Health Information Technology Oversight Council

1. Health InformationTechnology Oversight Council Greg Fraser MD MBI HIMSS Oregon Chapter Annual Conference January 28, 2010

2. Change is Upon Us(These Aren’t Your Ordinary Waves)HB 2009Federal Health ReformARRA HITECH

3. HB 2009 The HITOC duties set forth in HB 2009 include: Set Goals and Develop Strategic HIT Plan Coordinate and Leverage Existing Resources Adopt Standards for a Purchasing Collaborative for Electronic Health Records (EHR) Educate Public and Providers of Health Care Support and Oversee Health Records Bank Develop Reimbursement Program for EHR use and HIT Loan Program The HITOC components of HB 2009 were written before the ARRA legislation, yet the duties and goals are remarkably in sync with the federal initiatives. HITOC is building on the work of the Health Information Security and Privacy Collaborative and the Health Information Infrastructure Advisory Committee. Oregon is well positioned to be a leader in HIE.The HITOC components of HB 2009 were written before the ARRA legislation, yet the duties and goals are remarkably in sync with the federal initiatives. HITOC is building on the work of the Health Information Security and Privacy Collaborative and the Health Information Infrastructure Advisory Committee. Oregon is well positioned to be a leader in HIE.

4. HITOC to Coordinate State HIT Plan State HIT Plan Integration of the myriad efforts is going to be essential. The HITOC is beginning to work with private sector initiatives that will be critical to the success of HIE, such as the REC for developing technical assistance supports for providers, the Broadband expansion through Oregon Health Network and the FCC grants, and the workforce development initiatives being led in Oregon by OHSU and Portland Community College, in collaboration with other educational facilities. While we shouldn’t expect massive overnight changes, the opportunities for coordination and integration of systems to provide better services to the People of Oregon should be a critical focus of our planning processes. HIT and HIE are tools to advance health reform initiatives.Integration of the myriad efforts is going to be essential. The HITOC is beginning to work with private sector initiatives that will be critical to the success of HIE, such as the REC for developing technical assistance supports for providers, the Broadband expansion through Oregon Health Network and the FCC grants, and the workforce development initiatives being led in Oregon by OHSU and Portland Community College, in collaboration with other educational facilities. While we shouldn’t expect massive overnight changes, the opportunities for coordination and integration of systems to provide better services to the People of Oregon should be a critical focus of our planning processes. HIT and HIE are tools to advance health reform initiatives.

5. ARRA HITECH Changes the Game Key funding opportunities for Oregon include: State Health Information Exchange (HIE) Cooperative Agreement Program ($8.58 million over 4 years) Medicaid and Medicare Incentives for Providers using Electronic Health Records ($44,000 for individual providers; approximately $236 million to Oregon hospitals) Medicaid Incentive Program Planning Funds (90/10 federal matching funds) for Medicaid HIT Planning activities to establish the incentive program described above. Health Information Technology Extension Program (technical assistance to support and accelerate EHR and HIE) OCHIN, Inc. is the Oregon REC applicant. Other federal funding to non-state entities: HIT workforce development, community HIT infrastructure and exchange initiatives, research to achieve breakthrough strategies on HIT adoption barriers, and HIT implementation funding for Tribes and health center networks. Nearly $50 billion dollars has been appropriated by Congress for the advancement of health information exchange. This money, along with the standards of meaningful use of HIE and the requirements of the ONC and CMS, is changing the value propositions for various health care stakeholders, will level the playing field for many communities, small providers and hospitals, and will essentially be fuel to drive the advancement of an emerging field. Will it be enough? Not by itself.Nearly $50 billion dollars has been appropriated by Congress for the advancement of health information exchange. This money, along with the standards of meaningful use of HIE and the requirements of the ONC and CMS, is changing the value propositions for various health care stakeholders, will level the playing field for many communities, small providers and hospitals, and will essentially be fuel to drive the advancement of an emerging field. Will it be enough? Not by itself.

6. State HIE Plan: Landscape Local HIE and Health Systems Efforts: 6 operational or soon-to-be operational local HIEs 8 additional HIE efforts in planning stages 8 health systems connecting hospitals and affiliated clinics Gaps: Geographic areas with no local HIEs Small/rural providers Local public health departments State and county correction departments Tribal health clinics Critical access hospitals

7. Regional Coverage / Oregon HIE Oregon Health Information Technology Environment Assessment, 2009 Health Information Exchange (HIE) Activities Inventory www.oregon.gov/OHPPR/HITOC/docs/OregonHIE_Activities_103009P.pdf Oregon Health Information Technology Environment Assessment, 2009 Health Information Exchange (HIE) Activities Inventory www.oregon.gov/OHPPR/HITOC/docs/OregonHIE_Activities_103009P.pdf

8. State HIE Plan: HITOC Progress Working model for governance of HIE adopted by HITOC: Oregon HIE (ORHIE) to be a public/private partnership, non-profit Strategic planning workgroup named to develop recommendations on: Governance Technology Infrastructure Business and Technical Operations Finance Legal and Policy Stakeholder input Monthly webinars and e-newsletters Stakeholder surveys as needed Target submission date for Strategic and Operational Plans: July 15, 2010 Requires extensive coordination Other ARRA funded efforts, Internal and external health information databases and networks

9. Opportunities Health IT is a key part of the infrastructure that will support broad health reform goals Oregon can leverage regional investments to achieve statewide health information exchange Oregon has an unprecedented chance to begin alignment and coordination of state human services through information technology HIT and HIE are tools with multiple uses for improving quality, patient safety, overall patient care; monitoring and better preparing for public health needs, fewer duplicate tests and improved efficiency, and more informed health consumers. HIT and HIE are tools with multiple uses for improving quality, patient safety, overall patient care; monitoring and better preparing for public health needs, fewer duplicate tests and improved efficiency, and more informed health consumers.

10. Opportunities (continued) If designed properly, the exchange of health information in Oregon could lead to enormous benefits: Cost savings up to $1.3 billion a year Improved quality and coordination of care Increased patient safety, reduced medical errors Greater population health Data to support world class health care delivery system reforms and ongoing improvements Accountability Comes With Data HIT/HIE as a Tool for Health Reform Continuity of Care Between Providers Continuity of Care Between Providers and Patients Improved Quality Improved Safety Lower Costs Potential Impact of Widespread Adoption of Advanced Health Information Technologies on Oregon Health Expenditures, by David M. Witter, Jr. and Thomas Ricciardi, PhD, prepared for OHPR and Quality Corporation, September 2007. The projected overall Oregon health expenditure savings from the widespread adoption of health information technologies are $1.7 billion per year. About half of those savings would accrue to the Portland tri-county area, and another one-third to the six counties in the Willamette Valley, due to a higher concentration of healthcare providers. Of the total statewide savings, $0.6 billion is due to avoidable services, and $1.1 billion is due to increased clinical and operational efficiencies. Employers would benefit from $6.1 million in time-loss reductions. The cost impact for the required healthcare information technology systems statewide is estimated at between $0.44 billion and $0.75 billion per year. These estimates include both one-time and operating/maintenance costs. The cost estimates include (a) the widespread implementation of advanced HIT systems by providers, and (b) development of health information exchange services between providers. The net potential savings in Oregon from the widespread adoption of advanced health information technologies are between $1.0 and $1.3 billion annually. This level of savings would yield a net reduction of 4.3% to 5.9% on Oregon’s health expenditures. Such savings are possible within 12 years with aggressive implementation efforts. Accountability Comes With Data HIT/HIE as a Tool for Health Reform Continuity of Care Between Providers Continuity of Care Between Providers and Patients Improved Quality Improved Safety Lower Costs Potential Impact of Widespread Adoption of Advanced Health Information Technologies on Oregon Health Expenditures, by David M. Witter, Jr. and Thomas Ricciardi, PhD, prepared for OHPR and Quality Corporation, September 2007. The projected overall Oregon health expenditure savings from the widespread adoption of health information technologies are $1.7 billion per year. About half of those savings would accrue to the Portland tri-county area, and another one-third to the six counties in the Willamette Valley, due to a higher concentration of healthcare providers. Of the total statewide savings, $0.6 billion is due to avoidable services, and $1.1 billion is due to increased clinical and operational efficiencies. Employers would benefit from $6.1 million in time-loss reductions. The cost impact for the required healthcare information technology systems statewide is estimated at between $0.44 billion and $0.75 billion per year. These estimates include both one-time and operating/maintenance costs. The cost estimates include (a) the widespread implementation of advanced HIT systems by providers, and (b) development of health information exchange services between providers. The net potential savings in Oregon from the widespread adoption of advanced health information technologies are between $1.0 and $1.3 billion annually. This level of savings would yield a net reduction of 4.3% to 5.9% on Oregon’s health expenditures. Such savings are possible within 12 years with aggressive implementation efforts.

11. Challenges Aligning the business interests within a competitive health care marketplace will require substantial buy-in to broad goals for common good All states face challenges of designing sustainable funding for HIEs Both private and public investment will be needed Value propositions for various stakeholder sectors will be different Many of the services that could be performed by a statewide HIE may compete with the business plans of other organizations >40 operational HIEs in the US Sustainability model is different for every one >40 operational HIEs in the US Sustainability model is different for every one

12. Next Steps HIE State Plan: Feb-May: development of draft strategic and operational plans June: draft plan to Board for review and comment, released for public comment July: plan finalized and submitted for ONC approval Remember from slide 4: the State HIE Plan is only one piece of the puzzle.Remember from slide 4: the State HIE Plan is only one piece of the puzzle.

13. Two-way Communication is Vital HITOC.info@state.or.us Director of HITOC: Carol Robinson 1225 Ferry Street, SE, 1st Floor Salem, OR 97301 Phone: 503-373-1817 Fax: 503-378-5511 Email: carol.robinson@state.or.us Web: www.oregon.gov/OHPPR/HITOC “I use not only all the brains I have, but all that I can borrow.” – Woodrow Wilson“I use not only all the brains I have, but all that I can borrow.” – Woodrow Wilson