Mapping the Future of e-Health in Kentucky: Delivering Lower Cost, Higher Quality Health Care

1. Mapping the Future of e-Health in Kentucky: Delivering Lower Cost, Higher Quality Health Care Data Advisory Subcommittee Meeting May 30, 2007 Frankfort, KY

2. Overview • Why e-Health is needed • Background on e-Health in Kentucky • Current e-Health Projects • Future Vision and Recommendations Cabinet for Health and Family Services Slide #2

3. What is e-Health? e-Health is a broad term that encompasses any effort to use information technology in the areas of health and health care. Consists of Two Parts • HIT = health information technology (like a car) • HIE = health information exchange (the roads) Cabinet for Health and Family Services Slide #3

4. The Promise Lower costs Higher quality Healthier people

5. Why e-Health is important Even with highly trained, dedicated professionals and motivated patients… PAPER = • Higher costs • Medical errors • Missed care Cabinet for Health and Family Services Slide #5

6. Why e-Health is important We are on the cusp of enormous change… TRENDS • Health care affordability • Quality improvement • Pay for performance • Consumer-driven care • Health information on the Internet • Transparency • Personal Health Records …e-Health is fundamental to all of these Cabinet for Health and Family Services Slide #6

7. The Promise Could technology help us to… • get better information at the point of care? • reduce paperwork, duplication and other clinician headaches? • improve care and outcomes while controlling costs? Cabinet for Health and Family Services Slide #7

8. Poor Health Outcomes NOTE: ORANGE OR RED IS NOT GOOD ON THIS MAP

9. Better Information = Better Quality Example: VA vs Best Performers on Quality

10. Background on e-Health in Kentucky SB2 Kentucky e-Health Network Board

11. Senate Bill 2 • Senate Bill 2 (SB2) was passed by the General Assembly and signed into law by Governor Fletcher on March 8, 2005. • SB2 calls for the development and implementation of a statewide Kentucky e-Health Network, or “KeHN.” • The goal of KeHN is to improve the quality and reduce the cost of health care for Kentuckians. Cabinet for Health and Family Services Slide #11

12. Senate Bill 2 SB2 created two entities: • The Kentucky Healthcare Infrastructure Authority – a unique partnership between the • University of Kentucky • University of Louisville • The Kentucky e-Health Network Board • 22 board members • UK and UofL representatives serve as co-chairs • KeHN Board is attached to the Cabinet for Health and Family Services for administrative and technical support purposes. Cabinet for Health and Family Services Slide #12

13. Board Membership • Dr. Carol Steltenkamp University of Kentucky • Larry Cook University of Louisville • Mark Birdwhistell Secretary, Cabinet for Health and Family Services • William D. Hacker,M.D. Commissioner, Department for Public Health • Glenn Jennings Commissioner, Department for Medicaid Services • Mark Rutledge Commissioner, Commonwealth Office of Technology • Barbara Asher AstraZeneca International • Ford Brewer, M.D. Medical Director, Toyota Motor Manufacturing • Frank A. Butler Vice President for Medical Center Operations, UK Hospital • Bobby H. Dampier President and CEO, Trover Foundation, Madisonville • Marsha L. Donegan Vice President, Fidelity Investments, Covington Cabinet for Health and Family Services Slide #13

14. Board Membership • David Bensema, M.D. Physician, Central Internal Medicine, Lexington • Bruce Klockars President and CEO, Flaget Memorial Hospital, Bardstown • Jack Lord, M.D. Sr. Vice President/Chief Innovation Officer, Humana, Louisville • Kimberly Williams, M.D. Physician, St. Claire Regional Medical Center, Morehead • Deborah Clayton Commissioner, Dept. of Commercialization & Innovation • Thomas D. Layzell President, Council on Postsecondary Education • Julie McPeak Executive Director, Kentucky Office of Insurance (KOI) • Senator Daniel Mongiardo Senate District 30 – Bell, Harlan, Letcher, Perry counties • Senator Richard L. Roeding Senate District 11 – Boone, Gallatin, Kenton counties • Representative Tommy Thompson House District 14 – Ohio and Daviess counties • Representative Bob DeWeese, M.D. House District 48 – Jefferson county Cabinet for Health and Family Services Slide #14

15. E-Health Dilemma E-Health =Electronic Information(HIT) + Connectivity (HIE) • Objective: By 2014, all Kentuckians have interoperable EHR with statewide e-Health network for instant access anywhere. • HIT: But currently only about 25% of KY doctors use electronic health records (EHRs). • HIE: On average only 80% of claims are submitted electronically; little clinical information shared. Cabinet for Health and Family Services Slide #15

16. Kentucky HIE Efforts Cabinet for Health and Family Services Slide #16

17. Common e-Health Projects Cabinet for Health and Family Services Slide #17

18. e-Health Best Practices • How to make progress quickly? • >Leverage the electronic information and systems that are already in place. • >Focus on best practices in e-Health • Top 4 for Feasibility, Affordability and ROI: • Claims-based Health Record(TN: SharedHealth; VT) • Administrative Transactions(NEHIN, UHIN) • e-Prescribing(MA eHealth Collaborative, RI Quality Forum) • Clinical Messaging(HealthBridge, IHIE) Cabinet for Health and Family Services Slide #18

19. Current e-Health Projects Privacy and Security Collaboration e-Prescribing Partnerships in Kentucky (ePPIK) Grant Program Kentucky e-Health Summit Kentucky Health Information Partnership

20. Privacy and Security Project • Federally funded project through HHS & AHRQ • Assess impact of privacy and security practices on electronic health information exchange • 4 Groups formed with 50+ volunteers, working with staff from UK and U of L • Deliverables: Final Report & State Implementation Plan • Findings: • Patchwork of federal vs state laws need consistency • Sensitive protected health information (mental health, substance abuse, HIV/AIDS) need special attention in electronic information environment Cabinet for Health and Family Services Slide #20

21. ePPIK Grants • $300,000 in funds from Foundation for a Healthy Kentucky and Hal Rogers Grant • 5 Awardees received between $10,000 - $81,000 per grant • Grant funds to incentivize e-prescribing • Purchase EMR or e-Prescribing technology • Develop community partnerships • Goal: real end-to-end e-Prescribing Cabinet for Health and Family Services Slide #21

22. ePPIK Grants Cabinet for Health and Family Services Slide #22

23. Kentucky e-Health Summit • First Summit in January 2007 • More than 250 participants • Speakers: • Governor Ernie Fletcher • Dr. Robert Kolodner, Interim Director, ONCHIT • Janet Marchibroda, President, eHealth Initiative • E-Health Idea Fair • Next Summit: Dec. 6-7, 2007 Cabinet for Health and Family Services Slide #23

24. Kentucky Health Information Partnership (K-HIP)

25. Kentucky Health Information Partnership (K-HIP) • Trend among insurers: use claims-based information for clinical purposes • But use is low among physicians and efficacy uncertain because information is still fragmented by payor • Big Idea: Involve not just Medicaid and state employees, but all payors in Kentucky – one stop information access for providers Cabinet for Health and Family Services Slide #25

26. Kentucky Health Information Partnership (K-HIP) • Received $4.9 million Medicaid TransformationGrant funding - support initial development of partnership and Medicaid’s portion of costs for first 2 years • K-HIP as proposed would have 3 parts: • A statewide web-based portal • Clinical: A patient health summary using claims data initially • Administrative: standardized, multi-payor electronic administrative transactions Cabinet for Health and Family Services Slide #26

27. Examples of Patient Health Summaries Cabinet for Health and Family Services Slide #27

28. Examples of Patient Health Summaries Cabinet for Health and Family Services Slide #28

29. Examples of Patient Health Summaries Cabinet for Health and Family Services Slide #29

30. K-HIP Portal Information & Functions • Patient Health Summary would include: • Medication history • Provider visits – including outpatient, inpatient and emergency room visit information • Diagnosis codes • Lab and diagnostic test history • Immunization information • Patient demographic information • Administrative features would include: • Request for eligibility verification • Submission of request for pre-authorization • Check status of prior authorization request • Submission of new medical claims • Check status of submitted claims Cabinet for Health and Family Services Slide #30

31. K-HIP Benefits • Benefits: More time for patient care, less time on paperwork • No cost to practitioners to use • Single sign-on across all payors to access information • Information on more than 50% of Kentuckians • Reduced emergency room costs • Best estimates: health summary in ER can save $10 -$500 per patient • Overall ER savings for Kentucky = $7 million - $125 million • Higher quality care through • Improved drug management • Improved medical history • Reduce duplicative, unnecessary care Cabinet for Health and Family Services Slide #31

32. Kentucky Health Information Partnership **2005 figures; inpatient admits are a small fraction of total ER visits in Ky annually. Total number could be 2-3 times higher. Cabinet for Health and Family Services Slide #32

33. Federal Value-Driven Health Care Initiative

34. Value-Driven Health Care Four Cornerstones • Health IT Standards - Interoperable health information technology has the potential to create greater efficiency in health care delivery.  Additional standards must be developed and all health care systems and products should meet these standards as they are acquired or upgraded.   • Quality Standards - To make confident decisions about their health care providers and treatment options, consumers need quality of care information.  Quality measurement should be based on measures that are developed through consensus-based processes involving all stakeholders, such as the processes used by the AQA (multi-stakeholder group focused on physician quality measurement) and the Hospital Quality Alliance. • Price Standards - To make confident decisions about their health care providers and treatment options, consumers also need price information.  Efforts are underway to develop uniform approaches to measuring and reporting price information for the benefit of consumers.  In addition, strategies are being developed to measure the overall cost of services for common episodes of care and the treatment of common chronic diseases.  • Incentives- All parties - providers, patients, insurance plans, and payers - should participate in arrangements that reward both those who offer and those who purchase high-quality, competitively-priced health care.  Such arrangements may include implementation of pay-for-performance methods of reimbursement for providers or the offering of consumer-directed health plan products, such as account-based plans for enrollees in employer-sponsored health benefit plans. Cabinet for Health and Family Services Slide #34

35. HHS HIT Initiatives Cabinet for Health and Family Services Slide #35 Software Certification - Certification Commission for Health Information Technology (CCHIT) assesses and validates HIT products for functionality, interoperability, and security standards Standards Development - Health Information technology Standards Panel (HITSP) develops relevant and widely-accepted standards to facilitate interoperability

36. HHS HIT Initiatives HHS HIT Initiatives Cabinet for Health and Family Services Slide #36 Nationwide Health Information Network • Four original contracts to develop prototypes for architecture of nation’s health information infrastructure • Five sites in Eastern Kentucky and Lexington involved in Accenture Consortium • Round II due out soon – focus on state and regional collaboration

37. Other Federal e-Health Initiatives Cabinet for Health and Family Services Slide #37 Stark and Anti-kickback Safe Harbors • Enable entities to make donations of HIT to physicians and other health care providers • Interoperability is requirement of any donated software • Effective October 10, 2006 • New IRS ruling clarifies rules for non-profit hospitals State e-Health Alliance • National Governors Association working with the Office of the National Coordinator for Health Information Technology (ONC) has established body of state leaders to address state-level issues and challenges to interoperable electronic health information exchange • Dr. William Hacker, CHFS Undersecretary for Health, Chair of Health Information Protection Task Force

38. The Future of e-Health in Kentucky: Vision and Recommendations

39. Kentucky Electronic Health Network: State & Community Collaboration Cabinet for Health and Family Services Slide #39

40. Kentucky e-Health Action Plan • Foster Improvement in Quality of Care and Health Outcomes while Containing Health Care Costs • Facilitate Statewide Health Information Exchange • Foster Consumer Empowerment Through HIT and HIE • Foster Increased Use of Information Technology • Facilitate and Collaborate with Local HIE Efforts • Collaborate with Federal and Interstate eHealth Efforts • Link e-Health with Economic Development Efforts Cabinet for Health and Family Services Slide #40

41. Kentucky e-Health Action Plan – Immediate Recommendations • Perform statewide e-Health inventory, needs assessment and analysis of medical trading areas • Incentivize health IT adoption • Recognition program for e-Health innovators • Tools & assistance for practitioners looking at Health IT adoption • Build and support health information exchange efforts • Coordinate common interoperable infrastructure (master index, locator, data mapping) areas with HIE • Convene discussions in areas where no HIE exists • Coordinate e-Health efforts across state and local arenas • Continue work on KHIP, ePPIK grants, Privacy and Security Collaboration and seek additional funding Cabinet for Health and Family Services Slide #41

42. eHealth is one of the few policy options that canlower health care costs, increase quality of care, and improve the health of Kentuckians while also enhancing economic opportunity in the Commonwealth.

43. Trudi Matthews Senior Policy AdvisorCabinet for Health and Family Services502.564.7042trudi.matthews@ky.gov www.ehealth.ky.gov Questions?