Provider Education Toolkit New York State

1. Provider Education Toolkit New York State

2. Background Health Information Security & Privacy Collaboration (HISPC) established in 2006 by the U.S. Department of Health and Human Services. Initially comprised of 34 states and territories, the project expanded in 2008 to involve 42 states and territories. Seven multi-state collaboratives were formed to effectively address the privacy and security challenges presented by electronic health information exchange. The HISPC Provider Education Toolkit Collaborative comprised of 8 states (FL, KY, LA, MI, MO, MS, TN, WY) was formed to educate providers and increase awareness of the privacy and security benefits of health information exchange. As part of the HISPC Phase III extension period work, NY adapted the Provider Education Toolkit to meet the needs of its providers.

3. www.nyehealth.org Welcome to the New York State Provider Education Toolkit, adapted from materials created through the HISPC Provider Education Collaborative. Found at www.nyehealth.org, this resource was created specifically to assist the NY health care community… Get the facts about electronic health information exchange (HIE) Access the current HIE initiatives within the state Identify state laws applicable to HIE and privacy of personal health information Learn about the tools and resources you need to safely and securely get connected in your region to share patient information with other health care stakeholders

4. New York eHealth Collaborative • The New York eHealth Collaborative (NYeC, pronounced "nice") is a State designated public-private partnership and statewide policy body playing an integral role in the implementation of New York State's health IT strategy through a consensus-based approach. Key responsibilities include: • Convening, educating and engaging key constituencies, including health care and health IT leaders across the state, Regional Health Information Organizations, Community Health Information Technology Adoption Collaboratives ("CHITAs"), and other health IT initiatives • Developing Statewide Policy Guidance through a transparent governance process • Evaluating and establishing accountability measures for New York's health IT strategy

5. New York State Department of Health The New York State Department of Health, Office of Health Information Technology Transformation is charged with coordinating health IT programs and policies across the public and private health care sectors. Its goal is to enable improvements in health care quality, increase affordability and improve health care outcomes for New Yorkers. As part of its commitment to the public-private infrastructure evolving to support statewide interoperability, the State of New York has committed funding to NYeC to manage the statewide collaborative process.

6. What is Health Information Technology (Health IT)? Health IT refers broadly to electronic methods for storing and processing clinical data. Electronic health records allow for quick searching, tracking, analyzing, and retrieval of patient information by physicians and qualified staff in a safe and secure manner at the point of care.

7. How do I get connected? Through: Regional Health Information Organizations (RHIOs) RHIOs get and share information about patients from such places as hospitals, physicians, pharmacies, clinical laboratories, health insurers, and the Medicaid program Community Health Information Adoption Collaborations (CHITAs) A CHITA is a health IT services and support organization

8. What is a RHIO? A RHIO is a non-profit corporation that brings together health care stakeholders within a defined geographic area and facilitates and governs the electronic movement of health related information among participating stakeholders. It does this with the purpose of improving health and access to care in that community. RHIOs make up the larger health IT network the Statewide Health Information Network for New York (SHIN-NY). New York has funded the start up of RHIOs through the Healthcare Efficency and Affordability Law for New Yorkers (HEAL NY). RHIOs enable clinicians and patients to share a patient's medical information electronically with such places as hospitals, physicians, pharmacies, clinical laboratories, health insurers, and the Medicaid program. To locate a RHIO in your region, go to: http://www.nyehealth.org/nys-hit-projects For more info on the criteria for defining RHIOs and NY’s health IT strategy, go to: (http://www.health.state.ny.us/funding/rfa/0903160302/health_it_strategic_plan.pdf)

9. As a physician or a hospital, what support can I get from RHIOs for Health Information Exchange implementation? • Governance • Standardizing Clinical Requirements • Standardizing Technical Policies • Financing HIE • Patient Privacy • Standardizing Confidentiality and Security Policies • Patient Engagement • Authentication, Authorization, Access Controls, Auditing • Consent Management and other Fair Information Services • Data Aggregation • Data Reporting • Data Access • Standardized Participation Agreements

10. What is a CHITA? A CHITA is a health IT services and support organization (service bureau/extension center) to promote the implementation, adoption, training and effective use of interoperable electronic health records and other health IT tools by providers. CHITAs are also responsible for coordination of the support necessary for practice transformation, reimbursement changes and patient engagement, to vastly improve the availability and use of health information and help ensure that the expected quality and efficiency goals are realized from interoperable health IT. A CHITA may be a not-for-profit, for-profit corporation or local government agency, dedicated to promoting interoperable electronic health record adoption and effective use, provided that the organization demonstrates the competence and ability to provide directly or through partnerships low cost, high value health IT adoption and support services to providers and patients. More info: http://www.nyehealth.org/nys-hit-projects

11. As a physician or a hospital, what support can I get from CHITAs for EHR implementation? Readiness assessment Organizational development Change management Workflow re-design Practice transformation including the implementation of new reimbursement models Project management • Vendor/product selection • Implementation and configuration support • Interoperability services • User training • Ongoing support/help desk services • Process and quality improvement services to achieve patient care improvements

12. How is care going to be affected by health IT? • Having immediate access to key information, such as patients' diagnoses, allergies, lab test results, and medications; • The ability for all providers participating in the care of a patient in multiple settings to quickly access new and past test results and diagnosis and treatment information; • The ability to enter and store orders for prescriptions, tests, and other services in a computer-based system; • Using Clinical Decision support tools such as reminders, prompts, and alerts to improve compliance with best clinical practices, ensure regular screenings and other preventive practices, identify possible drug interactions, facilitate diagnoses and treatments, and reduce the frequency of adverse events.

13. How is care going to be affected by health IT? • Having patient support tools that give patients access to their personal health records and provide interactive patient education. • Computerized administrative tools, such as scheduling systems, would greatly improve efficiency and provide more timely service to patients. • Using reporting tools to enable health care organizations to respond more quickly to federal, state, and private reporting requirements, including those that support patient safety and disease surveillance.

14. How do you pay for it? The American Recovery and Reinvestment Act of 2009 (aka theFederal Stimulus Package) contains Medicare and Medicaid incentive payments to eligible providers, including physicians and hospitals, in order to increase the adoption of Electronic Health Records (EHRs). To receive the incentive payments beginning in 2011, providers must demonstrate “meaningful use” of a certified EHR.  There is also a federal EHR loan program that will be made available in the near future. Funding through HEAL NY health IT capital grants program has been available for health IT implementation since 2006. HEAL 5 projects are currently being implemented across the state. In addition, HEAL 10 projects will be focused on the Patient Centered Medical Home model in the coming months. Resources are available and opportunities exist in communities awarded HEAL funding for providers to adopt health IT. Other funding through the HEAL NY program and other state initiatives may be available in the future.

15. What is a certified EHR product and why do I need it? A certified EHR is one that is approved and certified by the Certification Commission for Healthcare Information Technology (CCHIT). CCHIT is a private, nonprofit initiative and a recognized certification body for electronic health records and their networks. NYS requires the use of EHR products that have been certified by CCHIT. NY will continue to evaluate the certification process on the federal level to assure consistency with future recommendations.

16. How will a provider demonstrate “meaningful use”of a certified EHR? Meaningful use of a certified EHR is still being defined by the federal HIT Policy Committee of the US Department of Health and Human Services. Final recommendations are expected to be released in July and federal regulations around meaningful use are expected to be in place by year’s end. Some of the earlier draft criteria focused on: - Use of a certified product complete with ePrescribing capability - The EHR technology is connected for the electronic exchange of Protected Health Information - Compliant with submission of reports on clinical quality measures

17. What are providers required to do to qualify forfederal incentives? There are two incentive payment programs available: one through Medicare and another through Medicaid. Both require that a provider prove "meaningful use" of a "qualified"EHR product to be eligible for the incentives. Physicians have to choose one program, but hospitals can qualify for both programs.

18. What is the impact of delay in implementing an EHR? Beginning in 2015, financial penalties can be incurred for failure to use EHRs. CMS will mandate that the Medicare physician fee schedule payments for non compliant providers be reduced by 1% for 2015; by 2% reduction for 2016; and by 3% for 2017 and subsequent years.

19. How do I maximize the potential for federal incentives? Commencing in 2011 and for the first five years, the Act will compensate physicians and hospitals who are “meaningful EHR users” in decreasing increments, with the largest incentives in 2011 and 2012. Beginning in 2015, health care providers will be penalized if they don’t have EHRs. No incentive payments will be available to those adopting EHRs after 2014.

20. What are the implications of HIPAA? NY law is more stringent than HIPAA for patient treatment, payment and health care operations. NY law requires providers to obtain patient consent for treatment. A patient centered affirmative consent policy was developed for the exchange of personal health information in NY through RHIOs. A state approved consent form was also developed to allow patients to choose who has access to their health information. At the federal level, the Health Information Technology for Economic and Clinical Health Act (HITECH) includes provisions affecting the exchange of data, including: • Extension of HIPAA to Business Associates • Security Breach Notification Mandate • New Restrictions on the Use and Disclosure of Protected Health Information • Additional Patient Rights • Increased HIPAA Penalties Federal regulations are expected to be released later this year.

21. For additional information… • Please visit: • www.nyehealth.org • www.health.state.ny.us/technology/ • www.secure4health.org The NYSDOH worked with the following organizations to produce this toolkit: Healthcare Association of NYS (HANYS) NY Chapter of the American College of Physicians (NYACP) Medical Society of the State of NY (MSSNY)