EHR State of the Nation

1. EHR State of the Nation 2011 Louisiana HIPAA and EHR Conference Carol H. Steckel, MPH Director, Center for Health Care Innovation and Technology

2. 1 Center for Health care innovation and technology LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS

3. Areas of Responsibility Researches, develops and assists with implementation of new initiatives within the Department. Responsible for the coordination and development of legislative reports, policy papers and other public documents issued by the Department. Monitors and coordinates the Department’s efforts related to ACA and other changes in federal law Collaborates with program offices to ensure the maximization of resources and effective systems to collect and analyze data Monitors and directs the work being done to enhance the use of information technology in Louisiana’s health care community LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS

4. LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS

5. Health Information Technology • Use of technology to improve care is one of the four core business objectives of DHH • HIT makes it possible for health care providers to better manage patient care through secure use and sharing of health information • Louisiana’s HIT agenda • Louisiana Health Information Exchange (LaHIE) • Louisiana Health Information Technology (LHIT) Resource Center • Louisiana Medicaid EHR Incentive Program • Crescent City Beacon Community (CCBC) LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS

6. The Evolving HIT Context LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS

7. Big Picture EHR Incentives Meaningful Use Providers Regional Extension Center Hospitals Innovative Models (CCNs) LaHIE DHH Payment Reforms (Value-based purchasing) Beacon Public Health Payers ACOs Community College Consortium

8. 2 Medicaid EHR Incentive Program LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS

9. Louisiana EHR Incentive Program Financial incentives to . . . • Adopt (acquire and install) • Implement (commenced utilization, train staff, deploy tools, exchange data) • Upgrade (expand functionality or interoperability) Or… • Meaningfully Use (meet specified criteria) . . . a certified EHR System LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS

10. Health Information Technology for Economic and Clinical Health Act (HITECH) HITECH Legislation’s purpose: To improve outcomes, facilitate access, simplify care, and reduce costs of health care nationwide by providing: • Major financial support to provider and States; • Learning opportunities created and leverages through technical assistance from CMS and others; • Will establish sustainable data-driven infrastructure that will create a framework for improving healthcare quality and outcomes LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS

11. Accomplishments 1st state to have an approved I-APD. Went live on January 3rd, 2011 1st state to make an incentive payment to an FQHC. 4th State to make an incentive payment. Have paid out more than $70 million in incentives with minimal staff support and significantly under budget. LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS

12. Medicaid EHR Incentive program national implementation LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS

13. Payments Made LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS

14. Program Participation Report Data as of 10-06-2011 Confidential CMS Sensitive Information – Requires Special Handling LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS

15. Why adopt EHRs? LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS Studies have estimated that up to 100,000 avoidable medical errors, such as dispensing improper medication, mislabeling test results or misreading handwritten treatment instructions, occur each year. EHRs are a central component of any HIE because they help medical professionals share information about patients easily, and allow them to spend less time filling out paperwork and more time providing care. Prior to the ARRA program, only 38% of physician reported having an EHR and only 4% reported using a fully functional EHR. US is far behind other countries. Estimates of ambulatory EHR use in Austria, Belgium and Australia are 75%, 78% and 79-90% respectively while Denmark, England, Finland, the Netherlands and New Zealand have reported rates above 90%. Source: Health information technology in the United States: Where we stand, 2008. Robert Wood Johnson Foundation, 2008.

16. 2 Crescent city beacon diabetes intervention LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS

17. Crescent City Beacon Community

18. Do EHRs really improve patient care? Source: Cebul, R.D., Love, T.E., et al. (2011) Electronic Health Records and Quality of Diabetes Care, New England Journal of Medicine. Across all insurance types, EHR sites were associated with significantly higher achievement of care and outcome standards and greater improvement in diabetes care These findings support the premise that federal policies encouraging the meaningful use of EHRs may improve the quality of care across insurance types LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS

19. How does MU drive health analytics? Innovations in care delivery as specified in ACA also provide incentives for using information most easily obtained through EHR-based organizations Certified EHRs have QM built-in. LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS

20. PCP Chronic Condition Patient Measures for DM LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS

21. 3 National push for adoption LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS

22. LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS

23. Incentives and Outreach HITECH represents the Nation’s first substantial commitment of Federal resources to support the widespread adoption of EHRs. LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS

24. Electronic Health Records Reduce Paperwork • EHRs can reduce the amount of time providers spend doing paperwork. • Administrative tasks, such as filling out forms and processing billing requests, represent a significant percentage of health care costs. EHRs can increase practice efficiencies by streamlining these tasks, significantly decreasing costs. • In addition, EHRs can deliver more information in additional directions. EHRs can be programmed for easy or even automatic delivery of information that needs to be shared with public health agencies or for the purpose of quality measurement. • Electronic Health Records Reduce Duplication of Testing • Because EHRs contain all of a patient's health information in one place, it is less likely that providers will have to spend time ordering—and reviewing the results of—unnecessary or duplicate tests and medical procedures. Less utilization means fewer costs. LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS

25. Moving Forward • National Priorities focus on utilizing EHRs to accomplish HIE activities • E-Prescribing • Receipt of structured lab results • Sharing patient summaries across unaffiliated organizations LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS

26. Challenges • Promoting development of a nationwide Health IT infrastructure that allows for electronic use and exchange of information that: • Ensures secure and protected patient health information • Improves health care quality • Reduces health care costs • Informs medical decisions at the time/place of care • Includes meaningful public input in infrastructure development • Improves coordination of care and information among hospitals, labs, physicians, etc. • Improves public health activities and facilitates early identification/rapid response to public health emergencies • Facilitates health and clinical research • Promotes early detection, prevention, and management of chronic diseases • Promotes a more effective marketplace • Improves efforts to reduce health disparities • Providing leadership in the development, recognition, and implementation of standards and the certification of Health IT products; • Health IT policy coordination; • Strategic planning for Health IT adoption and health information exchange; and • Establishing governance for the Nationwide Health Information Network. LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS

27. A True National Coordinator? States face a tangled web of data reporting and sources. We can work together to simplify our shared tasks and mission.

28. 4 Questions? LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS