Policy Landscape for

Health Information Technology

National Governors AssociationWashington, DC

Meeting with Washington Representatives

May 12, 2006 Sharon F. Canner

Vice President, Government AffairseHealth Initiative

May 12, 2006 2

eHI and Foundation Mission and Focus

• Improve the quality, safety, and efficiency of healthcare through information and information technology by:– Developing and disseminating knowledge or

common principles, policies and best practices for supporting transformation through HIT and health information exchange

– Providing seed funding for emerging state, regional and community-based multi-stakeholder initiatives

– Providing “hands-on help” or technical assistance to emerging collaborative efforts at the state, regional and local level

– Advocating for continued favorable national policies related to HIT and health information exchange

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Our Diverse Membership• Consumer and patient groups• Employers, healthcare purchasers, and payers• Health care information technology suppliers• Hospitals and other providers• Pharmaceutical and medical device manufacturers• Pharmacies, laboratories and other ancillary providers• Practicing clinicians and clinician groups• Public health agencies• Quality improvement organizations• Research and academic institutions• State, regional and community-based health information

organizations

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eHI is the “Go-to” Organization For State and Regional HIT and Health Information Exchange Efforts

eHealth Initiativeand Foundation

Knowledge

Advocacy Grants

Hands-on Help

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eHI Work Supporting States and Communities

• eHI Connecting Communities Membership: Over 260 state, regional and community-based collaboratives engaged in health information exchange– many RHIOs/HIEs (health information exchanges)

• eHI directly supports HIT planning and policy initiatives in 13 states

• eHI provides funding to communities to support health information exchange: Connecting Communities Awards Program – nine funded so far, a handful being awarded in next month

• eHI supports AHRQ’s National Resource Center for HIT as a subcontractor to NORC

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What is Health Information Exchange?

• Health information exchange provides the capability to electronically move clinical information between disparate healthcare information systems while maintaining the meaning of the information being exchanged.

• The goal of health information exchange is to facilitate access to and retrieval of clinical data to provide safer, more timely, efficient, effective, equitable, patient-centered care

• There is no single definition of a health information exchange (aka RHIO, CHINs, …)!

• YOU define what health information exchange means to you based upon your needs and priorities!

“Infrastructure to enable data sharing between organizations”

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Value of Health Information Exchange

• Standardized, encoded, electronic HIE would save $78B/yr:– Net Benefits to Stakeholders

• Providers - $34B• Payers - $22B• Labs - $13B• Radiology Centers - $8B• Pharmacies = $1B

– Reduces administrative burden of manual exchange– Decreases unnecessary duplicative tests(Source: Center for Information Technology Leadership, 2004)

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Hub of Best Practice Development for Transformation through Health

Information Exchange• On January 31, 2006 launched eHI’s Connecting

Communities Toolkit, with modules in key areas– Getting started: Assessing environment, engaging

stakeholders, developing shared vision and goals – Organization and governance, legal issues – Value creation, financing and sustainability – Policies for information sharing – Practice transformation and quality improvement– Technical implementation– Policy and advocacy

May 12, 2006 9

Hub of Best Practice Development for Transformation through Health

Information ExchangeLaunched four new working groups to support ongoing

development of principles, tools and resources– Getting Started, Organization and Governance

• Guide for Securing Non-Profit Tax Exempt Status• Toolkit http://toolkit.ehealthinitiative.org

– Value Creation and Financing• Market readiness assessment• Annual Survey of State, Regional and Community-based Health

Information Exchange Initiatives and RHIOs http://www.ehealthinitiative.org/pressrelease825main.mspx

– Practice Transformation and Quality • Guide for clinicians to interface with health information exchange efforts

– Technical Aspects

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Actively Helping More than 150 Communities

• Built a “Connecting Communities” Membership”: stakeholders involved in state, regional and community-based health information exchange initiatives and “RHIOs”– Stakeholders in states, regions and communities have

become Connecting Communities members– Monthly calls to share insights and bring national experts to

the communities to support efforts – Holding regional and national face to face learning forums:

Ohio and Florida completed, Kansas coming– Will vet and pilot rapidly emerging tools for health

information exchange

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Actively Helping States

• Providing direct technical assistance support to several states through HIT state policy initiative– Arizona– Kansas– Louisiana– Michigan– Minnesota– New Hampshire– New York– Wisconsin– Others

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Actively Helping Gulf Coast States

• Providing direct technical assistance support to the Gulf Coast states through contract with DHHS– Alabama– Florida– Louisiana– Mississippi– Texas

• Focus is on supporting development of health information exchange networks

• Media and communications strategy also part of the work

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State Technical Assistance • Increasing understanding of activities, viewpoints, and key

barriers within the state to inform strategy – State environment landscape – HIT / HIE inventory

• Providing education and increasing awareness across states • Making connections with peers in other states – “cooperative

model”• Laying the foundation for ongoing collaboration and forward

movement within the state• Providing national and industry expert review and assistance • Providing stakeholders with a high-level roadmap that states

have created themselves to catalyze HIT and HIE movement within the state

May 12, 2006 14

Understanding the National Agenda – Administration and Congress

• Enormous momentum around HIT and health information exchange both within Administration and Congress

• Key themes– Role of government, role of private sector– Need for standards and interoperability:

technical AND privacy and security– Need for alignment of incentives with BOTH

quality and efficiency goals and the HIT infrastructure to support them

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Administration Initiatives/Developments

• President George W. Bush created new sub-cabinet level position – 4/04 (Office of National Coordinator/ONC for HIT

• Strategic Framework released by ONC in 7/04• Summary of over 500 Responses to RFI for National

Health Information Network released in 5/05 • Secretary Michael Leavitt released four RFP’s re

Interoperability and Health Information Sharing Policies in 6/05

• American Health Information Community (AHIC) Commissioners announced 9/05

• Change of Leadership at ONC – April 2006 (National Coordinator Dr. David Brailer resigns)

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Strong Momentum for HIT and Health Information Exchange: Activities in

Administration• AHIC public-private “community” to provide

input to Sec. Leavitt re how to make health records digital and interoperable and assure that privacy and security are protected

• AHIC reviewed “break-through” areas that will create realizable benefits to consumers in two to three years and established workgroups with final recommendations May 16:

– Consumer empowerment– Electronic heath records– Chronic disease– Biosurveillance

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AHIC Commissioners• Craig R. Barrett, Chairman, Intel Corporation• Nancy Davenport-Ennis, CEO, National Patient Advocate

Foundation• Lillee Smith Gelinas, R.N., Chief Nursing Officer, VHA Inc• Douglas E. Henley, M.D., Executive Vice President, American

Academy of Family Physicians• Kevin D. Hutchinson, CEO, SureScripts• Charles N. Kahn III, President, Federation of American Hospitals• Steven S Reinemund, CEO and Chairman, PepsiCo• E. Mitchell Roob, Secretary, Indiana Family and Social Services

Administration• Scott P. Serota, President and CEO, Blue Cross Blue Shield

Association• Government: Secretary Leavitt and CMS, CDC, VA, DoD, Treasury,

OPM, Commerce and IFSSA representatives

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HIT and Health Information Exchange: Activities in Administration

• Four awards emerged from DHHS:– Standards harmonization process – awarded by

ONC to ANSI in Oct 2005– Compliance certification process for EHRs –

awarded by ONC to Certification Commission for HIT in Oct 2005

– Variations in organization-level business policies and state laws that affect privacy and security practices (including HIPAA) – awarded by AHRQ to RTI International in Oct 2005

– Nationwide health information network prototypes – ONC awarded four projects in November covering 12 communities

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Centers for Medicare & Medicaid Services Linking Quality and HIT

• Section 649 – Pay for Performance Demonstration Programs – link payment to better outcomes and use of HIT – launched in early 2005

• Quality Improvement Organizations playing a critical role…. Doctors Office Quality – Information Technology Program (DOQ-IT) – technical assistance for HIT in small physician practices included in eighth scope of work

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Centers for Medicare & Medicaid Services

• Chronic Care Demonstration Program (Medicare Support) linking payment to better outcomes – IT a critical component

• Section 646 “area-wide” demonstration announced in September 2005

• Physician Voluntary Program Reporting Program regarding quality of care began January 2006

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AHRQ Focus on HIT and Health Information Exchange

Over $150 million in grants and contracts for HIT• Over $100 million supporting approx 110

grants in 38 states – approximately 50% focus on health information exchange

• Contracts to six states to help develop statewide health information exchange networks – CO, DE, IN, RI, TN, UT - $29 million over five years

• National HIT Resource Center: collaboration led by NORC and including eHealth Initiative, CITL, Indiana University, Vanderbilt and CSC - $18.5 million over five years

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In Summary…

Administration• AHIC focuses national attention on standards

development and private-public sector collaboration

• Workgroups to deliver final recommendations in May

• RFPs key in advancing Interoperability and Health Information Sharing Policies awarded – details to come

• Activity in several agencies – details on CMS to come

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Signs of Momentum for HIT and Health Info Exchange: Activities

in Congress• 13 bills introduced in 2005, 4 in 2006

• Most bi-partisan

• Unprecedented collaboration between the Republicans and Democrats on the importance of leveraging HIT and the mobilization of information to address healthcare challenges

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Common Themes of Legislation

• The need for standards —creation of a public-private sector body designed to achieve consensus on and drive adoption of interoperability standards

• Grant and loan programs, for providers and regional health information technology networks – most link to use of standards and adoption of “quality measurement systems”

• Role of government – catalyst, driver of change• Value-based purchasing programs – measures

related to reporting of data, process measures including HIT, and eventually outcomes

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HIT Legislation

HIT Bills Pending Action• S 1418 (Wired for Health Care Act) passed

Senate in 2005• HR 4157 – Ways & Means (Johnson

R-CT/Deal R-GA) HIT bill • HR 4642 – Same as S 1418 (introduced in

House, Issa R-CA)• HR 4641 - Assisting Doctors to Obtain Proficient

and Transmissible Health Information Technology (Gingrey R-GA) tax credits

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HIT Legislation

• HR 4859 -Federal Family Health 4 Information Technology Act (Porter R-NV)

• Federal Employee Personal Health Records Act (Carper D-DE) - draft

• HR 4832 (Clay D-MO, Porter R-NV) - would codify ONC, create national interoperable health information infrastructure, fund provider loans, create Stark/Anti-kickback safe harbor

• S. 2772 - Health Partnership Act (Voinovich R-OH/Bingaman D-NM)- grants to states and others to improve coverage and healthcare infrastructure (5/9/06)

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Progress on Moving Legislation

• Energy and Commerce Markup scheduled for week of May 22/floor week of June 19Draft language has similarities to HR 4157

• Ways and Means has yet to schedule markup• Conference on House-passed legislation (big

assumption) with S 1418

- Major differences in approach

- S 1418 more prescriptive with funding

- House bare bones with no funding

May 12, 2006 28

Senate 1418: Wired for Healthcare Quality Act Passed in Nov. 2005• Key Elements:

– Authorizes ONCHIT – Authorizes public-private AHIC to advise Secretary,

recommend actions, and standards – Grants to providers, states and for regional/local HIT

plans– Demonstration program to integrate IT into clinical

education– Development of quality measures and government

capability to accept electronically reported measures– Creation of health information technology resource

center

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Senate 1418: Wired for Healthcare Quality Act

• Competitive Grants for Qualified HIT– For not-for-profit hospitals, federally qualified health

centers, individual or group practices or other health care providers

– Must adopt standards, implement and report quality measures, agree to notify patients of wrongful disclosure, demonstrate need, and provide matching funds ($1 for every $3)

– Preference given to rural, frontier or underserved areas or eligible entities that will link qualified HIT to local or regional health information plans

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Health Information Technology Promotion Act – (Johnson R-CT/Deal R-

GA) HR 4157

• Codifies ONCHIT headed by National Coordinator, responsible for activities, such as Principal advisor to Secretary on development and use of HIT Standards harmonization for use in exchange of health

information Certification/inspection of HIT products, services and

architecture• Requires study for harmonization of state

laws and regulations regarding security and confidentiality of health information

• Requires rule-making for adoption of ICD 10 codes

May 12, 2006 31

Johnson-Deal HIT cont’d

• Provides exemption from Stark, Anti-Kickback and other statutes for any non-monetary remuneration

• Requires remuneration without regard to the number or value of physician referrals

• Effective 180 days after bill enactment• Requires HHS Secretary to conduct a study

on safe harbor effectiveness in increasing HIT adoption

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Increasing Interest in Pay for Performance and Quality

• Medicare Value Based Purchasing legislation introduced in both House and Senate n 2005 and included in Senate Budget Reconciliation

• Health plans including, BCBSA, and RWJ grants• National Quality Forum getting consensus on

ambulatory care measures• Large private sector purchasers and CMS

increasing interest in quality within ambulatory care… Bridges to Excellence a key player

May 12, 2006 33

Action on Pay for Performance Legislation

• Medicare Value Purchasing Act of 2005 (Grassley R-IO, Baucus D-MT D, S 1356) incorporated in Senate Deficit Reduction Omnibus Reconciliation Act of 2005 (S 1932)

• Establishes phased-in value-based purchasing programs for physicians and other providers Ties reimbursement to reporting of data on quality measures Requires development/updating of quality measurement system to guide

value-based purchasing Requires HHS to contract/consult with diverse stakeholders to build

consensus around sets of measures Funding not considered sufficient to encourage physician participation

• House Deficit Reduction bill (HR 4241) did not include Medicare P4P provision

• P4P provisions dropped in conference

May 12, 2006 34

HIT Appropriations – FY 2007

• President’s budget requests: $169 million, an increase of $58 million over 2006, for

ONC $50 million to AHRQ for health IT, the same as the

FY2006 amount. These funds would be used to “advance the use of health IT to enhance patient safety.”

As part of the FY 07 Budget Resolution approved March 16, the Senate voted to create a reserve fund for HIT, which allows “scoring” over 5 years .

o Requires HIT legislation for implementation

May 12, 2006 35

Hearings – 2nd Session

• House Ways and Means Subcommittee March 1 on Medpac Recommendations

• House Government Reform Subcommittee March 15 re PHRs• House Energy and Commerce Subcommittee March 16 re

standards, interoperability and privacy – eHI testified• Ways and Means Health Subcommittee April 6 – 4th hearing

re Medicare adoption of HIT• House Small Business Committee/ Subcommittee on

Regulatory Oversight and Reform April 6 - feasibility of small physician practices adopting electronic medical records

• Senate Commerce Subcommittee May 17 – Accelerating the Adoption of HIT

May 12, 2006 36

Summary/Outlook

• Strong bi-partisan interest in HIT enabling legislation re standards and infrastructure

• House Energy and Commerce leadership on mark-up and floor strategy

• President proposes $169M to fund ONC, double FY 2006, although limited funds to support seed fund grants

• Election year favors HIT as strategy to address issues of cost and patient safety, yet few legislative days and diverse House-Senate approaches hinder action

• Privacy and Stark/Anti-kickback pose challenges

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Sharon F. CannerVice President, Government Affairs

eHealth Initiative

www.ehealthinitiative.org818 Connecticut Avenue, N.W., Suite 500

Washington, D.C. 20006202.624.3269

Sharon.canner@ehealthinitiative.org