Lisa K. Rawlins, Bureau Chief Florida Center for Health Information and Policy Analysis

1. Integrating the Florida Health Information Network with Florida’s Regional Health Information Organizations Presentation to the House Committee on Health Quality January 9, 2007 Lisa K. Rawlins, Bureau Chief Florida Center for Health Information and Policy Analysis Agency for Health Care Administration

2. The Florida Health Information Network is the Result of: • Health policy decisions in the Florida Legislature and Governor’s Office endorsing the Florida Health Information Network • Funding from the Legislature for grants to Regional Health Information Organizations • Leadership from the Governor’s Health Information Infrastructure Advisory Board

3. Health Policy Background to the Florida Health Information Network and the FHIN Grants Program

4. Select Committee on Affordable Health Care for Floridians, January 2004 • Proposed promoting “compatible information technology that permits secure, private information sharing throughout health care” and the “use of technology to create a single medical record that belongs to the patient and families”

5. Executive Order Initiates the Florida Health Information Network • Florida’s Governor Jeb Bush signed Executive Order Number 04-93 on May 4, 2004 addressing the need for state leadership in the area of health information technology infrastructure development

6. Health Information Networks Included as an Innovative Idea • Idea 85 of Speaker Rubio’s 100 Innovative Ideas addresses health information exchange • “Improve patient care through technology by expanding electronic health records and regional health information networks.”

7. The Governor’s Health Information Infrastructure Advisory Board • Advisory Board formed to create “a plan to promote the development and implementation of a Florida health information infrastructure” • The Board’s 2005 Interim Report of the GHIIAB called for the creation of the Florida Health Information Network

8. Strategy for the Florida Health Information Network • Develop a network to enable the sharing of meaningful electronic patient data • Promote the exchange of electronic patient data on the network by: • Driving the adoption of electronic medical records systems by individual providers and • Developing regional health information organizations

9. Building the Florida Health Information Network

10. Definition of the Florida Health Information Network • The Florida Health Information Network is the statewide network that will integrate the Regional Health Information Networks to enable statewide health information exchange

11. Geography of the FHIN Florida’s Health Information Networks 1. Big Bend RHIO 2. Central Florida RHIO 3. Community Health Information Organization 4. Escambia HIN 5. Jacksonville Health Information Network 6. Palm Beach County Community Health Alliance 7. Pinellas RHIO 8. Space Coast Health Information Network 9. South Florida HII 10. Tampa Bay RHIO

12. The Florida Health Information Network Begins at the Local Level • The Florida Health Information Network is being built from the local community up • An essential element of the strategic plan is to empower local stakeholder collaborations focused on health information exchange • The drivers of this plan are the Grants Program and Regional Health Information Organizations in the local community

13. Legislation Passed in 2006 Authorizes a Health Information Network • House Bill 7073 amended§ 408.05 (4)(a) 9, F.S. to address a statewide health information network, directing the Florida Center to: • Monitor innovations in health information technology, informatics, and the exchange of health information and maintain a repository of technical resources to support the development of a health information network.

14. Legislation Passed in 2006 Authorizes Integration of Health Care Datasets • House Bill 7073 also directed AHCA to: • … initiate, oversee, manage, and evaluate the integration of health care data from each state agency that collects, stores, and reports on health care issues and make that data available to any health care practitioner through a state health information network.(§ 408.05 (4)(c), F.S.)

15. Specifying the Network Architecture through a White Paper • The Florida Health Information Network White Paper was written to address: • The technical architecture of the FHIN • The requirements of interoperability among the RHIOs and the FHIN • The needed security precautions to ensure confidentiality of data exchange in the FHIN • For a copy of the White Paper, visit: • http://ahca.myflorida.com/dhit/FHIN_White_Paper.shtml

16. Architecture of Florida Health Information Network Medicaid Florida Center DOH SHOTsVital Statistics Certification of Physicians with DOH Licensing Database

17. Developing Florida Regional Health Information Organizations through the Grants Program

18. 2006 Legislation Authorizes the Grants Program • House Bill 7073 amended § 408.05 (4)(b), F.S., directing the Agency to: • … administer, manage, and monitor grants to not-for-profit organizations, regional health information organizations, public health departments, or state agencies that submit proposals for planning, implementation, or training projects to advance the development of a health information network.

19. What is a Regional Health Information Organization?

20. Grants Program to Develop Regional Health Information Organizations • Planning Grants: Support engaging local health care stakeholders to develop a strategic plan for health information exchange • Implementation Grants: Support projects that demonstrate health information exchange among two or more competing providers • Training Grants: Support practitioner training designed to increase physician and dentist use of electronic health record systems

21. Grants Program, FY 2005-2006 • The Agency awarded nine grants with $1.5 million in appropriation from the Legislature • Five Planning Grants • Three Implementation Grants • One Training Grant

22. Grants Program, FY 2006-2007 • The Agency awarded seven grants with a $2 million appropriation from the Legislature • Big Bend Regional Health Information Organization • Tampa Bay Regional Health Information Organization • Palm Beach County Community Health Alliance • South Florida Health Information Infrastructure • Escambia Health Information Network • JaxCare, Inc. • Community Health Information Organization

23. An Example of a Florida Regional Health Information Organization:Big Bend RHIOTallahassee, Florida

24. Region Served by the Big Bend RHIO Tallahassee

25. Big Bend RHIO is Anchored in the Community • Board members represent local providers • Most clinical Board members have sophisticated Electronic Medical Record systems in use • FSU College of Medicine, Tallahassee Community College included on Board • Capital Health Plan covers 37% of patients • Optical Fiber medical area network (pMAN), currently providing connectivity

26. Big Bend RHIO RHIN Architecture VPN Small organizations can connect either directly to the RHIN or through a VPN gateway Organizations can connect bi-directly to feed their data and receive data directly into their EMR In the early Phases CHP, CRMC & TMH will provide a one way feed of their data. They have the largest repositories and the priority is to make their data available ASAP

27. Health Information Exchange Services • Big Bend RHIO will establish a community repository for the storage and retrieval of: • Demographic/encounter data • Medication claims data and e-prescribing • Document viewer including lab/radiology • Secure messaging • Disaster recovery • Remote data backup outside service area

28. Future of the Grants Program • Leverage the development of more Regional Health Information Organizations in Florida to create the base for health information exchange • Develop the Florida Health Information Network by interconnecting local health information networks

29. Next Steps for the Florida Health Information Network • Establish a statutory entity, the Florida Health Information Network Corporation to implement the state level network • As a not-for-profit organization, the Florida Health Information Network Corporation would be accountable to the public and responsive to health care providers

30. The Florida Health Information Network Corporation will: • Specify standards to ensure interconnectivity and maintain security • Develop uniform policies regarding confidentiality of patient records and patient authorization • As a public-private partnership, will develop the critical mass of information resources to achieve a sustainable statewide system of regional networks

31. The Future of the Florida Health Information Network • The Florida Health Information Network vision will integrate clinical health information exchange in Florida through a network architecture that will empower physicians to access timely and accurate medical records in order to deliver high quality medical care for their patients.

32. Lisa K. Rawlins, Bureau Chief Agency for Health Care Administration Florida Center for Health Information and Policy Analysis 2727 Mahan Drive Tallahassee, FL 32309 rawlinsl@ahca.myflorida.com