Technology, Members and Things That Start with the Letter “H”

1. Technology, Members and Things That Start with the Letter “H” Oklahoma Health Care Authority Board Retreat Midwest City, Oklahoma - August 25-27, 2010John Calabro, CIO

2. Key Definition • HEALTH INFORMATION INFRASTRUCTURE ADVISORY BOARD • The Authority shall operate as a hub for health information exchange between health related state agencies and other health information organizations. Information exchange shall be implemented through interagency agreements among all health related agencies. The agreement shall ensure, but shall not be limited to: • confidentiality of information • funding and implementation of the plan, which may include phased-in implementation, and procedures for coordinating, monitoring, and • improving data exchange that is compatible with current adopters of electronic medical record systems and health information technologies. • Oklahoma Health Care Authority • Oklahoma State Department of Health, • Oklahoma Department of Mental Health and Substance Abuse Services • Oklahoma Department of Human Services • Oklahoma State and Education Employees Group Insurance Board • Oklahoma Insurance Department • Oklahoma Department of Corrections • Oklahoma State Department of Rehabilitative Services • Oklahoma City-County Health Department • Tulsa-County Health Department

3. Key Definition Electronic Health Record (EHR) - An electronic record of health-related information on an individual that conforms to nationally recognized interoperability standards and that can be created, managed, and consulted by authorized clinicians and staff across more than one health care organization. EHR is associated with the ‘HIT’ initiatives.

4. Key Definition Health Information Exchange (HIE) is the actual electronic mobilization or movement of healthcare information across organizations within a region or community. HIE is the capability to move clinical information electronically between disparate healthcare information systems while maintaining the accuracy of the information being exchanged. Its goal is to facilitate access to and retrieval of clinical data to provide safer, more timely, efficient, effective, and patient-centered care. The term does not define the governance of the exchange model or the purpose of the information in the exchange.

5. Key Definition • HUB: The primary vehicles to accomplish the mission will be the application of web based technologies, data warehouse functions, personalized assistance centers, “agent partner” advocates and professional communications and marketing efforts. The website would be a resource available to all Oklahomans, not just those without insurance coverage. The HUB should also emphasize patient motivation through use of this website, and stress its importance as a means to drive down health care costs by patient involvement in chronic condition management, and improved compliance with provider recommendations. Similar results are also possible for primary and preventative care. • Establish a system of certification for insurance programs offered in this state to be recommended by the HUB • Establish a system for the credentialing of insurance producers who intend to market insurance programs certified by the state in accordance with this section • Establish a system of counseling, including a website, for those individuals who are without health insurance and are not covered by Medicaid, that includes but is not limited to: (a) educating consumers about insurance programs certified by the state in accordance with this section, (b) aiding consumers in choosing policies that cover medically necessary services for that consumer, and (c) educating consumers on how to utilize primary and preventative care in order to reduce the unnecessary utilization of services by the consumer • Establish a system whereby if an individual qualifies for a subsidy under the premium assistance program, established in Section 1010.1 of Title 56 of the Oklahoma Statutes, that person is able to become enrolled through the HUB in conjunction with local, qualified insurance producers.

6. H i i A B H A N H i T H i E H U B Health InformationInfrastructure Advisory Board Health Access Network Health Information Technology Health Information Exchange Health Insurance Exchange

7. MOST FAMOUS BASEBALL LINEUP BECAUSE NATURALLY WHY WHAT DON’T CARE TOMORROW WHO I DON’T KNOW TODAY

8. Technology Enablers Health Information Exchange Health Access Network Health Insurance Exchange “H” Health Information Technology

9. TECHNOLOGY BASEBALL LINEUP HAN

10. TECHNOLOGY BASEBALL LINEUP HIT HAN

11. TECHNOLOGY BASEBALL LINEUP HIT HAN HIE

12. TECHNOLOGY BASEBALL LINEUP HIT HAN HIE HUB

13. TECHNOLOGY BASEBALL LINEUP Affordable Care Act HIT HAN HIE HUB

14. TECHNOLOGY BASEBALL LINEUP Recovery Act Affordable Care Act HIT HAN HIE HUB

15. TECHNOLOGY BASEBALL LINEUP Recovery Act New MMIS Fiscal Agent Affordable Care Act HIT HAN HIE HUB

16. TECHNOLOGY BASEBALL LINEUP Recovery Act New MMIS Fiscal Agent Affordable Care Act HIT HIPAA 5010 HAN HIE HUB

17. TECHNOLOGY BASEBALL LINEUP Recovery Act New MMIS Fiscal Agent Affordable Care Act HIT HIPAA 5010 HAN HIE ICD - 10 HUB

18. HEALTH CARE INDUSTRY ROADBLOCK

19. TARGETS HAN CY 2010 ARRA MMIS HUB Planning CY 2011 CY 2012 CY 2013 CY 2014 Implement Implement Implement Implement HIT HIPAA ICD-10 CY 2015 ACA HIE Operations + Sustainability

20. Affordable Care Act CMS Medicaid EHR Incentive Program Health Information Exchange Loan Program ARRA Regional Extension Center Workforce Grants Broadband Grants ARRA Beacon Community Grant Meaningful Use TBD Oklahoma Health Care Authority (SoonerCare) Oklahoma Health Information Exchange Trust TBD Oklahoma Foundation for Medical Quality Several schools Office of State Finance et al The Community Council of Tulsa – GTHAN Oklahoma Health Care Authority + Oklahoma State Department of Health Who is on First? State Designated Entities.

21. Incremental Approach to HIE Implementation How to meet health information exchange when HIE organizations do not currently exist or do not connect all clinical trading partners in my town? CY 2015 should include required participation in statewide - nationwide HIE Require capability and data exchange where possible in CY 2011 Defer to OHIET the requirements and roadmap specific to Oklahoma Seek Federal approvals in CY 2010

22. OHIET Oklahoma HIT Coordinator Oklahoma Health Information Exchange Trust Supporting State Agencies Legal Taskforces and Workgroups Taskforces and Workgroups Taskforces and Workgroups Advisory Board Taskforces and Workgroups Taskforces and Workgroups

23. OHIET Advisory Board • Oklahoma Health Care Authority, • Oklahoma State Department of Health, • Oklahoma Department of Mental Health and Substance Abuse Services, • University of Oklahoma Health Sciences Center, • Oklahoma State University Center for Health Sciences, • A nominee of the Indian Health Service Office responsible for Oklahoma, • A representative of Tribal interests, • Oklahoma Hospital Association, • Oklahoma Osteopathic Association, • Oklahoma Pharmacy Association, • Oklahoma State Medical Association, • Oklahoma State Chamber of Commerce, • Oklahoma Association of Health Plans. • Security and privacy representative nominated by the OKHISPC, • A health information exchange representative as nominated by the Health Information Exchange workgroup, • A consumer appointed by the Governor, • A nominee of the Oklahoma Regional Extension Center steering committee (HITREC)

24. OHIET – Network of Networks • OHIET wants local health information exchanges to develop where feasible

25. OHIET – Network of Networks • OHIET wants local health information exchanges to develop where feasible • Common data standards will allow network-network data communications

26. OHIET – Network of Networks • OHIET wants local health information exchanges to develop where feasible • Common data standards will allow network-network data communications • Geographic gaps in coverage anywhere in Oklahoma will be OHIET facilitated

27. OHIET – Network of Networks • OHIET wants local health information exchanges to develop where feasible • Common data standards will allow network-network data communications • Geographic gaps in coverage anywhere in Oklahoma will be OHIET facilitated • Chain together local HIE into a statewide system across Oklahoma

28. OHIET – Network of Networks • OHIET wants local health information exchanges to develop where feasible • Common data standards will allow network-network data communications • Geographic gaps in coverage anywhere in Oklahoma will be OHIET facilitated • Chain together local HIE into a statewide system across Oklahoma • Link to federal programs [NHIN, VA, IHS, Medicare, TriCare, DoD, SSA, et al]

29. OHIET – Network of Networks • OHIET wants local health information exchanges to develop where feasible • Common data standards will allow network-network data communications • Geographic gaps in coverage anywhere in Oklahoma will be OHIET facilitated • Chain together local HIE into a statewide system across Oklahoma • Link to federal programs [NHIN, VA, IHS, Medicare, TriCare, DoD, SSA, et al] • Do state agencies need to have an HIE?

30. HEALTH INFORMATION EXCHANGE OF ELECTRONIC HEALTH RECORD DATA STATE Patient Pharmacy Hospital FEDERAL PROGRAMS Lab Regional HIE Insurance Provider

31. HEALTH INFORMATION EXCHANGE • eMPI finds a patient • RLS know the location of data • HIE retrieves the data • Lab information • Clinical case summary • ePrescribing INITIAL ONC PRIORITY

32. HEALTH INFORMATION EXCHANGE • eMPI finds a patient • RLS know the location of data • HIE retrieves the data • Lab information • Clinical case summary • ePrescribing • Medication history • Insurance coverage • Immunizations INITIAL ONC PRIORITY LATER

33. SoonerCare and HIE The OHCA ePrescribing strategy should merge into HIE approach No LAB results within OHCA SoonerCare has a need for clinical case summary from the HIE; OHCA has no clinical case summary data to contribute to HIE

34. SoonerCare and HIE The OHCA ePrescribing strategy should merge into HIE approach No LAB results within OHCA SoonerCare has a need for clinical case summary from the HIE; OHCA has no clinical case summary data to contribute to HIE OHCA does have medication history OHCA has real time insurance data OSDH has immunization data; OHCA has ‘some’ data to contribute to HIE

35. HIE Strategic and Operations Plan SoP being written Deadline for ONC submittal is August 31, 2010 OSDH + OHCA must sign the SoP Must get ONC prior approval of the SoP before any future funding

36. PATIENT-CENTRIC

37. Tangible Benefits Quantify and measure health care quality Give providers more reliable data helping to avoid medical errors and make better decisions Avoid redundant testing Lower consumer hassles Help reduce provider administrative burdens Engage consumers Minimize drug seeking behaviors Statewide detection of infectious disease Lead to value based on evidence Rural areas have access to data

38. Technology Must Have a Customer • Patients • Reduced hassles • Improved quality • Providers - Facilities • Practice Environment • Improved quality

39. Donated Talent • consumers • hospitals • medical associations • state agencies • medical schools • health plans • tribes • IHS • whole host of others

40. Oklahoma EHR Incentive Program State Medicaid HIT Plan formally sent to CMS/RO on July 28, 2010 SMHP already reviewed informally OHCA will execute a contract amendment with HP for fiscal agent services to pay the incentives An I-APD is being written which will authorize the federal draw OHCA aiming for January 2011 start Medicare aiming for May 2011

41. Oklahoma EHR Incentive Program PANELIST WILL GO THROUGH THE HIT PROGRAM DETAILS