e-Health Overview: Findings and Recommendations for the Kentucky e-Health Network Board

1. e-Health Overview: Findings and Recommendations for the Kentucky e-Health Network Board Presented by: Benjamin Beaton & Trudi Matthews Cabinet for Health and Family Services April 18, 2006

2. Overview 1) Kentucky in the National e-Health Framework 2) Introduction to e-Health Efforts in Six States 3) Summary of Lessons Learned from Other States 4) Recommendations and Next Steps Glossary of Terms • AHIC = American Health Information Community • EMR = Electronic Medical Record (clinical record system) • HIE = Health Information Exchange • HIT = Health Information Technology • NHIN = National Health Information Network • ONC = Office of the National Coordinator for HIT (Dr. Brailer) • RHIO = Regional Health Information Organization

3. Role of KY in National e-Health Framework • National efforts: • National architecture: National Health Information Network (NHIN) • Standards development: HIT Standards Panel • Technology certification: Certification Commission on Health Information Technology (CCHIT) • Federal board: American Health Information Community (AHIC) • State-level efforts: • Regional and state information sharing projects • Shared infrastructure • HIE organization and governance • Encouragement of increased EMR and HIT adoption

4. Role ofKY inNational e-Health Framework • Federal-state partnership efforts: • Security & Privacy collaboration (HISPC) • 4 AHIC workgroups, 5 breakthrough projects: • Biosurveillance: ER data for public health • Chronic Care: Secure messaging 3a) Consumer Empowerment: Electronic registration summary 3b) Consumer Empowerment: Electronic medication history 4) Electronic Health Records: Lab data

5. Arizona • August2005:Governor signs Executive Order establishing“Arizona Health-e Connection” • Nov. 2005: Statewide summit held,Steering Committee & Task Groups created • April 5, 2006: Released Roadmap featuringpriority projects • State-wide Web portal • Patient health history (Rx, Dx, tests) • Regional clinical messaging • Grant funds for small and rural providers for EMRs

6. Indiana • Indiana Network for Patient Care: First e-Health initiative in IN lead by health informatics institute and univ. hospitals;allowedEDstaff torequest electronic patient clinical abstract (5 major Indianapolis hospitals) • Clinical leaders saw thate-Healthcould work and offer real value • Feb. 2004: Indiana Health Information Exchange(IHIE) incorporated • Stakeholder-governed, little state involvement, not statewide but planning to build a statewide network • IHIEusesDocs4Docs- clinical messaging service (labs, radiology, other tests) • Self-supporting: IHIE cash-positivein 2006

7. Florida • May 2004: EstablishedGovernor’s Health Information Infrastructure Advisory Board • Florida Health Information Network(FHIN): non-profitentity to facilitate statewide health information exchange • Staterecord locator will assemble patient information from multiple servers based in RHIOs across state • Drawing on existing electronic information sources • Grants to support 8 of 12 developing RHIOs ($1.5M total) • State-led efforts encouraging and utilizing additionalprivate sector efforts • Availity: Multipayor Web portal foradministrative & financialtransactions between providers, payors; part of FHIN • Will soon offer Payor-Based Health Record (PBHR) to providers

8. Minnesota • Minnesota e-Health Initiative established by legislation in 2004 • Established Advisory Committee and subgroups to tackle work plan for statewide e-Health network • Held statewide summit and released Roadmap to Legislature in 2005 • State created Minnesota Healthcare Connection – nonprofit entity to connect community e-Health efforts, including short term projects • Medication history • Enhanced disease reporting • Immunization registry • Electronic lab reporting

9. Utah • 1993: Utah Health Information Network (UHIN) established as state-ownednonprofit entity • One of the only statesto see long-term success of its Community Health Information Network (CHIN) effort • Common standards &shared technologyused for electronic exchange(EDI) of administrative & financialinformation– claims submission & status, adjudication, eligibility • State law requires Utah Insurance Department to adopt standards for health care claims if UHIN adopts them • Working to expand into clinical areas (medical and Rx histories, labs, discharge summaries)

10. Categories of Common e-Health Projects

11. Summary of Lessons Learned • Funding • Major external funding has waned • Smaller funding opportunities mean narrowly-tailored projects with near-term ROI • Build toward overarching goal through smaller, incremental projects • Organizational/Leadership Structures • State-led (Governor’s Exec Order – AZ, FL; Legislation – MN, OR, VT) • Public/Private (MN, RI) • Private Sector-led (CO, IN, MA)

12. Summary of Lessons Learned • Research Needs • Policy-oriented research; not technical, theoretical • Great strides coming from private sector innovation • Collaborative hurdles are greater than technological challenges • Progress most likely when parties… • Identify space where it makes sense to collaborate, not compete • Frankly acknowledge proprietary interests & competition in the room • Identify common goals and objectives of improved quality, increased efficiency

13. Recommendations • Be ambitious but practical • Focus on facilitating health information exchange, notfinancing HIT adoption • Leverage health data already availableelectronically& projects already underway • Respect providerneeds & practice patterns • Identify barriers to HIT adoption and HIE; propose common solutions • Combine long-term vision with short-term quality improvement and ROI

14. Recommendationsand Next Steps 1) Be ambitious but practical • Pursue projects that offerROI and tangible quality improvement • Incremental, rather than whole-scale, change • Buildexperience, trust,& knowledge baseby working together over time • Pursue collaborative and voluntary projects; don’t force e-Health on KY providers • Identifycommon issuesand agree not tocompete in that space: Move themfroma competitive environment to acollaborative environment *Next Step: Pursue common administrativeproject(s)that facilitateand fund sustainable clinical information sharing

15. Recommendationsand Next Steps 2) Focus on facilitating health information exchange, notfinancing HIT adoption • Health information cannot be exchanged electronically unless it is first recorded electronically • Policies and projectsshouldalways encouragesmart HIT investment by KY providers • The e-Health Board cannot subsidizestatewide HIT adoption; neither should it prescribe the vendors and software providers should utilize • Provider investment in EMRs and other HITencouraged: • In a collaborative fashion whenever possible, and • Mindful of national certification and standards efforts • HIE =Moving datafrom silos to the point of care; working toward accurate, interoperable records *NextSteps: ePrescribing grant program; Partnerships with provider associations on HIT adoption

16. Recommendationsand Next Steps 3) Leverage available electronic health information & ongoing projects • Projects should target data already available electronically (claims data, Rx, some labs) • KY can’t afford to wait until all clinical data is digital – we must begin exchanging the most useful data available • When possible, coordinate among & learn from various local & regional e-health efforts, e.g., Accenture NHIN prototype *Next Step: Target health data available through claims histories

17. Recommendationsand Next Steps 4) Respect provider practice patterns, patient needs • Providers will not utilize tools or information that does not integrate into their workflow • All e-health projects should meet thresholds of usefulness and pervasiveness • What information will help engage patients and providers in better health? *Next Step: Work with provider & patient communities toidentify current HITutilization andbiggest needs, challenges

18. Recommendations and Next Steps 5) Identify barriers to HIT adoption and information exchange; propose common solutions to those barriers • Could include laws, regulations, incentives, business practices, and reimbursement patterns • Continuous effort to improve the regulatory and business climate in KY for HIE and HIT *Next Steps: HISPC Security & Privacy Collaboration; Board should identify and vet marketplace barriers, then propose and pursue solutions

19. Recommendationsand Next Steps 6) Focus on projects withearly ROI& quality gains that build toward long-term goals • Develop and refine goalsfor statewide HIE and integration with NHIN • Flexibility and feedback are necessary infast-changing national and industry landscape • Projects should be sustainable: KY cannot rely on large amounts of external funding • Projects must be scalable to long-term goals: Initial collaborations may form foundation for larger network, with shared experience generating trust & benefits *Next Step: Appoint multi-stakeholder Advisory Group tasked with exploring best models for statewide HIE inKY and how KY will interface with the NHIN

20. Recommendationsand Next Steps 7) Role ofthe state government in development of KYe-Health Network • Major force in health care market through purchase, use, and reimbursement of HIT by state agencies • Facilitator and convener of community and statewide initiatives • Partner with associations in encouragement of HIT investment • Policy development and support of e-Health Network Board • Interface with federal government (ONC) and other states’ e-Health efforts • NOT the builder/purchaser/owner/operator of large HIE infrastructure, or record keeper for patient health information *Next Steps: Partner with provider associations; Link Board liaisons to 4 AHIC workgroups; Examine regulatory issues that help or hurt HIE or HIT investment

21. CHFS Action Items May Meeting: • Developproposed 2006Work Planbased on feedback of e-Health Network Board • Work with co-chairs to configure Advisory Group for Board approval • Identify and research potential projects based on Board feedback • HISPC Security & Privacy Collaboration • ePrescribing grant opportunity • Link board member liaisons to AHIC workgroups • Biosurveillance • Chronic Care • Consumer Empowerment • Electronic Health Records