Connecting California: The Role of State Leadership in Advancing Health Information Technology

1. Connecting California:The Role of State Leadership in Advancing Health Information Technology CCST Board and Council Meeting Molly Coye, MD, MPH Chair, CalRHIO Planning Committee CEO, Health Tech October 19, 2005

2. The Vision If I go to see my doctor, she or he will have all the information needed right on the spot. I won't have to fill in any more forms, lab tests won't be repeated, and my doctor will know if I've been to see another doctor, or to a hospital, and what medicines I'm taking.

3. The Vision If I'm taken to the hospital in an emergency, the nurses and doctors in the emergency department will be able to find out all the information they need to take care of me - within seconds.

4. The Vision I have my own personal health record, that I keep at home on my computer or as a printed record. It has all the information I need about my medical history, current conditions, medicines I'm taking, the doctors that are caring for me, and education about my medical conditions.

5. The Vision If there is a public health emergency.…my records will be available to treat me or my family at any location. The Vision: Health care that is safe, of high quality, and efficient, in an information-rich environment that meets the needs of consumers, patients, providers and others in California’s communities.

6. Lessons from Katrina “There may not have been an experience that demonstrates, for me or the country, more powerfully the need for electronic health records ... than Katrina." Mike Leavitt, HHS Secretary

7. Lessons from Katrina “Starting yesterday (9/14), doctors in eight shelters for evacuees could go to the Internet to search prescription drug records on more than 800,000 people from the storm-racked region.” Washington Post

8. National HIT Picture • Federal advocacy for healthcare IT • Secretary Leavitt a strong proponent • Limited federal funding • $125M proposed for health care HIT in FY 2006 • Re-structuring the market • Establishing standards • ‘Harmonizing’ privacy and security legislation • Safe harbor for hospital funding of physician IT • Accrediting products as standard-compatible • Stimulating development of models for national ‘highway’ • Linkage to Pay-for-Performance • Medicare pilot • MedPAC proposal for pay-for-use of IT • Interoperability standards underway • Strong White House support • Congressional stampede

9. The Baseline: Is California Ready? • Estimates, for all California consumers and patients: • 10 %: online appointment scheduling • 20 %: pharmacy refills • 40 %: enroll in health plan online • 5 %: email with physician • 5 %: pay medical bills online • 10 %: customized health education • 5 %: personal health record online Source: Structured inquiry of California health care leaders, November 2004

10. Is Technology Transforming California Healthcare ? • Estimates for Infrastructure: • 10 %: physicians using ‘EMR light’ • 30 %: integrated clinical data within integrated delivery networks (IDNs) • 5 %: integrated data: plan - IDNs • <2 %: community health data shared • <5 %: telemedicine-enabled • 10 %: EMR light • 20 %: full EMR Source: Structured inquiry of California health care leaders, November 2004

11. The Opportunity: Safety, Satisfaction and Efficiency Increase access to information • Without HIE, 30% of the time, physicians could not find information previously recorded in a paper chart Reduce duplicate testing • Same drug or radiology exam ordered 11% of the time; patients agreed to duplicate testing 50% of the time Ensure complete information • Physicians unaware of 1 in 4 patient prescriptions Eliminate uncertainty • On average, test results come from 5 or more locations; problems with retrieval accounted for 1 in 7 admissions and 1 of 5 lab tests and radiology exams Reduce data collection/transfer costs • Cost of tracking down and obtaining information on the data user/originator sides range from $12 - $28 per visit *Electronic Medical Records – Getting it Right and Going to Scale. W. Edward Hammond, III, Ph.D. Commonwealth Fund background paper. www.cmwf.orgpublication #695. January 2004.

12. Annual Cost National - $7.7 billion $6.5 billion for hospitals $1.2 billion for physicians California - $77 million (est.) Annual Savings National - $81 billion $77 billion improved efficiency $5 billion reduced medical errors California - $8.1 billion (est.) The Opportunity: Cost and Savings Potential benefits of EHR adoption: (Assume 90% adoption over 15 years) Sources: National estimates: Rand California estimates: Extrapolation

13. The Opportunity: Office-Based Patient Care

14. The Vision Advancing the use of new technologies to make people healthier. The Mission To create a trusted source of expert information about the future of healthcare technologies. Health Technology Center The Means • A nonprofit pooled research center for delivery systems and health plans. Funding independent of technology developers and vendors.

15. HealthTech Partners Stanford Hospital and Clinics University HealthSystem Consortium (UHC) Froedtert Hospital Hospital Corporation of America (HCA) Greenville Medical Center Health Alliance of Greater Cincinnati Blue Shield of California Foundation Lucile Packard Medical Center Chinese Hospital & Health Plan Catholic Health Initiatives CHI) St. Alphonsus Regional Medical Center Rockingham Memorial Salem Hospital El Camino Hospital Banner Health System Baylor Health Care System Bon Secours Health System Carolinas HealthCare System Catholic Healthcare West Centers for Medicare and Medicaid Services (CMS) Federal Liaison CHRISTUS Health Parkview Health Partners HealthCare System The Queen’s Medical Center Veterans’ Health Administration Overlake Hospital UC Davis Health System Methodist Health System Lumetra Ascension Health CAPH John Muir/Mt. Diablo Health System Group Health Cooperative Kaiser Permanente Mills-Peninsula Health Services PeaceHealth Premier, Inc. Providence Health System Sutter Health VHA Inc. WellPoint Health Networks Texas Health Resources New 2005 SCAN Health Plan University of Chicago Hospitals and Health System Palomar Pomerado Health Memorial Hermann Sandia National Laboratories TEKES/SITRA Trillium Health Centre Stormont-Vail HealthCare

16. CalRHIO’s Role • Independent umbrella organization • Leading a collaborative effort to: • incrementally build a statewide information exchange for California • implement projects that build systems for data exchange, and demonstrate their feasibility and utility • ensure participation by safety net providers and underserved populations in data exchange and IT investment • build financial and business case models for health information exchange • facilitate creation of common governance, process, technology, and other elements needed for regional and statewide data exchange organizations

17. CalRHIO’s Role • encourage business, healthcare, and policy leaders to create private and public policy agendas and funding for data exchange and IT investment • help organizers of local and regional data exchange efforts within California work toward common goals and share what they develop and learn • ensure that California’s data exchange projects are consistent with national technology platforms and networks • identify legislation and regulation necessary for statewide data sharing

18. Large RHIO A Found 3 Community B Community C Statewide Highway for Health Information Exchange National Health Information Network CalRHIO A - 3 Payers found 15 Looking for Private Ryan – in CA! B - 1 Little RHIO B Found 1 Community A Medical Group/ MSO None Multi-Community RHIO C Found 2 C - 2

19. Health-e-LA Geographic Coverage Northern Sierra CalRHIO and CAPG cover the entire state Mendocino Marin Central Valley Smart Health Santa Cruz RHIO Santa Cruz CCN Loma Linda Riverside Santa Barbara Long Beach San Diego

20. 2005 Projects • Linking hospital emergency departmentsacross the state • Defining the infrastructure necessary for statewide health data exchange • Supporting enhanced safety in medication management • Improving the efficiency of administrative functionsfor plans and providers • Giving consumers more direct access to health information in a Personal Health Record

21. CalRHIO’s Future Role • Core functions of CalRHIO • Convene and support communications, problem-solving • Resource center • State policy analysis and development • Representation to federal agencies • Health care IT in 2010 • National ‘highway’ for data exchange established • Public utility or commercial models • State and federal privacy and security protections • Standards support interoperability • Two key tasks for CalRHIO • Statewide exchange of health data • Statewide adoption of electronic health records and supporting applications by all health care entities

22. Other States Act • Nationwide 150+ bills in state legislatures addressing HIT • 13 states have introduced or passed HIT legislation or have Governor support through an Executive Order • 40 states have one or more community-based data exchanges or grants for regional health information organizations • 28 states have formal efforts for secure health care data exchange underway • Source: Health Information and Management Systems Society (HIMSS)

23. New York Legislature Created Major Funding • $1 billion over 4 years to: • Finance HIT investment in projects that will build a statewide infrastructure to share clinical information • $1.5 billion over 3 years through fed/state Medicaid waiver for HIT investment • Created HIT grant sources and other budget initiatives in 2005-6 • $3 million for physician HIT development • $10 million for pay for performance (P4P) initiatives which will connect to HIT development • Focus • Regional HIE projects • E-prescribing • EHRs

24. Governor leveraging HIT to reform state’s Medicaid Program Gov. Phil Bredesen announced pilot to improve health care delivery in SW Tennessee; managed by State in partnership with Vanderbilt University Medical Center 1 million patients in 3 counties; 5 year demonstration pilot Funded by AHRQ, technology provided by Vanderbilt University and Accenture Focus: ED linkage Clinical and administrative, eventually financial Tennessee

25. Arizona Governor takes lead in Call to Action Summit • Gov. Janet Napolitano led October Summit to create a successful statewide electronic medical records system • More than 300 representatives from the health care, technology and government sectors attended • Gov. acted on recommendations from a steering committee she had formed to develop a roadmap for providing EMRs to all Arizonans by 2010 • Funding TBD

26. Kentucky Legislation calls for statewide network • Nation's first legislated statewide electronic health network.  (Took four years to pass law.) • Universities of Kentucky and Louisville to create the Kentucky Health Care Infrastructure Authority, which would coordinate efforts such as conducting pilot projects and managing the network. • Gov. Ernie Fletcher (R), a physician, to appoint members to a Kentucky e-Health Network Board, which would oversee the development and implementation of the network. • The board to meet monthly and include health care providers, patient representatives and other stakeholders.

27. Florida Governor creates advisory board • Gov. Jeb Bush, May 4, 2004, created the Health Information Infrastructure Advisory Board. • Established to advise the Agency for Health Care Administration (AHCA) which administers Florida's $14 billion Medicaid program, licenses and regulates more than 32,000 health care facilities and 30 HMOs, and publishes health care data and statistics • Funding from AHRQ Grant

28. Gulf States Infrastructure expected to emerge post Katrina • Example: KatrinaHealth.org developed in 10 days; available from anywhere in US • an online service for authorized health professionals to gain electronic access to prescription medication records for evacuees from Hurricane Katrina • medication and dosage information to renew prescriptions, prescribe new medications, and coordinate care

29. Why Now? • Federal leadership, pressure and pending legislation • Technology makes data exchange possible, affordable • California and other states are mobilizing • Standards are under development • State leadership

30. Potential State Role in California Funding • Waiver: Enable Medi-Cal to pay its share of investments in community-wide IT infrastructure; provide financial incentives to providers who use HIT; add telemedicine as covered service • Funding: • Explore use of proceeds from converted not-for-profits to create investment fund/revolving loan fund to support RHIOs • Authorize finance authority or other entity to establish revolving loan fund • Create budget line-item to fund CalRHIO Mandates • Mandate that every California nursing home resident have an EHR with retrievable medication data by July 1, 2006 • Mandate that every Californian have a PHR by 2007

31. Potential State Role California Legislation • Researching need: removal of legal barriers to acquisition and effective use of HIT • Example: privacy and security of personal health information • Researching need: legislation to create certification process for RHIOs • trusted intermediaries charged with facilitating HIE and promoting public health • promote consumer trust • limit liabilities resulting from good-faith participation in HIE

32. Are we prepared for the “Big One”? How can we help?