Health Information Technology 101Rural HIT Pre-Conference Workshop

2010 National Conference of State Flex ProgramsJuly 12, 2010

600 East Superior Street, Suite 404 I Duluth, MN 55802 I Ph. 218.727.9390 I www.ruralcenter.org

Tami Lichtenberg, M.A.Center for Health Care Innovation

Kate Stenehjem, M.L.S.National Rural Health Resource Center

Outline

• What is health information technology (HIT) and why is it important?

• American Recovery and Reinvestment Act of 2009 (ARRA) HITECH Grants

• Meaningful Use

• Telehealth

• How is Flex involved with HIT?

• Questions and Answers

HIT in a Nutshell• Electronic health records for patients

• Secure electronic networks to deliver up-to-date records whenever and wherever the patient or clinician may need them

• Electronic transmittal of medical test results speed and streamline processes

• Confidential access for consumers to their own personal health information online

HIT in a Nutshell• Electronic, and more efficient, communication

between patients and health care providers

• Electronic prescribing of medications, treatments, and tests help avoid medical errors

• Decision support systems to provide clinicians with up-to-the-minute information on best practices and treatment options

• Electronic devices like handheld computers to make information available at the point of care

What is an EMR?

Electronic Medical Record

• Used by health care practitioners to document, monitor, and manage health care delivery within the care delivery organization

• Legal record of services

• Owned by the care delivery organization

• Patient may have access to some information through a portal but is not interactive for the patient’s use

What is an EHR?Electronic Health Record

• Subset of information from various care delivery organizations’ EMRs where patient had encounters

• Owned by patient or stakeholder

• Provides interactive patient access and patient ability to append information

• Connected by National Health Information Network, this exchange of information is called Health Information Exchange (HIE)

What is a PHR?Personal Health Record (PHR)

• Electronic, universally available, lifelong resource of health information

• Individuals own and manage the information

• Both healthcare providers and the individual contribute information

• Maintained in a secure and private environment, with the individual determining rights of access

• Separate from and does not replace the legal record of any provider

What is Telehealth?

• Use of medical information exchanged from one place to another via electronic communications to improve patients’ health status

• Technologies used in telehealth typically include:– Videoconferencing– Internet– Store-and-forward imaging– Streaming media– Terrestrial and wireless communications

Telehealth

• Can be as basic as a telephone or as advanced as satellite technology to broadcast a consultation to multiple locations using videoconferencing and medical imaging

• Telehealth services can include:

– Specialist referral services

– Patient consultations

– Remote patient monitoring

Telehealth Issues

• Limited scope of reimbursement

• Legal questions about geographic boundaries

• Safety and standards for telehealth applications

• Privacy, security, and confidentiality of data

• For more information on telehealth, visit the Telehealth Resource Centers at: http://telehealthresourcecenter.org/

Why is HIT Important?

• Improves the quality, safety, and effectiveness of health care

• Helps ensure that providers have the most current information about the condition they are treating

• Avoids duplication and medical errors

• Works to ensure efficient, coordinated, and secure information exchange for patients receiving care from multiple providers

ARRA HITECH Funding

• ARRA established funding for the following HITECH Programs:– HIT Regional Extension Centers (Sec. 3012)– CMS Incentives “Meaningful Use” (Sec. 4201)– Health Information Exchange (Sec. 3013)– HIT Workforce Development (Sec. 3016)– Beacon Community Program (Sec. 3011)– Strategic HIT Advanced Research Projects

(SHARP) (Sec. 3011)

HIT Regional Extension Centers (RECs)

• Focus most intensive technical assistance on clinicians furnishing primary-care services

– Particular emphasis on individual and small group practices (<10 clinicians with prescriptive privileges)

HIT Regional Extension Centers (RECs)

• Intensive TA to clinicians providing primary care:

– Public and critical access hospitals

– Community health centers

– Other settings that predominantly serve uninsured, underinsured, and medically underserved populations

HIT Regional Extension Centers (RECs)

• RECs will support health care providers with direct, individualized, and on-site TA:

– Selecting a certified EHR

– Achieving effective implementation

– Enhancing clinical and administrative workflows with EHR to improve quality and value of care

– Protect the integrity, privacy, and security of patients’ health information

HIT Regional Extension Centers: Expansion Supplement

• Designed to provide assistance to CAH and rural hospitals in their service area– Less than 50 beds in the RECs geographic

service area• On-site technical assistance will be a key service

• RECs are expected to work with both CAHs and rural hospitals who have not yet adopted EHR systems, and those with existing EHR systems, to assist them in achieving meaningful use of certified EHR technology

CMS Incentives

• Incentives based on the definition of “Meaningful Use”

– The American Recovery and Reinvestment Act of 2009 (ARRA) authorizes the Centers for Medicare & Medicaid Services (CMS) to provide a reimbursement incentive for physician and hospital providers who are successful in becoming “meaningful users” of an electronic health record (EHR).

Meaningful Use Overview

• HITECH Act established three fundamental criteria requirements for meaningful use:

1. Use of certified EHR technology in a meaningful manner

2. Certified EHR technology is connected in a manner that provides for the electronic exchange of health information to improve the quality and coordination of care

3. In using certified EHR technology, the provider submits clinical quality measures and other measures as determined by the secretary

Source: Dr. Paul Kleeberg, presentation to the Technical Assistance and Services Center, 2010

Goals of Meaningful Use

• Improve quality, safety, efficiency, and reduce health disparities

• Engage patients and families

• Improve care coordination

• Ensure adequate privacy and security protections for personal health information

• Improve population and public health

Source: Dr. Paul Kleeberg, presentation to the Technical Assistance and Services Center, 2010

Meaningful Use: Eligible Professionals

• Medicare

– A physician as defined in Section 1861(r) of the Social Security Act, which includes the following five types of professionals:

• Doctor of Medicine or Osteopathy

• Doctor of Dental Surgery or Medicine

• Doctor of Podiatric Medicine

• Doctor of Optometry

• Chiropractor

Meaningful Use: Eligible Professionals

• Medicaid

– Physicians

– Dentists

– Certified Nurse-Midwives

– Nurse Practitioners

– Physician Assistants who are practicing in Federally Qualified Health Centers (FQHCs) or Rural Health Clinics (RHCs) led by a physician assistant.

CAH Medicare Incentives

• CAHs that are meaningful users by 2011 are eligible for 4 years of enhanced Medicare payments with immediate full depreciation of certified EHR costs, including undepreciated costs from previous years

CAH Medicare Incentives

• Penalties for non-users start in 2015

• Summary: CAHs that become meaningful users between 2011-2015 qualify for incentives and avoid penalties

• For more information on incentives: http://www.ruralcenter.org/tasc/resources/hit-incentives-and-state-grant-opportunities-american-recovery-and-reinvestment-act-2

State HIE Cooperative Agreement Program

• Supports achieving widespread and sustainable health information exchange (HIE)

– Develop and implement privacy and security requirements

– Develop directories and technical services to enable interoperability

– Coordinate with Medicaid and state public health programs

State HIE Cooperative Agreement Program

• Supports achieving widespread and sustainable health information exchange (HIE) (cont.)

– Remove barriers that may hinder effective HIE

– Ensure an effective model for HIE governance and accountability

– Convene stakeholders to build trust in and support for HIE

HIT Workforce Development

• Assists in the establishment and/or expansion of education programs designed to train a highly skilled workforce of HIT professionals to effectively implement and enable the use of secure, interoperable electronic health record systems.

HIT Workforce Development

• Programs include:

– Community College Consortia to Educate Health IT Professionals

– Curriculum Development Centers Program

– Program of Assistance for University-Based Training

– Competency Examination Program

HIT Workforce Development: Community College Consortia

• Five regional groups of more than 70 member community colleges in all 50 states

• Received $36 million in grants to develop or improve non-degree HIT training programs

• Complete in six months or less

• Train more than 10,500 new HIT professionals annually by 2012

HIT Workforce Development: Curriculum Development Centers

• Provide funding to support HIT curriculum development

• Materials developed will be used by the member colleges of the regional Community College Consortia and will also be available to institutions of higher education across the country

• $10 million in grants to 5 institutions

HIT Workforce Development: Curriculum Development Centers

• Oregon Health & Sciences University received additional funding to serve as the National Training and Dissemination Center (NTDC)

– Host in-person training event for community college faculty

– Establish a secure electronic from which all materials may be downloaded

– Collect feedback from instructors and students

– Coordinate subsequent revisions of curriculum materials

HIT Workforce Development: Program of Assistance for University-Based Training

• Designed to rapidly and sustainably increase the specific HIT professional roles requiring university-level training

• Targets Six Roles:1. Clinician/Public Health Leader2. Health Information Management and

Exchange Specialist3. Health Information Privacy and Security

Specialist4. Research and Development Scientist5. Programmers and Software Engineer6. Health IT Sub-specialist

HIT Workforce Development: Program of Assistance for University-Based Training

HIT Workforce Development:Competency Examination Program

• Funding for institutions of higher education to support the development and initial administration of a set of HIT competency examinations

HIT Workforce Development:Competency Examination Program

• Assess basic competency for two types of individuals to demonstrate competency in certain HIT workforce roles integral to achieving meaningful use of electronic health information:

– Individuals trained through short-duration, non-degree health IT programs

– Members of the workforce with relevant experience or other types of training

Beacon Community Program

• Provides funding to communities at the cutting edge of EHR adoption and HIE to push them to a new level of sustainable health care quality and efficiency

• Demonstrates the vision of a future where hospitals, clinicians, and patients are meaningful users of HIT

• Achieves measurable improvements in health care quality, safety, efficiency, and population health

Beacon Community Program

• Demonstrates how HIT can help providers and consumers develop innovative ways of delivering care leading to sustainable and measurable health and efficiency improvements

• Generates lessons learned on how other communities can achieve similar goals enabled by HIT

Strategic Health IT AdvancedResearch Projects (SHARP)

• Funded research focused on achieving breakthrough advances to address well-documented problems that have impeded adoption of HIT

• Office of the National Coordinator for HIT (ONC) awarded four cooperative agreements totaling $60 million ($15 million each)

Strategic Health IT AdvancedResearch Projects (SHARP)

• Topics include:

– Security of HIT

– Patient-Centered Cognitive Support

– Health Care Application and Network Platform Architecture

– Secondary Use of EHR Data

How is Flex Involved with HIT?

• HIT is not currently a required objective in the Flex Grant, but it is optional for 2011 under work in supporting Quality Improvement

• HIT can be used as a tool to improve quality; and activities can include:– accessing available TA– sharing HIT infrastructure– staff, training, and clinician support

• Funds should not be used to purchase hardware and software for CAHs

Flex Funds• Some activities and TA for needs could include :

– Sharing of HIT infrastructure or staff

– Health Information Exchange

– Implementation assistance

– Strategic planning

– EHR development between facilities

– Education and awareness

– Online tools, resources, distance learning

– HIT trainings

Additional Services Provided by TASC

• HIT Education relevant to state Flex grantees

• Ongoing dissemination of HIT Information

• Rural HIT Resource Center that will include HIT roadmaps, readiness assessments and other tools

• Rural HIT Experts to provide technical assistance

Tami Lichtenberg, M.A.

Executive DirectorCenter for Healthcare

InnovationCollege of St. Scholastica

(218) 625-4921tlichten@css.edu

Kate Stenehjem, M.L.S.

Information SpecialistNational Rural Health

Resource Center(218) 727-9390 ext. 236

kstenehjem@ruralcenter.org