Federal Perspective on Behavioral Health Information Technology

1. Federal Perspective on Behavioral Health Information Technology Strategic Planning for Providers October 23, 2009

2. President’s Vision for Health IT • Medical information will follow consumers so that they are at the center of their own care • Consumers will be able to choose physicians and hospitals based on clinical performance results made available to them • Clinicians will have a patient's complete medical history, computerized ordering systems, and electronic reminders • Quality initiatives will measure performance and drive quality-based competition in the industry • Public health and bioterrorism surveillance will be seamlessly integrated into care • Clinical research will be accelerated and post-marketing surveillance will be expanded.

3. “Health Information Technology for Economic and Clinical Health Act” (“HITECH Act”) • The American Recovery and Reinvestment Act of 2009 (Pub. L. 111-5) (ARRA) includes provisions to promote the adoption of interoperable health information technology to promote meaningful use of health information technology to improve the quality and value of American health care. These provisions are set forth in Title XIII of Division A and Title IV of Division B.

4. The American Recovery and Reinvestment Act of 2009 • The ARRA appropriates a total of $2 billion in discretionary funding, in addition to incentive payments under the Medicare and Medicaid programs for providers' adoption and meaningful use of certified electronic health record technology.

5. Key ONC Programs, Distribution and Recipients for the HITECH ACT

6. Estimated Timelines of Key HITECH ACT Activities 2009 2010 2011 2015 2016 • Feb 17, 2009 • Passage of ARRA • Policy & Standards Committee Appointments • Publish Update Federal HIT Plan • RFP for State Grants, HIE’s & Other • Dec 31, 2009 • Secretary shall adopt an initial set of standards, implementation specifications and certification criteria through rulemaking processes • Award competitive grants to States & State Loan Programs • HHS supports adoption of technical privacy, governance & financing frameworks for HIE • Health IT regional extension centers funded • Award Workforce Training Grants • Award New Technology R & D Grants • Medicare Incentive payments for Hospitals & Professionals begin • “Meaningful Use” requirement in effect • Penalties for failing to adopt and effectively use HIT begin • Medicare and Medicaid payment incentives end.

7. Regional Centers Will Help Implement EHR • The major focus for the Centers' work with most of the providers that they serve will be to help to select and successfully implement certified electronic health records (EHRs). • 700 million for Regional Center program Federal Register: May 28, 2009 (Volume 74, Number 101)] [Notices] [Page 25550-25552]

8. ONC’s Goals for the Regional Centers • Encourage adoption of electronic health records by clinicians and hospitals; • Assist clinicians and hospitals to become meaningful users of electronic health records; and • Increase the probability that adopters of electronic health record systems will become meaningful users of the technology.

9. Regional Center Funding • ONC proposes using ARRA funding for two-year awards made in FY2010. • ONC anticipate an average award value on the order of $1 million to $2 million per center. The maximum award to any one regional center is $10 million. • Funding may also be approximately allocated to the regional centers in relative proportion to the numbers of prioritized direct assistance recipients identified in the HITECH Act.

10. Office of the National Coordinator for Health Information Technology Initial Performance Measures • Increase physician adoption of EHRs • Increase the percentage of small practices with EHRs • Percent of physician offices adopting ambulatory EHRs in the past 12 months that meet certification criteria http://www.hhs.gov/recovery/reports/plans/onc_hit.pdf

11. BackgroundSAMHSA HIT Efforts • Extensive participation in the development of the HL7 Electronic Health Record Functional Model through to its adoption as an American National Standards Institute (ANSI) standard. • Health Level Seven develops specifications, the most widely used being a messaging standard that enables disparate healthcare applications to exchange keys sets of clinical and administrative data. • Soliciting more than 130 Behavioral Health stakeholders to participate in and leading the development of the Behavioral Health EHR HL7 Profile and adoption as an ANSI national standard in December, 2008. • Participation in the HITSP since its inception. The Healthcare Information Technology Standards Panel (HITSP) is a cooperative partnership between the public and private sectors. The Panel was formed for the purpose of harmonizing and integrating standards that will meet clinical and business needs for sharing information among organizations and systems.

12. BackgroundSAMHSA HIT Efforts (cont’d) • SAMHSA’s main standards focus has been to promoted develop privacy protection standards that will work for behavioral health, modeled on 42 CFR part 2. • Also developing strategy to use personal health records (PHRs) as a Health Information (HIE) as best way to give clients maximum control over who can use their information

13. BackgroundSAMHSA HIT Efforts (cont’d) • Directing the development of a data concordance spanning state Medicaid, Mental Health, and Substance Abuse Treatment state agency data systems to gauge states’ readiness to adopt interoperable, state-wide EHRs. • Sponsoring the National Association of State Mental Health Program Directors survey of state agency EHR adoption efforts.

14. MH Specialty Providers • MH specialty providers are an important part of the public safety net – approximately 2000 organizations serve nearly 3 million persons annually • Number one funder is Medicaid – therefore must conform to Medicaid data/billing requirements • Only about a third of these providers have some form of EHR, which may or may not meet federal certification standards

15. State Involvement in SUD related EHR • Since 2000, 18 States and counties have collaborated in the development & deployment of Web-based, electronic Behavioral health record systems (EBHRs), mostly for specialty SUD treatment providers. SAMHSA offered TA until 2004. These jurisdictions continued to host their own systems without SAMHSA help.

16. EBHRs Policy Goals • Improve service quality and cost effectiveness via real time monitoring of utilization patterns, treatment process, and client outcomes, jurisdiction wide • Standardization of clinical records so one provider can understand another provider’s records, across entire States and counties • Minimize investment & operating costs

17. EBHRs Policy Goals Cont… • Coordination of care among specialty substance abuse providers and, increasingly, between specialty substance abuse and mental health providers, following 42 CFR Part 2 privacy protections • Coordination of services with criminal justice. • Collaboration among States and counties to maximize re-use and minimize re-invention of system software.

18. SAMHSA HIT Goals • With States and counties, develop & certify the new open source, Reference Ebhrs Model (REM) • All interested States, counties, and Tribes re-use and deploy REM • With States, develop open source SIBS services • All interested States re-use and deploy SIBS services • Increase in the number behavioral health treatment providers trained to use EBHRs.

19. CMBHS

20. Texas’ New EBHRs

21. Relationship of SAMHSA’s Activities to the HITECH Act • Try to automate as many BH treatment providers as possible & connect them to the NHIN (currently without significant HITECH support) • Pioneer “meaningful use” outcome measures generated via state-hosted Safety-net Information Banking Systems (SIBS) NHIN-Nationwide Health Information Network

22. SAMHSA Health IT Initiative (Dollars in Millions)

23. Timeline Sensitivity • Increases HIT TA to States that re-starts at 3.2M in ’09, $3.5 in ‘10 • Continue development of open source EBHRs as fully integrated clinical services for safety net MH and SA • TA for jurisdictions that currently reuse open source, to upgrade to new Reference Electronic Behavioral Health Record system Model

24. Disadvantages of Not Adopting EBHRs • Safety net Behavioral Health (BH) falls behind rest of health care in coordination of care and documentation of treatment outcomes • Safety net BH cannot improve case management and quality improvement process based on objective outcome measures. • Safety net BH cannot justify greater public spending for treatment based on measured ‘cost offsets’ (e.g. less crime & fewer inmates) • Continued long delays in Medicaid or Medicare reimbursement

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