Kevin W. Ryan JD, MA Associate Director – ACHI Assistant Professor – UAMS COPH

1. Rural TeleCon ’0610th Annual Conference of the Rural Telecommunications Congress Kevin W. Ryan JD, MA Associate Director – ACHI Assistant Professor – UAMS COPH

2. The coming tsunami of electronic health information exchange – important dates • 2014 - EHR to be widespread • 2009 – e-prescribing required by MMA • 2006 – ?

3. Where are we today in 2006? • EHR usage study shows slow progress toward Bush’s 2014 goal – Healthcare IT News • <10% of physicians employee an EHR system that benefits patient care • <5% of hospitals use computerized physician order entry • Reasons for slow progress • Lack of interconnectivity / interoperability • Costs • Fear of legal burdens • Uncertain tech support • Concerns about rapid obsolescence • Rural area providers least likely to adopt EHR

4. Rationale for an interoperable EHR • Cost savings • Decreased medical errors • Improved public health surveillance

5. General issues with EHR • Verification of patient consent for release of medical records information. • Forwarding patient information without a signed release form. • Perceived need to obtain IRB approval for release of identified patient data.

6. General barriers to obtaining an interoperable EHR • “The way we have always done it” mentality • Ownership of responsibility • Discrepancy in application and interpretation of HIPAA • State law regarding mandated reporting / privacy of communicable diseases • “Just say no!”

7. Interoperability issues • Lack of common platform • Legal / regulatory / policy impediments to information exchange • Bandwidth

8. US DHHS Health Information Exchange Plan • Harmonize standards • Create certification criteria for EHR products / technology • Develop prototype network architecture • Identify / address variations in state laws / business policies affecting privacy and security that impedes / facilitates exchange of health information

9. Health Information Security and Privacy Collaboration - HISPC • Funded by DHS Agency for Healthcare Quality and Research • Managed by NGA / RTI • 33 states and Puerto Rico

10. Mission • Bring together broad range of stakeholders • Identify legal / policy / practice barriers to electronic exchange of health information • Develop through a consensus process recommended solutions • Create state level report to Federal government • Cooperate in establishment of NHIN

11. Arkansas HISPC Project • The Arkansas HISPC project management team consists of various partners within the state with interest or expertise in the areas of Health Information Technology, HIPPA and Law. • AR Center for Health Improvement • AR Department of Health and Human Services • AR Foundation for Medical Care • The Brock-Chad Group (Legal Consultants) • Stakeholders / interested parties

12. Present Arkansas Health Information Exchange Initiatives • Arkansas Hospital Association: Investigation of statewide EHR • Employee Benefits Division (EBD), Quality Sub-Committee: Quality of care measurement standards – link with EHR • Arkansas Blue Cross/Blue Shield: Convening quality initiative stakeholders • Arkansas Foundation for Medical Care: Aligning forces for regional quality healthcare improvement. • Arkansas Center for Health Improvement: VISTA feasibility study. Assisting EBD with quality sub-committee. • Arkansas Public Health Bioterrorism System: Statewide public health agency system implementation • ANGELS Project: • Telemedicine:

13. Arkansas HISPC Project • Evaluation of legal issues regarding information sharing. • Community buy-in regarding the need and mechanisms for application. • Formation of collaborative partners in the activities around health information exchange. • Access to information and issues experienced by other states, who can serve as a resource as Arkansas’s activities develop.

14. Stakeholder Representation and Outreach • Hospitals • Pharmacy • Payers • Professional association / societies • Public health agencies • Community clinics / health centers • Legal representatives • Consumers • Industry

15. Data Collection Process • Facilitated face-to-face meetings discussing health information exchange scenarios. • E-group input

16. Challenges • Convening sufficiently diverse groups • Perceived lack of need • Perceived inability to address issue

17. Deliverables • Establishment of a sustainable state level initiative • Linked activities with regional / national efforts • Reports • Interim • Final

18. Your participation in this project is welcomed. • Kevin W. Ryan JD, MA • 501.526.2244 • ryankevinw@uams.edu • Shirley Tyson – HISPC Project Director • 501.526.2257 • tysonshirley@uams.edu