Presented by: Rebecca Novak Healthcare Perspective, LLC

1. Accelerating Reform InitiativeFebruary 2010 Learning SessionCritical Factors Influencing Implementation: Information Systems Presented by: Rebecca Novak Healthcare Perspective, LLC

2. Agenda • Understanding Current Initiatives related to Healthcare Information Systems • Setting the Stage for Health Care Reform is Already Underway • ARRA/HITECH • Meaningful Use – What Does it Mean? • Health Information Exchange • Other Federal Initiatives • HIPAA 5010 • ICD-10 • Steps to Survival

3. ARRA/HITECH • ARRA – American Resources for Recovery Act • This is the stimulus package that was passed in February 2009. • Set aside $19.2 Billion Dollars for Health Care IT • Infrastructure Grants – another $7-$8 Billion. • Reimbursement Incentives - $17 Billion • HITECH Section - Health Information Technology for Economic and Clinical Health Act includes: • Meaningful Use – Reimbursement Enhancement • Health Information Exchange • Health Information Technology Exchanges • New Privacy and Security Provisions

4. Major Goals and Objectives for Healthcare IT • Goals: • Increase national adoption of Health IT • Assure systems are interoperable, improve quality and improve care coordination • Tactics: • Government to lead and promulgate standards development • Over $19 Billion for HIT Infrastructure • Significant savings of Federal dollars long term • Updates and strengthens HIPAA regulations.

5. ARRA/HITECH Provisions • Codifies Office of the National Coordinator (ONC) • Creates an HIT Policy Committee • Creates an HIT Standards Committee • Introduces new Privacy and Security standards • Creates $17 Billion dollars in Medicare and Medicaid incentives • Focus of funds is on Meaningful Use adoption • No upfront funds – based on use of certified products • Requirements increase over time and money follows

6. Components of ARRA/HITECH • Medicare/Medicaid incentive begin as early as 2011 and can flow as late as 2016 • Early adoption is incentivized by payments • Late adoption is discouraged by: • Reduction incentive payments • Eventually (2016) by penalties • Medicaid payments are based on minimum volumes and will flow through the States • Payments require important conditions based on “Meaningful Use” and “Certified EHR Products”

7. Components of ARRA/HITECH • Privacy and Security • HIPAA applies to business associates same as to covered entities (CE) • Covered entity must notify individuals within 60 days if breach occurs and if affects > 500 – then both HHS and Media must be notified • Patients have right to accounting of disclosures • New CE – PHR (Personal Health Record) Vendors and HIE (Health Information Exchange) Vendors • Introduces “minimum necessary” data sets for uses and disclosures. • Suggestion: Make sure Privacy Officers are aware of these changes. • http://www.himss.org/ASP/topics_privacy.asp

8. Message from ONC

9. Interoperability through HIE and CCD

11. CCD Contents

12. CCD - Human Readable Format

13. CCD - Machine Readable Format

14. EMR Adoption Rates

15. HITECH Priority Grants • State Health Information Exchange Grant Programs • Grants are being issues early in 2010 to begin development of Local and State HIEs • CMS is requiring state Medicaid agencies to participate • Focus initially on electronic labs and eprescribing • Focus eventually on full EHR interoperability • Must address needs of special populations…including…those with mental and substance abuse disorders…medically underserved… • Build trust in and support for a statewide HIE • http://www.hhs.gov/recovery/programs/hitech/stateinfoexch.html

16. HITECH Priority Grants • Health Information Technology Extension Program • Offer technical assistance, guidance and information on best practices to support and accelerate health care provider’s efforts to become meaningful users of EHRs • Established at least 70 regional centers that will offer technical assistance. • HITECH acts clearly prioritizes access to health information technology for historically underserved and other special-needs programs. • Regional centers will focus…community health centers and in other settings that predominantly serve uninsured, underinsured and medically underserved populations. • Full operations by December 2010. • http://www.hhs.gov/recovery/programs/hitech/factsheet.html

17. ARRA/HITECH Quick Notes • Meaningful Use • Still being defined but generally understood • Electronic lab data • Electronic prescribing • Electronic order entry by clinicians (CPOE) • Increasing standards between 2011 and 2015 • Health Information Exchange • Electronic exchange of clinical data • Appears to be following HL-7 CCD/CCR • Clinical Care Document/Continuity of Care Record • State driven process with linkage to NHIN (National Health Information Network) • Fully operational by 2015

18. ARRA HIT Incentive Stages

19. Other Federal Initiatives • HIPAA 5010 and ICD-10 • Final Rule issued January 2009 • Convert from HIPAA Version 4010 to 5010 by January 1, 2012 • Convert from ICD-9 to IDC-10 by October 1, 2013

20. Other Federal Initiatives • HIPAA 5010 and ICD-10 • Final Rule issued January 2009 • Convert from HIPAA Version 4010 to 5010 by January 1, 2012 • Convert from ICD-9 to IDC-10 by October 1, 2013

21. 5010 and IDC-10 • 5010 • Major changes to 837 (claims), 835 (remittance), 270/271 (eligibility) and other HIPAA transactions • Required for ICD-10 • Major testing efforts between providers and payers • ICD-10 • Coding involves more specificity, more codes, more complexity • Core billing systems will need to change • All interfaces that include diagnosis will need to change and be tested

24. Steps to Survival • Fully Implement EHR at your Agency • Must first digitize the core EMR at your agency • Clinical Care, Assessments and Clinical Orders • Implement e-Prescribing as soon as possible (2011) • Important first step towards meaningful use criteria • Implement the CCD/CCR as soon as possible (2011) • Look for opportunities for grants • Look for HIEs in your area – pay attention • Look to state and especially Medicaid for information • Talk your vendors • New releases and technology will most likely be needed to meet the requirements for Meaningful Use • Begin preparing individuals providing services – timeliness of documentation is key……

25. Strategies • Strategic Synergy • Focus and Defer • Manage Through • Outsource

30. Industry Resources • Department of Health and Human Resources • NIATx • National Council for Behavioral Health (NCCBH) • Bazelon Center • Healthcare Information and Management Systems Society (HIMSS)

31. Final Comments & Questions