Texas Approach to Supporting Statewide Health Information Exchange

1. Texas Approach to Supporting Statewide Health Information Exchange 2013 Crossroads Conference Healthcare Informatics in West Texas June 6, 2013

2. Presentation Overview • Background • Who, What, Why? • Texas Vision and Approach to Statewide HIE • Legislative Update • Resource Information

3. Who are we? • The Texas Health Services Authority (THSA) was created in 2007 by the Texas Legislature through House Bill 1066 • Public-private partnership, legally structured as a nonprofit corporation, to promote and coordinate the development of HIE in Texas • Governed by a 13-member Board of Directors appointed by the Governor with advice and consent of the Texas Senate

4. What are we doing and why? • Funding authority provided through the American Recovery and Reinvestment Act for planning and implementation grants to states to facilitate and expand HIE. • In March 2010, the Office of the National Coordinator (ONC) for HIT, US Department of Health and Human Services, awarded Texas $28.8 million over four years to plan and implement HIE in Texas. • Implementation of the Texas HIE Plan is being coordinated between the Texas Health and Human Services Commission and THSA.

5. What are we doing any why? Short-Term: Federal Funds • Develop and implement State HIE Plan in accordance with ONC grant award. • Support core HIE services to ensure hospitals and physicians can exchange clinical health data across secure networks to qualify for Medicare and Medicaid Electronic Health Record (EHR) incentive payments. • Ensure Texas providers and hospitals are eligible to receive billions in “meaningful use” incentive payments over the next decade.

6. What are we doing and why? • Meaningful Use Stage 2 focuses on actual use cases of electronic information exchange • Measure #1 requires that a provider send a summary of care record for more than 50% of transitions of care and referrals • Measure #2 requires that a provider electronically transmit a summary of care for more than 10% of transitions of care and referrals • Measure #3 requires at least one summary of care document sent electronically to recipient with different EHR vendor or to CMS test EHR

7. What are we doing any why? Long-Term: Quality, Safety, and Efficiency • Ensure providers have the right information at the right time. • Better care • Reduce duplicate tests • Avoid adverse drug interactions • Improve quality by increasing provider access to up-to-date clinical research and new clinical guidelines to use when making medical decisions • Increase patient access to health information and empower patients to better manage their personal care.

8. What is our Approach to Statewide HIE? GOAL Enable improvements in the quality and efficiency of the Texas health care sector by enabling HIE infrastructure for the state. OBJECTIVE Deliver private, secure, and reliable HIE services to all Texas patients and providers through local HIE networks where the capacity exists and through Health Information Service Providers (HISPs) where it does not. STRATEGIES • General State-Level Operations • Local HIE Grant Program • White Space Initiative

9. What are we doing to support local and regional HIE initiatives? • $19.5 million Local HIE Grant Program to support new or expanding HIE initiatives by partially funding planning, development, and operations of local HIE networks • Administered by HHSC with support from THSA • Funded 16 HIEs through this program; 12 moved into operations in 2012 • HIEs committed to connect 80-90% of all hospitals and physicians in Texas • Significant local accountability

10. Local HIE Servicer Area Interactive map available at: http://hietexas.org/local-hies/hie-service-areas-and-info

11. Local HIE Profile Sheets • Contact Information • Governance • Technical Model • HIE Services • Privacy and Security • Sustainability Approach • http://www.hietexas.org/local-hies/hie-service-areas-and-info

12. What should I do if I am interested in joining an HIE? • Determine which HIE or HIEs are covering your county. • http://hietexas.org/local-hies/hie-service-areas-and-info • Review the HIE profile sheet(s) to ensure you understand what services the HIE is offering, the technology model they are supporting, their approach to privacy and security, fees, etc. • Contact the HIE to learn how to sign up to participate. • Get involved with the HIE through its governance to help to ensure the HIE is meeting your needs and the needs of other providers in your community.

13. What are we doing to support providers not served by a Local HIE? • The THSA has qualified HISPs to support hospitals and physicians located in areas without a local HIE, or the Texas “White Space.” • HISPs provide secure email-based messaging solutions for the transport of clinical information between providers, including clinical summary exchange and electronic lab results. • HISP connectivity services enable subscribing providers to meet federal Meaningful Use requirements. • All HISPs are eligible to receive a subsidized payment on behalf of eligible Texas hospitals and physicians to reduce initial provider service costs.

14. Why is a THSA-qualified HISP a good HIE option? • Using a THSA-qualified HISP is a simple, efficient, secure, and low cost way to exchange patient information with other clinicians in compliance with HIPAA and federal Meaningful Use requirements. • SIMPLE– Enables exchange of patient information with other clinicians using secure e-mail. No new hardware – a computer with access to the Internet is all that is needed. • EFFICIENT- Pull the plug on your fax machine and send out referrals and consults via secure e-mail right from your computer. • SECURE- E-mail messages are secure and fully HIPAA-compliant, with all messages and attachments encrypted. • LOWCOST - The THSA is offering a subsidy in the form of a voucher to offset your initial costs ($400 per physician/$5,000 per hospitals). No long-term contract required.

15. How would a provider use a HISP? The diagram above depicts a primary care physician (PCP) making a referral to a specialist. The PCP could export a patient’s care summary from their EHR, attach it to a Direct message along with a referral order, and send it over to the specialist via the email-like HISP.  The specialist can then login to a Direct email account, open the message, download the care summary and referral, and import it into their EHR.  If the PCP or specialist does not have a compatible EHR, a PDF version of the summary and referral could also be attached and sent securely through a HISP.

16. What should I do if I am interested in using a THSA-qualified HISP? • Request a Voucher Number from THSA. • http://hietexas.org/white-space/voucher-requests • Select a THSA-qualified HISP. • Use the HISP you have selected to securely send clinical information to other providers.

17. Where can I find more information? • HISP Pricing and Profile Sheets • White Space Fact Sheet and Q&A • Voucher Request Process • Marketing Materials • All available at: www.hietexas.org/white-space/overview

18. What is general state-level operations? • Planning and Governance • Convene stakeholders and build consensus • State-Level Technical Services • Inter-HIE/HISP Connectivity • Gateway Services to eHealth Exchange and State-Level Data Sources • Consent Management • Sustainability • HIT Policy Development • Privacy and Security • Interoperability

19. THSA State-Level Shared Services (HIETexas)

20. HIETexas Services • Current • Local Participants • Local HIEs – Grant program awardees • Other Authorized HIEs with the State • eHealth Exchange Participants (e.g., other state HIEs, VA, DoD, and SSA) • Medication History – Data source for HIEs in Texas • Future • State Data Sources (e.g., Medicaid, Immunization Registry, Cancer Registry, and Prescription Access in Texas)

21. HIETexas Services • Security • Federated Trust • Authentication, Access • Security, Confidentiality, Accuracy • Patient Consent Management • Service to query HIETexas for all available consent documents for a patient from all other participants • Clinical Document Exchange (Treatment) • Service to query HIETexas for all available clinical documents for a patient from all other participants • eHealth Exchange Connectivity • Medication History

22. HIETexas – Key Principles • THSA follows an open, transparent, and inclusive process • Patient privacy, security, and preferences are foundational • No protected health information data will be made available, stored, or accessible to HIETexas or InterSystems • We will align with applicable national (open) standards • Our systems will be designed to scale and be responsive • We are risk adverse

23. Legislative Update – Health Information Exchange • SB 1643 (Williams, 83R) relates to the monitoring of prescriptions for certain controlled substances; and also provides a penalty. • An amendment was added to SB 1643 that includes HIE-related issues: • Defines “Health Information Exchange” • Allows health care providers to access information in the Prescription Drug Monitoring Program through an HIE • SB 1367 (Duncan, 83R) relates to abolishing the Texas Health Insurance Pool • Redirects $5 Million of prompt-pay penalties to the THSA

24. Legislative Update - Privacy • Two bills passed this session relating to medical privacy • SB 1609 (Schwertner, 83R) • SB 1610 (Schwertner, 83R) • SB 1609 amends the Texas covered entity training provision implemented by HB 300 (Nelson, 82R) last session. • Clarifies context of training; extends time for completion of training to 90 days, and again within one year of material change in law; and limits time to retain of proof of training to 6 years • SB 1610 amends the “breach notification” provision implemented by HB 300 (Nelson, 82R) last session. • Clarifies which law must be followed when the individual affected by breach resides in another state; and allows written notice to be given at the last known address of the individual

25. Where can I read more? • www.hietexas.org - THSA/Statewide HIE Website • State HIE Plan • Local HIE Grant Program RFA, HIE Profiles, and Approved Business and Operational Plans • White Space Program Background, Marketing Materials, FAQ, and RFQ • THSA Annual Report to Governor and Texas Legislature • Privacy and Security White Papers • Links to other reports and other helpful sites

27. Tony Gilman Chief Executive Officer Texas Health Services Authority (512) 814-0321 tony.gilman@thsa.org www.HIETexas.org Follow THSA on Twitter @HIETexas