Update on the Florida Health Information Network

1. Update on the Florida Health Information Network AcademyHealth Annual Research Meeting Health Information Technology Interest Group Meeting Orlando, Florida ~ June 2 , 2007 Christopher B. Sullivan, Ph.D. Florida Center for Health Information and Policy Analysis Agency for Health Care Administration

2. Nationwide Health Information Network The Nationwide Health Information Network proposes to “link all health records through an interoperable system that protects privacy as it connects patients, providers and payers, resulting in fewer medical mistakes, less hassle, lower costs and better health.“ Department of Health and Human Services Secretary Mike Leavitt http://www.hhs.gov/healthit/

3. Framework for Strategic Action for the Nationwide Health Information Network Health information technology allows the comprehensive management of medical information and its secure exchange between health care consumers and providers. It will: • Improve health care quality • Reduce health care costs • Decrease paperwork • Expand access to affordable care http://www.hhs.gov/healthit/

4. Framework for Strategic Action Interoperable health information technology will improve individual patient care, but it will also bring many public health benefits including: • Early detection of infectious disease outbreaks Improved chronic disease management; and • Evaluation of health care based on quality information that can be compared. http://www.hhs.gov/healthit

5. Nationwide Health Information Network

6. The Florida Health Information Network The Florida Health Information Network vision calls for integrating clinical health information exchange in Florida through a statewide health information network that will empower physicians to access timely and accurate medical records in order to deliver the highest quality medical care for their patients.

7. Functions of the Florida Health Information Network • The Florida Health Information Network will facilitate communications and data exchange among the Regional Health Information Organizations (RHIOs) by coordinating requests for medical records across Florida and delivering those records to the physician • The Florida Health Information Network will also specify and maintain technical standards for interoperability among the RHIOs

8. The Florida Health Information Network Begins at the Local Level • The Florida Health Information Network is being built from the local community up • An essential element of the strategic plan is to empower local stakeholder collaborations focused on health information exchange • The driver of this plan is the FHIN Grants Program and Regional Health Information Organizations in the local community

9. Grants Program to Develop Regional Health Information Organizations • Planning Grants: Support engaging local health care stakeholders to develop a strategic plan for health information exchange • Implementation Grants: Support projects that demonstrate health information exchange among two or more competing providers • Training Grants: Support practitioner training designed to increase physician and dentist use of electronic health record systems

10. Grants Program, 2006-2007 • In 2005 the Legislature appropriated $1.5 million for grants awarded to nine projects • Five Planning Grants • Three Implementation Grants • One Training Grant • In 2006 the Agency awarded six grants with another $2 million from the Legislature • All six were Implementation Grants • The Legislature allocated $2 million for FHIN grants in 2007-2008

11. The Florida Health Information Network Florida’s Health Information Networks 1. Big Bend RHIO 2. Central Florida RHIO 3. Community Health Information Organization 4. Escambia HIN 5. Jacksonville Health Information Network 6. Palm Beach County Community Health Alliance 7. Pinellas RHIO 8. Space Coast Health Information Network 9. South Florida HII 10. Tampa Bay RHIO See: http://ahca.myflorida.com/dhit

12. Some Examples of Florida’s RHIOs: • Palm Beach County Community Health Alliance • Big Bend RHIO • Tampa Bay RHIO • Escambia Health Information Network • South Florida Health Information Infrastructure • Community Health Informatics Organization

13. What is a Regional Health Information Organization?

14. Partners Public Funders Free Clinics Private Funders Health Dept. Social Services Hospitals PBC Community Health Alliance (An Alliance of Funders and Providers Serving Health Care Consumers) Collaborative Projects Care Expansion Language Access Project Access Shared EHR Common Eligibility Palm Beach County Community Health Alliance

15. Western Palm Beach County Health Information Infrastructure Operations and Evaluation Project The Glades Community • 28% uninsured rate • Glades General Hospital is the only Acute Care facility • 17,753 ER visits; 1,900 Medicaid discharges in 2002 • Prevent duplication between hospital and clinics

16. Big Bend RHIO

17. Tampa Bay RHIO

18. Escambia Health Information Network

19. Community Health Informatics Organization

20. South Florida Health Information Initiative

21. Technical Standards for the Florida Health Information Network • Florida Health Information NetworkArchitectural Considerations for State Infrastructure - Draft White Paper • Minimal Clinical Dataset • Authentication of end users and transaction audit trails to ensure network security • Master Patient Index and Record Locator Service • Privacy and Confidentiality of patient records

22. Functions of the Florida Health Information Network • The FHIN will facilitate communications and data queries among Regional Health Information Organizations • The FHIN will take the lead in specifying technical standards • The FHIN will provide a portal for state agency health care data and other databases

23. 1. Big Bend RHIO2. Tampa Bay RHIO3. Palm Beach County Community Health Alliance4. South Florida HII5. Escambia HIN6. Jacksonville HIN7. Community Health Information Organization 8. Central Florida RHIO9. Pinellas RHIO10. Space Coast HIN Medicaid Florida Center DOH SHOTsVital Statistics Florida Health Information Network Certification of Physicians with DOH Licensing Database

24. Technical Standards for the FHIN

25. Some Other Projects of the Florida Health Information Network • Agency for Healthcare Research and Quality Health Information Privacy and Security Project • FCC Rural Broadband Pilot Project • Medicaid Transformation Grant • 2007 Nationwide Health Information Network Grant

26. HISPC Project Overview • Florida was one of 33 states and Puerto Rico awarded a contract from the Agency for Health Care Research and Quality and administered by RTI, Inc. to conduct a study of the variations in business practices and laws related to electronic health information exchange (E-Health Exchange)

27. Privacy and Security Project Objectives • To identify business practices and policies related to electronic health information exchange (HIE) • To analyze the policies and laws that are “barriers” to HIE • To identify solutions to the “barriers” • To develop a plan for implementing the solutions

28. Proposed Implementation Strategy

29. The Agency for Health Care Administration and the Big Bend RHIO are pursuing a grant from the Federal Communication Commission to provide broadband connections to rural hospitals.The goal is to facilitate the creation of a nationwide broadband network dedicated to health care, health care providers in rural and urban locations. Developing Connectivity through an FCC Telehealth Pilot Program

30. FCCTelehealth Pilot Program The FCC grant will cover deploying transmission facilities and advanced telecommunications and information services, including any associated non-recurring and recurring costs. The pilot program will also support construction of telehealth audio-visual facilities. Participants will be free to use available technology.

31. Proposed Objectives of the Project: Connect rural hospitals located in the Big Bend and Panhandle with urban providers and pediatric specialists. Extend Florida Health Information Network applications to rural providers. Employ telehealth applications for chronic disease monitoring in the home. Develop a funding formula for sustainability of services to eligible providers in rural counties or underserved areas.

32. Targeted Rural Areas in Florida’s Panhandle Measures of population density, urbanization, and daily commuting are used to identify urban cores and adjacent territory that is economically integrated with those cores – Rural-Urban Commuting Areas, shown in purple.

33. Graceville Jackson County Gadsden County Bonifay Madison Calhoun Liberty Perry Apalachicola Port St. Joe

34. Medicaid Transformation Grant

35. 2007 Nationwide Health Information Network Grants Focus on interfaces: • Between health information service providers and provider organizations • Include specialty networks and systems • Include government health systems • Biosurveillance • Consumer empowerment • Medication history use case

36. Next Steps for Sustainability of Health Information Exchange in Florida • The Florida Health Information Network and the RHIOs must continue to work together on issues of common interest • Legislative appropriations for startup funding is still of great importance to the RHIOs • Developing a viable business model for the Florida Health Information Network and RHIOs is also essential for continued sustainability

37. eHealth Initiative Summary Roadmap for Florida • eHealth Initiative evaluated the state of RHIO development in Florida through an extensive set of interviews with RHIO representatives • eHealth Initiative provided a report on the status and future potential of health information exchange in Florida • eHI also published a roadmap for identifying and implementing exchange services that will drive utilization and long term sustainability

38. Blueprint for Building a Sustainable Health Information Exchange Organization • Blue Cross Blue Shield of Florida donated a business development team to work with the Florida Center in creating a business plan for the Florida Health Information Network • The BCBSF team created a revenue model based on subscription fees and transaction costs over a five year period • The revenue model showed the Florida Health Information Network becoming sustainable within five years if adequately funded in the first three years

39. Foundation for eHealth Initiative Value and Sustainability Model • eHealth Initiative is also working with the Florida Center and RHIOs to provide training in its Value and Sustainability Model • The model is based on a suite of tools, products, and services which provide analytical support, discipline, and rigor to planning • Market Readiness Assessment Tool • Value Tool • Risk Estimation • Business Plan Template and Pro Forma Tool © Foundation for eHealth Initiative

40. The Future of the Florida Health Information Network • The Florida Health Information Network vision anticipates integrating Florida’s RHIOs in a seamless health information exchange • The success of the statewide network also depends on reaching out to the Department of Health and working together to achieve the common goal of exchanging records electronically for the benefit of patients across the state

41. Christopher B. Sullivan, Ph.D. Agency for Health Care Administration Florida Center for Health Information and Policy Analysis Office of Health Information Technology 2727 Mahan Drive Tallahassee, FL 32309 sullivac@ahca.myflorida.com