Health Information Technology Maryland's Approach May 11, 2011

1. Health Information TechnologyMaryland's ApproachMay 11, 2011 TheMARYLAND HEALTH CARE COMMISSION

2. Discussion Items • Health IT - An Essential Care Delivery Framework • State Involvement in Health IT • Leading Initiatives • Privacy and Security - Policy Development • Legislation on the Horizon

3. Why Health IT is Important • The best evidence suggests: • People receive only about half the preventive care recommended • People with acute or chronic conditions receive about two-thirds of the care they need • About one-fifth to one-third of both acute and chronic care is unnecessary Whelan, Ellen-Marie; Sekhar, Sonia, “Costly and Dangerous Treatments Weigh Down Health Care,” Center for American Progress, 2009

4. Health IT System Savings – Efficiency • Properly implemented and widely adopted, health IT will save money and significantly improve health care quality • Annual savings from efficiency alone could average $77 billion or more per year in both inpatient and outpatient care • Largest savings come from reduced hospital stays as a result from increased safety and better scheduling and coordination, reduced nurses’ administrative time, and more efficient drug utilization Rand Health, Research Highlights, “Health Information Technology, Can HIT Lower Costs and Improve Quality?” 2005

5. Health IT Enabled Chronic Care Management • Improves diagnostic accuracy by providing prompts, alerts, and reminders built around evidence based guidelines and real time clinical knowledge • Reduces adverse drug interactions and dosing complications, permits the primary care physicians to monitor script refills, avoid hospital utilization, and improve treatment plan adherence “Coordinating Chronic Care Management through HIEs,” Deloitte Center for Health Solutions, 2007

6. Health IT Enabled Chronic Care Management (Continued) • Facilitates the interaction between the provider and the patient by providing real-time knowledge about a patient between visits and reduces avoidable complications and costs from unmanaged chronic conditions • Allows a team of providers to work with the physician and patient to determine the best course of self-care management and to share information to better coordinate care, monitor outcomes, and avoid complications “Coordinating Chronic Care Management through HIEs,” Deloitte Center for Health Solutions, 2007

7. The Maryland Goal Advance the health and wellness of Marylanders by implementing the best in the nation clinical data sharing utility that ensures consumers have access to the highest quality, most efficient, and safest care by giving providers access to the right information at the right time

8. MHCC Involvement • The MHCC has a broad mandate to promote health information technology (health IT) statewide that will improve patient safety, quality of care, and administrative efficiencies • The MHCC‘s health IT initiatives supports the national strategy to implement information technology in the health care sector • By working together with consumers, payers, providers, and purchasers, the MHCC expects to achieve its mandate

9. Information Sharing - Guiding Principles • Ensure that providers have greater access to secure and accurate health information when and where it is needed • Enhance public health initiatives such as biosurveillance, disease management, and emergency preparedness efforts • Balances the need for information sharing with the need for strong privacy and security policies

10. Policy Reports Framing The Challenge • The MHCC convened a series of multi-stakeholder groups to discuss a range of policy issues and published a number of major policy reports • The Task Force to Study Electronic Health Records • Review of the Task Force to Study Electronic Health Records 2007 Final Report Recommendations • Assessment of Privacy and Security Policies and Business Practices • Privacy and Security Solutions and Implementation Report • Service Area Health Information Exchange: A Hospital Data Sharing Community Resource Guide • Health Information Technology: An Assessment of Maryland Hospitals • Management Services Organizations: A Vision of State Designated Organizations for Physician Practices

11. Principles Guiding the Future of HIE • A decentralized standards-based hybrid model that supports both distributed data, personal health records, and health record banks • This approach ensures that data is held where it is created and not in a large centralized HIE repository • Allow statewide availability for the secure transfer of a defined set of clinical information between appropriate participating entities • Enable the consumer to control the flow of electronic health information • Include opt-out as the baseline consumer consent process

12. Key Planning Activities • Two multi-stakeholder groups were chosen by a panel of well-known experts on health IT to examine different models for a statewide citizen-centric exchange • Chesapeake Regional Information System for our Patients (CRISP) • Montgomery County Health Information Exchange Collaborative (MCHIE)

13. State Designation • Following the nine-month planning project, the MHCC released a Request for Application to implement a statewide HIE • July 2009, the MHCC designated CRISP as the statewide HIE; the following month, the HSCRC agreed to fund $10M in development cost

14. Policy Development

15. Overview • The Policy Board has the authority to evaluate and recommend to the MHCC the policies that will govern the statewide HIE • Members were selected based upon their expertise, with a strong emphasis on achieving both broad stakeholder representation and a strong consumer orientation • The existence of a Policy Board that is separate from the statewide HIE assures participation by the public in both policy development

16. Policies for Development • Roughly 20 policies related to privacy and security have already been identified

17. Sensitive Health Information Policy Development - Items of Consideration • The Sensitive Health Information policy aims to keep select PHI confidential, by definition sensitive health information is subjective and varies depending on the specifics of an individual consumer’s situation and context • In general, sensitive health information is considered to be information that carries with it unusually high risks in the event of disclosure • The state designated HIE currently does not have the capability to selectively identify or prevent the exchange of specific PHI

18. Sensitive Health Information Policy • The Policy Board recommended the MHCC adopt a policy on sensitive health information that calls for the HIE to implement key requirements on participating organizations: • Adhere to federal and state law when exchanging PHI through the statewide HIE • Participating organizations with the technical capability should allow consumers to request that sensitive information be withheld from the statewide HIE • Notify consumers and the state designated HIE of an inadvertent release of sensitive health information to the state designated HIE after a consumer requested that it be withheld • Participating organizations that are not able to withhold publishing health information deemed sensitive as part of the organization’s PHI will not upload information to the state designated HIE except in cases of point-to-point messaging

19. On the HorizonHouse Bill 784 Medical Records - Health Information Exchanges

20. Key Elements of the Legislation • Requires MHCC to adopt regulations for the privacy and security of protected health information obtained or released through a health information exchange • Requires that an insurer that releases personal health information to providers make the information available to the state-designated exchange • Establishes liability protections under certain circumstances for an HIE and a health care provider

21. Questions? TheMARYLAND HEALTH CARE COMMISSION