Electronic Health Records and Health Information Exchange: Implications for Rural Hospitals

1. Rick Snyder Vice President, Finance & Information Services Oklahoma Hospital Association Brian Yeaman, MD Director, Physician Informatics Norman Regional Health System Greater Oklahoma City Hospital Council Electronic Health Records and Health Information Exchange:Implications for Rural Hospitals

2. American Recovery and Reinvestment Act of 2009 (ARRA) • Incentive payments for meaningful use of certified Electronic Health Records • Hospitals and Eligible Professionals • Medicare incentives • Medicaid incentives

3. Hospital Incentive Payments • Qualify as early as Oct 1, 2010 • Range for OK PPS: ~$2 million - $8 million • Median: $3.7 million • State potential: $311 million • Qualifying after FFY 2013 reduces amount • CAH: Medicare share of capital + 20% • FFY 2015: Incentives end; penalties begin

4. Hospital Incentive PaymentsMedicaid • Requires: 10% Medicaid inpatient volume • CAHs can qualify – not based on costs • $500,000 to $1,200,000 • $108 million potential for OK hospitals • State has some discretion in design

5. Eligible Professionals Medicare incentives capped at $44,000 (plus 10% in HPSAs) OR Medicaid incentives capped at $63,750 (if 30% of practice is Medicaid (Peds: 20%)) Paid over 5 years beginning Jan. 2011 Penalties for non-adoption begin Jan. 2015 Hospital-based professionals ineligible

6. EHR Adoption Rates • 2008 RWJF study of 2,952 hospitals • Comprehensive EHR:1.5% of US hospitals • Basic EHR (physician, nursing notes): 7.6% • Rural hospitals: • 0.6% comprehensive EHR • 4.0% basic EHR

7. OHA members tell us:

8. OHA members tell us:Potential obstacles to your hospital adopting EHR: • Insufficient IT staff • Incentive payments will likely not cover EHR costs • Medical Staff is not supportive • Cannot find a suitable EHR

9. OHA members tell us: OHA can help most by… • Providing education on incentives • Providing education on EHRs • Offering a “group deal” • Helping arrange financing • Helping select EHR

10. EHR Certification • Certification Commission for Health Information Technology (CCHIT) • CCHIT Certified • Preliminary ARRA certification • Site certification • HHS Health IT Policy Committee recommendation • Allow multiple Certification organizations • Accreditation process for certifying organizations • HHS will propose rules

11. “Meaningful Use” • HIT Policy Committee • HIT Standards Committee • Public input • Policy Committee’s August 19 matrix • Proposed rule due by December 31 • 60 day comment period • Final rule: middle or end of spring 2010

12. NE Oklahoma origins • Oklahoma City exchange • Projects around the state • Attractive pricing for hospitals and their physicians

13. Regional Extension Centers – ARRA Section 3012 • National: HIT Research Center • Develop or recognize best practices to support and accelerate efforts to: • Adopt, implement, and effectively utilize HIT for • Electronic exchange and • Use of information • Regional Extension Centers • Provide technical Assistance • Disseminate best practices and other information • Support and accelerate efforts to adopt, implement, and utilize HIT

15. Regional Extension Centers • ARRA law: • Hospitals (public, NFP, CAH) • Federally Qualified Health Centers • Entities serving uninsured, medically underserved • Individual and small group practices in primary care • Funding opportunity: • Primary care providers in small group practices, public hospitals & CAHs, CHCs and RHCs, other settings for the uninsured/medically underserved

16. Regional Extension Centers • OFMQ selected by stakeholders • Three waves of funding • $6.5 million potential for Oklahoma • Substantial matching required in years 3 and 4

17. State Loan Program • 5:1 federal match for loans to providers • Administered through Medicaid agencies • OHCA will apply; has requested state match in SFY 2011 budget • Projected availability: October 2010

18. SHIECAP • State Health Information Exchange Cooperative Agreement Program • Planning and Implementation grants • State funding required • 2011 1/10 • 2012 1/7 • 2013 1/3

19. SHIECAP

20. SHIECAP: Oklahoma Health Information Exchange • “Network of networks” • Planning phase beginning Jan. 2010 • TBD: Governance, financing, … • ONC approval of State plan required before implementation is funded • OHA participating in planning; volunteers?

21. OHA Trade Show – HIT vendors • Spectron Corp – McKesson products & more – booth 320 • CPSI – booth 800 • Phoenix Health Systems – booth 111 • Meditech, CPSI, others, including MedSphere OpenVista

22. Resources • http://healthit.ahrq.gov/RuralHITtoolbox • http://www.cchit.org/ • http://www.okoha.com/ARRA