Networks� testing national exchange across states

27. State View There was an overview of Federal initiatives and actions�. What are we doing in SD to move our initiative forward and tie with Federal efforts?There was an overview of Federal initiatives and actions�. What are we doing in SD to move our initiative forward and tie with Federal efforts?

28. Challenges EMR/EHR adoption varies from 2% - 20% Geographic and technology disparities Consumer confidence Other barriers First we need to recognize the challenges SD like many other states faces major barriers We are working to address and provide solutions to barriers EMR/EHR Adoption Capital for purchase, maintenance costs, provider resistance, lack of IT staff Geographic / Technology disparities Broadband internet, medically underserved areas, lack of providers Consumer Confidence Privacy and security concerns among others Other Getting technology in place Education Legal issues Governance First we need to recognize the challenges SD like many other states faces major barriers We are working to address and provide solutions to barriers EMR/EHR Adoption Capital for purchase, maintenance costs, provider resistance, lack of IT staff Geographic / Technology disparities Broadband internet, medically underserved areas, lack of providers Consumer Confidence Privacy and security concerns among others Other Getting technology in place Education Legal issues Governance

29. Moving Toward the Tipping Point 2006 SDEHRA Environmental Scan Gauge readiness Implementation plans Barriers Current Use Today Somewhere between EMR/EHR Adoption HIE Planning and Development Planning, Infrastructure, and Adoption will bring us closer to the tipping point Late 2011 or 2012 We�ll have reached the Pilot / Test phase and that will be the momentum builder2006 SDEHRA Environmental Scan Gauge readiness Implementation plans Barriers Current Use Today Somewhere between EMR/EHR Adoption HIE Planning and Development Planning, Infrastructure, and Adoption will bring us closer to the tipping point Late 2011 or 2012 We�ll have reached the Pilot / Test phase and that will be the momentum builder

30. HIE Development & the future Development of statewide HIE�s across the nation will be tied together via the NHIN.Development of statewide HIE�s across the nation will be tied together via the NHIN.

31. Spirit Of Collaboration� Last two slides show our challenges and where we are along the path�. So�.. How did we get there? What is our driving force? Governor Rounds visionary leadership and direction to improve the health AND care for all South Dakotan�s Support and dedication of our stakeholders Last two slides show our challenges and where we are along the path�. So�.. How did we get there? What is our driving force? Governor Rounds visionary leadership and direction to improve the health AND care for all South Dakotan�s Support and dedication of our stakeholders

32. Governor signs EO 2009-01 � Formalizing the eHealth Collaborative Brings together and validates 3 years of work by countless individuals Gives traction to group to move forward (rubber hits the road) Gives authority to Secretary of Health to appoint members Appoints a representative of DOH to serve as Senior Director Gives the Collaborative the following guides To pursue in the public interest Provide leadership and coordination of Health IT activities Consider ways to advance adoption and identify partners Incorporate national standard setting organization recommendations Work in conjunction with other organizations to ensure successGovernor signs EO 2009-01 � Formalizing the eHealth Collaborative Brings together and validates 3 years of work by countless individuals Gives traction to group to move forward (rubber hits the road) Gives authority to Secretary of Health to appoint members Appoints a representative of DOH to serve as Senior Director Gives the Collaborative the following guides To pursue in the public interest Provide leadership and coordination of Health IT activities Consider ways to advance adoption and identify partners Incorporate national standard setting organization recommendations Work in conjunction with other organizations to ensure success

33. SD eHealth Collaborative CORE Improve quality, safety, and efficiency of health care for all South Dakotan�s Also Core in any health IT adoption / use Improved patient care � Patient is the bottom lineCORE Improve quality, safety, and efficiency of health care for all South Dakotan�s Also Core in any health IT adoption / use Improved patient care � Patient is the bottom line

34. Collaborative Members Holly Arends DHS Nancy Beaumont SDFMC Lynn Beck Consumer Arlyn Broekhuis Sanford Health Jacque Cole, RN DakotaCare Rebekah Cradduck SDAHO Mark East SDSMA Laurie Gill DOH Gary Goeden BIT Scot Graff CHAD Dick Latuchie Regional Health Dennis Kaufman Good Samaritan Society Linda Maas SDHIMA Randy Moses DOI Jim Vachal, RpH Brown Clinic Gayle Varty, RN St. Mary�s Healthcare Center Jim Veline Avera Health Revi Warne DSS Sam Wilson AARP Robust, varied cross section of stakeholders Generously supporting our efforts by providing time and expenses All working toward a common vision Speaks well to SD spirit and attitudeRobust, varied cross section of stakeholders Generously supporting our efforts by providing time and expenses All working toward a common vision Speaks well to SD spirit and attitude

35. 4 new Advisory Committees identified Technical Advisory Committee Education & Outreach Advisory Committee Policy / Governance Advisory Committee Legal / Legislative Advisory Committee All will work in conjunction with each other. Each Advisory Committee will intertwine their work with the others. Give Example � Technical, remembers Education, Policy, needed Legal work, and Privacy & Security in any recommendation. Additional Finance Advisory Committee Will have a rep from each of the other 5 advisory committees Advisory Committee Functions Serve as research and develop bodies Bring recommendations to Collaborative for discussion or action Supply expertise in their respective areas for the common good of the Collaborative 4 new Advisory Committees identified Technical Advisory Committee Education & Outreach Advisory Committee Policy / Governance Advisory Committee Legal / Legislative Advisory Committee All will work in conjunction with each other. Each Advisory Committee will intertwine their work with the others. Give Example � Technical, remembers Education, Policy, needed Legal work, and Privacy & Security in any recommendation. Additional Finance Advisory Committee Will have a rep from each of the other 5 advisory committees Advisory Committee Functions Serve as research and develop bodies Bring recommendations to Collaborative for discussion or action Supply expertise in their respective areas for the common good of the Collaborative

36. The Journey Begins 2006 Formed by Governor�s HCC SDEHRA Environmental Scan 2007 Address barriers 1st Annual HIT Summit HISPC IOA proposal accepted Where did we begin and where are we now? Stumbled when we started � SD Spirit of determination First application to participate in HISPC rejected We would rather have a solution vetted in SD and focused to meet our needs 2006 Formed as a sub-committee of the Governor�s Health Care Commission DOH, DHS, DSS partnered to perform assessment 2007 Armed with knowledge from the assessment Began to address barriers Provide Interim solutions Also hosted 1st HIT Summit State, Regional, and National experts Submitted a successful proposal to the HISPC IOA 5 states and 1 territory Alaska, Iowa, Guam, New Jersey, North Carolina, South Dakota Where did we begin and where are we now? Stumbled when we started � SD Spirit of determination First application to participate in HISPC rejected We would rather have a solution vetted in SD and focused to meet our needs 2006 Formed as a sub-committee of the Governor�s Health Care Commission DOH, DHS, DSS partnered to perform assessment 2007 Armed with knowledge from the assessment Began to address barriers Provide Interim solutions Also hosted 1st HIT Summit State, Regional, and National experts Submitted a successful proposal to the HISPC IOA 5 states and 1 territory Alaska, Iowa, Guam, New Jersey, North Carolina, South Dakota

37. The Journey Continues 2008 Roadmap developed CMS EHR Demo awarded HISPC IOA pilots 2nd Annual HIT Summit 2009 Governor Rounds signs Executive Order formalizing the eHealth Collaborative 1st eHealth Collaborative Meeting Center for Advancement of Health IT formed More to come� 2008 Strategic roadmap developed focusing on Education, Data, Legal and Technical issues Awarded one of 12 (now 4) nationwide projects from CMS Another example of how we persevered by applying even though we didn�t feel we could meet the practice requirements Provides financial incentives to primary care practice physicians to implement EHR�s Created model agreements to exchange public health data across state lines under HISPC IOA Public-to-Public exchange of immunization registry data IA/SD and IA/SD/GU/NJ Private-to-Private exchange Templates endorsed nationally by AIRA and other federal agencies First of their kind in the nation live data exchanges across multiple state lines Currently participating in a phase IV project to distribute and expand on work Later I�ll show you a brief clip from the Provider Education Collaboration Hosted our 2nd annual HIT Summit Microsoft Health Vault executive delivered keynote address 2009 Governor Rounds signs first EO of 2009 formalizing the eHealth Collaborative Collaborative meets for first time � Adopts by-laws, reviews recommendations, continues to develop planning documents Creates the Center for Advancement of Health IT at Dakota State University ( I�ll talk more about in a bit) More to come�. We don�t sit still2008 Strategic roadmap developed focusing on Education, Data, Legal and Technical issues Awarded one of 12 (now 4) nationwide projects from CMS Another example of how we persevered by applying even though we didn�t feel we could meet the practice requirements Provides financial incentives to primary care practice physicians to implement EHR�s Created model agreements to exchange public health data across state lines under HISPC IOA Public-to-Public exchange of immunization registry data IA/SD and IA/SD/GU/NJ Private-to-Private exchange Templates endorsed nationally by AIRA and other federal agencies First of their kind in the nation live data exchanges across multiple state lines Currently participating in a phase IV project to distribute and expand on work Later I�ll show you a brief clip from the Provider Education Collaboration Hosted our 2nd annual HIT Summit Microsoft Health Vault executive delivered keynote address 2009 Governor Rounds signs first EO of 2009 formalizing the eHealth Collaborative Collaborative meets for first time � Adopts by-laws, reviews recommendations, continues to develop planning documents Creates the Center for Advancement of Health IT at Dakota State University ( I�ll talk more about in a bit) More to come�. We don�t sit still

38. 2009 Major Projects eHealth Collaborative advisory committees formed Center for Advancement of Health IT (CAHIT) State HIE Cooperative Agreement (Oct 16) Assist CAHIT with REC Application (Dec) Strategic & Operational plan for adoption of health IT / HIE submitted to ONC Provider / Facility surveys 2009 Focused on planning Reforming the Collaborative Defining a new advisory committees Prioritizing stakeholder groups Forming CAHIT with DSU and our other state universities ARRA and FCC funding proposals Reworking and creating a comprehensive survey tool Gauge and measure success2009 Focused on planning Reforming the Collaborative Defining a new advisory committees Prioritizing stakeholder groups Forming CAHIT with DSU and our other state universities ARRA and FCC funding proposals Reworking and creating a comprehensive survey tool Gauge and measure success

39. Collaborative Goals Fostering early adoption of EMR/EHR Building infrastructure / capacity Promoting collaboration Supporting consumers, providers, payers Creating resource center Implementing health information exchange to improve quality, safety, and efficiency of health care for all South Dakotan�s In Summary My function is to coordinate, facilitate, and advance the Governor�s Health IT initiative Through: In Summary My function is to coordinate, facilitate, and advance the Governor�s Health IT initiative Through:

40. More Information Meeting dates, locations, and minutes HISPC information CMS EHR Demo information Much more�Meeting dates, locations, and minutes HISPC information CMS EHR Demo information Much more�

41. Closing Thoughts� The Bottom Line The Patient Comes First Health IT will facilitate delivery of patient care Reduce Costs and errors Increase Quality HIE�s improve delivery of information to clinicians Data exchange across stakeholders Timely information Increased Quality Funding Health IT is an investment in the future of healthcare in South Dakota

43. Contact