S T A T E O F M A I N E GO V E R N O R ’ S O F F I C E O F H E A L T H P O L I C Y A N D F I N A N C E

15 S T A T E H O U S E S T A T I O N AUGUSTA, MAINE 04333-0078

JOHN E. BALDACCI TRISH RILEY GOVERNOR DIRECTOR

1. Welcome 2. Minutes from August Mtg 3. OSCHIT Program Status

a. RFPs i. LWG on Privacy and Security

1. facilitator/consultant vendor selection ii. Consumer Education

1. revisions b. State HIT/HIE Plan

i. ONC approval! Next steps c. Workforce Development Strategy Session d. Health Data Workgroup

i. Plan ii. Coordination with CVE/PTE workgroup

4. Updates on ONC/CMS grant funded HIT Programs

a. Regional Extension Center - HIN b. Community College consortia – KVCC and SMCC

i. Strategic Planning Session c. Beacon Community Program - EMHS d. MaineCare HIT Plan – OMS e. Chipra Grant – OMS f. MPCA HIT initiatives

5. (Tentative) Presentation and Discussion on What We Know About System Adoption and Implementation in the State of Maine

6. Materials available on OSC website www.maine.gov/hit

LWG RFP Status

• Minor delay in the schedule caused a slip in our plan

• August – RFP Posted in KJ as Required• Closing Date was August 31• Review Committee Met September 2nd

• We are in the process of finalizing the process• Intend to have an announcement by EOB

tomorrow.

LWG Plan

Communication RFP

• The RFP needs to be posted for comment for 7-10 days• Rewrite the RFP and begin process for solicitation of

bids• October – select bidder• Nov – work to begin

State HIT/HIE Plan

Dear Grantee: This email is being sent on behalf of Cynthia Perry.  Attached is your Revised Notice of Grant Award

(NGA) from the Office of the National Coordinator (ONC) resulting from your application under the Funding Opportunity Announcement Number, EP-HIT-09-001, “American Recovery and Reinvestment Act of 2009, Title XIII Health Information Technology, Subtitle B – Incentives for the Use of Health Information Technology, Section 3013, State Grants to Promote Health Information Technology.”

This Revised NGA is the legal award document advising you that the program restriction in the amount of $5,939,461 budgeted for Implementation has been removed based on the documentation submitted by your organization in response to Special Conditions of Award. 

This award is conditional based upon receipt, within 30 days, and approval of the following:

Sub-Awards: Any grants or contracts being sub-awarded to perform substantive programmatic work under this cooperative agreement must be approved by the Office of Grants Management if the following information was not provided at the time of approval of your budget.  In order for the Office of Grants Management to approve any sub-awards, the following 6 elements need to be provided: Name of Sub-awardee, Method of Selection, Period of Performance, Scope of Work, Method of Accountability, and itemized budget and justification. (Please see attached document for further explanation).

Because of the need for transparency regarding executive compensation using Federal dollars, we are requesting compensation justifications for your top 3 executives to include the OSC Director and OSC Coordinator

State’s Privacy and Security Framework

Narrative of the State’s Privacy and Security Framework.  While the policies may be covered in the HealthInfoNet procedures attached to the plan, we need a narrative discussion that covers all the elements of the HHS policy and security framework, listed below.  We have given the State 45 days to complete this post-award.

• Disclosure Limitation• Individual Access• Correction• Openness and Transparency • Individual Choice • Collection and Use• Data Quality and Integrity• Safeguards• Accountability• A copy of the HHS P&S Framework can be found here:

http://healthit.hhs.gov/portal/server.pt/gateway/PTARGS_0_10731_848088_0_0_18/NationwidePS_Framework-5.pdf

Workforce Development Strategy Session

• October 5th at the McKernon Center of SMCC– Educational institutions– DOL– Hospitals and ambulatory providers– HIN/REC– OSC

• Outcome: A plan for going forward

Health Data Workgroup

Goal: To develop a roadmap to build Maine’s health data, analysis, and research infrastructure to support health care financing and delivery system reform integrating the State Health Information Technology Plan

Description

Maine needs to have a robust data infrastructure to support the implementation of health reform, including the capacity to use health data to support health care providers and systems, purchasers, government, and researchers to understand the performance of the health system in Maine at all levels. While some data will be available from national sources (e.g. CPS to evaluate changes in coverage), our ability to support state and regional analysis of health system performance will depend on having coordinated, integrated, and efficient health data systems.

Description of Work

To develop a roadmap that (1) defines what Maine’s health data infrastructure should look like, (2) inventories and evaluates the current health data systems and capacity in the state (including the policy and legal analysis needed to understand issues of data sharing and access, privacy etc), (3) identifies the critical gaps that the state faces, and (4) defines the steps needed to continue to build Maine health data and data use future.

Behavioral Health Forum

• Initiated by Hanley and MeHAF• One day forum with the outcome to start a

process to plan how behavioral health will be included in the state HIT strategy/plan

• Date in October-November, TBD

• DISCUSSION – Long Term Care, Home Health, Hospice have similar needs as does telemedicine. Ideas?

Updates from HIT Iniatives

• HealthInfoNet – HIE• HealthInfoNet – REC• Community College System• Bangor Beacon Community Program• MaineCare• Maine Primary Care Association

• Other?

Maine Health Information Technology (HIT)Status Report for MaineCare and Office of the State Coordinator for HIT

Project Team: Andy Coburn

Cathy McGuire

Martha Elbaum Williamson

Al Leighton

Deb Thayer

Stuart Bratesman

June 17, 2010

Public Health and Health Policy Muskie School, USM

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Overview

• Project Background– Purpose and Timeframe(s)– Strengths & Limitations

• Survey Methods– Ambulatory Practices– Dental Practices– Acute Care Hospitals

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Overview

• Results to Date – Report follows outline for “as is” assessment– Frequencies for each survey provide additional detail

(Appendixes A – C)– Analysis compares data to criteria outlined in draft rule

• Discussion – Determine any necessary additional analyses for SMHP (e.g.

estimated # of eligible professionals, analysis by adoption)– Determine next steps for additional follow-up to increase survey

participation among groups surveyed – Discuss next steps to set approach for next phase of work of

interest to OSC and OMS

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Project Background

Purpose• To develop data collection instruments, administer them, and

analyze resulting data to inform an “as is” environmental assessment of the status of HIT among providers who are potentially eligible for incentive payments for HIT adoption and use.

• To develop data collection instruments, administer them, and analyze the resulting data to inform statewide HIT efforts being led by Maine’s Office of the State Coordinator for HIT.

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Project Background

April May June July AugustAmbulatory Practice Survey Survey DevelopmentSurvey LaunchFollow-UpData Cleaning And AnalysisHospital SurveySurvey DevelopmentSurvey LaunchFollow-UpData Cleaning And AnalysisDental Practice SurveySurvey DevelopmentSurvey LaunchFollow-Up Data Cleaning And AnalysisReportingInitial FrequenciesPopulated SMHP OutlineData Cleaning and AnalysisAnalysis to OMS/OSCDraft ReportDeliver to OMS/OSCScope Data Collection for Statewide HIT ProjectReview existing InformationMeet with Key StakeholdersOutline Scope and Methods

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Survey Methods

Overall• Develop Survey Tools • Develop Survey Samples• Develop Methods

Limitations• Timeframe (web-based survey)• Available Contact Information• Lack of Provider-to-Site-to-Organization Mapping

Strengths• Data is timely• Instrument reflects current understanding of draft rules

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Survey Methods

Ambulatory Practices• Response rate – 41 percent

• Denominator/Population– Practice lists compiled from several sources– 1546 practices included in lists– 155 duplicates identified– 65 found to be ineligible (as practices)– 15 practices on list had closed– 1311 remaining practices in denominator

• Practices responding - 538

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Survey Methods

Dental Practices• Response rate – 34 percent

• Denominator/Population– Practice lists compiled from OMS – 220 practices on list and used as denominator

• Practices responding - 75

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Survey Methods

Acute Care Hospitals• Response rate – 75 percent

• Denominator/Population– Practice lists compiled from OMS – 40 hospitals on list used as denominator

• Hospitals responding – 30

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Results to DateOverall

HIT Adoption among Maine Providers

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Results to DateAmbulatory Practice Survey

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Results to DateAmbulatory Practice Survey

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Results to DateAmbulatory Practice Survey

• Among 418 practices responding– 46% Do not have an EHR– 4% Have purchased or begun installation– 6% Installed in some areas – 44% Installed and in use in all or nearly all areas

• Practices with EHR– Most practices use CCHIT certified systems– 70% reported completing installation in 2008 or earlier– 26% reported completing installation more recently (2009 or

2010)

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Results to DateAmbulatory Practice Survey

• EHR Adoption by Practice Size

– 68% of 102 large practices (6 or more providers)

– 60% of 124 medium size practices (3 to 5 providers)

– 32% of 180 small practices (1 or 2 providers)

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Results to DateAmbulatory Practice Survey

EHR Adoption by Practice Type

– 38% of 190 specialty practices

– 60% of 215 primary care practices

– Note: Multi-specialty groups are included with specialists and may include primary care providers

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Results to DateAmbulatory Practice Survey

– EHR adoption ranges from 13% of 8 responding practices in Piscataquis County to 82% of 11 responding practices in Lincoln County

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Results to DateAmbulatory Practice Survey

Practices with EHRs • Practices reported using their EHR systems for a variety of

purposes:

– Order entry(82% have CPOE systems/modules)

– Decision support during patient encounter (a majority or near majority use the EHR routinely for a number of clinical decision supports)

– File insurance claims

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Results to DateAmbulatory PracticesMeaningful Use Requirement Criteria for Eligible Professionals Status among respondents with

EHRCPOE 80 percent of all orders 69% meet criteria

Drug-drug, drug allergy, drug formulary checking All capabilities enabled 35% drug-drug34% Drug-allergyFormulary 18% (at point of prescribing)

Maintain up-to-date problem list 80 percent of patients have at least one entry or indication of no problems

84% meet criteria

Generate and transmit e-Rx At least 75 percent permissible Rx transmitted electronically

60% meet criteria

Maintain active medication and allergy list 80 percent of patients seen have at least one entry or indication of none.

89 % meet criteria for medications92% meet criteria for allergies

Record demographics 80 percent of patients seen have gender, race, DOB, ethnicity, preferred language, insurance recorded.

Age, DDOB, Gender 97% meetRace 57% meetEthnicity 48% meetLang. 46% meetInsurance 95% meet

Record vital signs 80 percent of patients 2+ years have BP and BMI; growth chart for ages 2-20

BP-83% meetBMI-63% meetChart growth-57%

Record smoking status 80 percent of patients over 13 seen 62% meet criteria (tobacco use)

Incorporate test results into EHR 50 percent of results expressed as a number or positive/negative. Generate at least one report

74% meet criteria

Generate list of patients with specific conditions Generate at least one report 88% meet criteria

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Results to DateAmbulatory Practice Survey

Meaningful Use Requirement Criteria for Eligible Professionals Status among respondents with EHR

Report quality measures to CMS and the States For 2011, capture required data electronically and provide aggregate numerator and denominator by attestation, for 2012 and later, submit electronically

55% using EHR17% using EHR and paper chart

Send reminders for preventive/follow-up care Send reminders for preventive/follow-up care to 50 percent of patients age 50+

51% meet criteria14% send reminders, but for fewer than 50%

Check insurance eligibility Check eligibility electronically for 80 percent patients seen

39% meet criteria(30% check for fewer than 80% of patients)

Submit claims electronically File 80 percent of claims electronically 84% meet criteriaProvide patients with their health information on request

80 percent of patients who make the request receive it within 48 hours; test results, problem list, med list, allergies

29% usually provide within 48 hours of request (electronic copy) 59% do not have or do not know if they have this capability.

Provide access to clinical summaries Clinical summaries provided for 80 percent of office visits

28% meet19% provide for fewer than 80% of visits

Provide timely access to new results 10 percent of all patients seen receive access to lab results, problem list, medication and allergy lists within 96 hours of provider receipt

9% meet (electronic access)

Exchange meaningful clinical information with care team

One test of capability to exchange key clinical information

A small percentage of practices routinely exchange electronic data with other providers, hospitals and other care settings

Perform medication reconciliation Provide at least 80 percent of encounters and care transitions

46% meet criteria(17% for fewer than 80% of encounters and transitions; 37% do not or are not sure)

Provide summary record at transitions in care and referrals

Provide at least 80 percent of encounters and care transitions in care and referral

43% meet criteria(6% for fewer than 80% of transitions or referrals; 51% do not or are not sure)

Information to immunization registries submitted electronically

Capability to submit data to immunization registries and submission where required and accepted (Stage 1-at least one test of electronic submission capability)

4% report sending electronic data to immunization registries electronically

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Results to DateAmbulatory Practice Survey

Intent to Apply for Incentives

• 35% Not Sure• 14% Not Applying• 36% Applying for Both (Medicaid and Medicare)• 7% Applying for Medicaid only

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Results to DateAmbulatory Practice Survey

Practices without EHRs – Intent to Implement EHRs• 30% have no plans to implement an EHR in 1-5 years• 13% planning to implement in 4-5 years• 40% planning to implement in 1-2 years• 17% will implement within 1 year

Practices without EHRs- Functional Capacities• 95% do not have CPOE (3% have, but don’t use)• 78% do not have e-Rx systems

Barriers to Implementation • 67% cite cost as a significant barrier• 45% cite cost to maintain as a significant barrier

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Results to DateDental Practice Survey

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Results to DateDental Practice Survey

Respondents• 47% General Dentistry / Solo Practice • 11% Specialty Dentistry / Solo Practice• 16% General Dentistry / Group Practice• 9% Specialty Dentistry / Group Practice• 17% Community Dental Clinic

Use of Paper Charts• 20% Entirely paperless• 24% PMS/EDR is most complete source of patient information• 20% Some paper, some electronic records• 35% Primarily paper, some electronic records

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Results to DateHospital Survey

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Results to DateHospital Survey

• Among 30 hospitals responding– 3% Do not have an EHR– 17% Installed in some areas – 80% Installed and in use in all or nearly all areas

• Hospitals with EHR– 80% reported completing installation in 2006 or earlier– 20% reported completing installation more recently (2007 -

2009)

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Results to DateHospital Survey

• Clinical Staff Using EHR Routinely– 3% < 25%– 3% 25-50%– 28% 51-90%– 66% >91%

• Providers Using EHR Routinely – 14% < 25%– 14% 25-50%– 41% 51-90%– 31% >91%

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Results to DateHospital SurveyMeaningful Use Requirement Criteria for Eligible Professionals Status among respondents with

EHRCPOE 10 percent of all orders Lab orders – 70% meet criteria

Radiology – 70% meet criteria Medications– 66% meet criteriaConsultation–39% meet criteriaNursing – 76% meet criteria

Drug-drug, drug allergy, drug formulary checking All capabilities enabled 47% drug-drug47% Drug-allergyFormulary 20% (at point of prescribing)

Maintain up-to-date problem list 80 percent of patients have at least one entry or indication of no problems

Maintain active medication and allergy list 80 percent of patients seen have at least one entry or indication of none

86 % meet criteria for medications92% meet criteria for allergies

Record demographics 80 percent of patients admitted have gender, race, DOB, ethnicity, preferred language, insurance recorded, and cause of death recorded

Name address contact info. 100% meetGender and DOB 100% meetRace and ethnicity 86% meetPreferred language 81%meetInsurance 100% meetCause of death 56% meet

Record vital signs 80 percent of patients 2+ years have BP and BMI; growth chart for ages 2-20

Height, weight, BP - 82% meet criteriaCalculate display BMI - 68% meet criteriaGrowth chart - 43% meet criteria

Incorporate test results into EHR 50 percent of results expressed as a number or positive/negative

Of respondents with EHR providing data: Lab. Reports – 100% meet criteria Radiology reports– 100% meetRadiology images – 100% meetDiagnostic test results – 77%Diagnostic test images – 32%

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Results to DateHospital SurveyMeaningful Use Requirement Criteria for Eligible Professionals Status among respondents with EHR

Report quality measures to CMS and the States For 2011, capture required data electronically and provide aggregate numerator and denominator by attestation, for 2012 and later, submit electronically

To outside Organization 15% using EHR only 74% using EHR and paper chartTo Public health agencies 63% (electronically submit)

Check insurance eligibility Check eligibility electronically for 80 percent patients admitted

79% meet criteria7% check, but for <80%

Submit claims electronically File 80 percent of claims electronically 96% meet criteria

Provide patients with their health information on request

80 percent of patients who make the request receive it within 48 hours; test results, problem list, med list, allergies, discharge summary, procedures

18% meet criteria25% provide information but to <80%57% Do not provide patients (does your current system provide electronic copy?)

Provide patients with discharge information 80 percent of patients who request it, receive electronic copy of discharge instructions Medication list – 82% meet

Exchange meaningful clinical information with care team

One test of capability to exchange key clinical information (cannot share EHR)

96% (EHR not specified)

Perform medication reconciliation Provide at least 80 percent of encounters and care transitions

Nine of the 15 hospitals reporting data on this item meet criteria

Provide summary record at transitions in care and referrals

Provide summary care record at 80 percent of transitions in care and referral

7% meet criteria 18% provide, but for less than 80% percent of transitions/referrals

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Results to DateHospital Survey

Year of First Medicaid Application• 40% 2011• 40% 2012• 4% 2013• 16% Not Sure

Most Challenging Meaningful Use Criteria Cited:•Generate the numerator and denominator data for quality reporting directly from EHR, Perform medication reconciliation across settings of care (12 hospitals), •Exchange clinical information with other providers (10), •implement CPOE at the specified level of sophistication (9), •Implement clinical decisions support rules, give patients access to their data in electronic form (6), and•Generate problem lists using codified data sets (6). 41

Discussion

– Determine any necessary additional analyses for SMHP (e.g. estimated # of eligible professionals, analysis by adoption)

– Determine next steps for additional follow-up to increase survey participation among groups surveyed

– Discuss next steps to set approach for next phase of work for of interest to OSC and OMS

– Other discussion topics??????

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Questions?

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