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Health Information Technology Summit August 23, 2007 Ramkota Hotel Sioux Falls, SD. Laurie Gill Deputy Secretary South Dakota Department of Health 600 East Capitol Avenue Pierre, SD 57501 605-773-3361 [email protected] Driving Force. Governor Rounds Health Care Commission

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Health Information Technology Summit

August 23, 2007Ramkota HotelSioux Falls, SD


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Laurie Gill

Deputy Secretary

South Dakota Department of Health

600 East Capitol Avenue

Pierre, SD 57501

605-773-3361

[email protected]


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Driving Force

  • Governor Rounds

  • Health Care Commission

  • Electronic Health Record Subcommittee



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Steering Committee

  • Doneen Hollingsworth, Co-Chair, South Dakota Department of Health

  • Deb Bowman, Co-Chair, South Dakota Department of Social Services

  • Dave Hewett, SD Association Healthcare Organizations

  • Dr. Stephen Schroeder, SD Foundation for Medical Care

  • John Porter, Avera

  • Kelby Krabbenhoft, Sanford Health

  • Dana Darger, Rapid City Regional

  • Kristie Fiegen, Junior Achievement of SD

  • Bill Nelson, Coteau des Prairies Hospital

  • Barb Smith, SD State Medical Association

  • Dr. Jim Reynolds, North Central Heart Institute

  • Dr. Charles Hart, Rapid City Regional Hospital

  • Dr. Jim Szana, Dentistry at the St. Charles

  • Otto Doll, Bureau of Information and Telecommunications


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SDEHRA Goals

  • Assess variations in organization-level business policies and state laws that affect health information exchange (HIE)

  • Identify barriers and best practices relating to HIE

  • Identify privacy and security issues relating to HIE

  • Investigate HIE possibilities for South Dakota and surrounding region


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Two-prong approach

  • Online surveys for payers, providers, and consumers

    • Over 350 received

      • 210 Consumers

      • 155 Providers

      • 2 Payers

  • Four regional focus groups

    • Rapid City, Aberdeen, Pierre, Sioux Falls

    • 75+ representatives from multiple disciplines


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SDEHRA Participants

  • Clinicians

  • Physician Groups

  • Federal Health Facilities

  • Hospitals

  • Payers

  • Community Clinics

  • Pharmacies

  • Laboratories

  • Long-Term Care Facilities

  • Hospice

  • Correctional Facilities

  • Professional Associations

  • Consumer Organizations

  • Consumers

  • Etc.


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Prepare to Share...Share for better Care!

Kick-Off conference held in October. Laura Adams from the Rhode Island Quality Institute gave the keynote address. Over 100 participants around the state were a part of the conference.

Presentation is available on the www.SDEHRA.org website.


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Timeline

  • October 2006

    • Kick Off Conference

  • November 2006

    • Focus / Work Groups Designated

  • December 2006

    • Survey Process Begins

  • January 2007 – March 2007

    • Focus / Work Group Meetings

    • Surveys Finalized

  • April 2007 – June 2007

    • Results Analyzed

    • Final Report Preparations

  • July 2007

    • Final Report Issued

  • August 2007

    • Health Information Technology Summit


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SDEHRA Outcomes

  • South Dakota focused

    • “Prepare to Share, Share for Better Care”

  • Address barriers

    • Legal, Organizational-Level, Financial

  • Provide a roadmap for future IT initiatives in SD

  • Website – www.SDEHRA.org

    • Multiple resources including slides from today’s presentations are available


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Dakota State University

820 North Washington Avenue Madison, SD 57042


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Data Collection

  • Survey Instruments

    • Provider

    • Consumer

    • Payer

  • Focus Groups

  • Legal Analysis


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Survey Development

  • Consumer Survey

    • AARP (national/state)

  • Payer Survey

    • SD Division of Insurance

  • Provider Survey

    • RHIO task force

    • Selected providers

    • Kick-Off Conference attendees


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Survey Distribution

  • Email and newsletter announcements

    • SDAHO, SDHIMA, etc.

  • Letters to associations and providers

  • News releases (print, radio, television)

    • Television coverage

    • KSOO Viewpoint University Talkshow

    • Newspaper articles

  • Reminders

    • News releases

    • Postcards

    • Association newsletters









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Provider IT Infrastructure of an EHR?

  • 36% have redundancy hardware for information systems

  • 51% system provides redundancy (backup) of data

  • 86% facility systems are accessible with authentication

  • 87% facility’s employees use a unique user identifier to access their information systems

  • 100% main authentication method currently used is passwords

  • 60% employee training for password authentication and auditing to maintain password security

  • 69% facility-forced password changes

  • 77% physical access to computing resources by employees is NOT considered a barrier to increasing use of electronic records


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Consumer Surveys of an EHR?





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EHR Benefits of an EHR?


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EHR Accuracy of an EHR?



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Focus Groups of an EHR?


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Locations of an EHR?


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Scenarios of an EHR?

  • Treatment/patient care

  • Payment

  • Regional health information organizations

  • Law enforcement

  • Prescription drugs

  • Operations/marketing

  • Public health/bioterrorism

  • Employee health information

  • State government oversight


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Focus Group Assignment of an EHR?

  • Identify the issues of the scenario

  • Describe how the situation in the scenario was handled in their particular work setting

  • Describe the ideal practice standard

  • Identify barriers that could possibly prevent the ideal practice standard from occurring


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Ideal Practice Recommendations of an EHR?

  • Easy, secure access to patient information

  • Interoperability (between computer systems)

  • Medication prescribing

  • Standardized regulations


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Easy, secure access to patient information of an EHR?

  • Common patient identifier

  • Online patient authorization to release medical information

  • Use of a Continuity of Care Record (CCR)

  • Use of an EHR by all healthcare providers with a standardized format

  • Use of a Picture Archiving and Communication System (PACS) for easy access to all types of images

  • Use of a data repository

  • Automatic alert for reportable diseases

  • Access to information by third party payers for reimbursement only


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Interoperability (between computer systems) of an EHR?

  • Universal or standardized formats

  • Use of a Computerized Physician Order Entry (CPOE) system by all healthcare practitioners


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Medication prescribing of an EHR?

  • Online formulary list of all third party payers

  • Computerized alert system when ordering medications to prevent interactions, overdosing, etc.


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Standardized regulations of an EHR?

  • Uniformity of laws between states

  • Federal laws do not conflict with state laws


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Common Barriers Identified of an EHR?

  • Lack of resources

  • Technology issues

  • Legislation

  • Interoperability

  • Consumer issues


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Lack of resources of an EHR?

  • Cost of

    • staff education and training

      • the need for specific knowledge of HIPAA regulations regarding Release of Information (ROI) in an emergency such as bioterrorism

      • time to train staff on new policies and procedures regarding the use of the EHR system and hardware

    • needed hardware

      • upgrading of hardware as technology and requirements change

    • needed software

      • maintaining support once implementation is complete


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Technology issues of an EHR?

  • All facilities not utilizing the EHR, CPOE, PACS, etc.

  • Physician/staff resistance to new technology

  • Concern for security, confidentiality, and access

  • Password maintenance

  • Network maintenance

  • Planned and unplanned down time of the system

  • Unavailability of broad-band transmission in some areas


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Legislation of an EHR?

  • State-to-state differing regulations

  • Conflict with federal and state laws

  • Ownership of the medical information

  • Legal medical record


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Interoperability of an EHR?

  • Many EHR vendors and lack of interoperability between the systems

  • Lack of universal standards for different systems communicating with each other


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Consumer issues of an EHR?

  • Consumer education

  • Internet availability in rural areas

  • Security and confidentiality concerns

  • Ability to opt out of a Regional Health Information Organization (RHIO)


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Legal Analysis of an EHR?


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Information Reviewed of an EHR?

  • SDHIMA Legal Manual

  • Focus Group Scenarios

  • Relevant journal and Law Review articles

  • Additional information from related websites


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Findings of an EHR?

  • Current South Dakota statutes and administrative rules governing health information exchange need refining to better comply with federal HIPAA standards.

  • There is a need for plain English wording or interpretation to HIPAA compliance within South Dakota. Such a wording will help South Dakota physicians, hospitals, clinicians, insurers, researchers and managed care organizations limit the opportunity for legal and financial risk.

  • South Dakota should implement a system of balanced interests between patients and providers.


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Recommendations of an EHR?


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Recommendations of an EHR?

  • Purpose of study was gathering information.

  • This section represents an effort to analyze, interpret, and condense that information.

  • Goal:

    • Clear, well-motivated, broad, actionable items

    • address the issues as South Dakota migrates toward electronic health information systems

  • Context:

    • Electronic Health Information Systems are coming


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Recommendations of an EHR?

  • Quick Summary

    • Develop a Center

    • Continue Research

    • Develop and Deliver Education

    • Design and Develop Prototype Systems

    • Begin to Address Legal Issues


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Develop a Center supporting of an EHR?Electronic Health Information Exchange

  • Develop a center or organization to provide united and focusedleadership as well as provide continuity to the EHR adoption process, along with information, support and resources for electronic health care in South Dakota.

  • Keys:

    • Balance – among disparate stakeholders

    • Broad view – supporting exchange of electronic health information without other agenda


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Continue Research and Investigation of an EHR?

  • Need to fill gaps

  • Need to increase participation

  • Need to examine resources – both internal and external – which can help to smooth the path to effective electronic health information


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Education and Training of an EHR?

  • An unavoidable issue with new technology:

    • understanding and using it effectively

  • Affects consumers and service providers

  • Mitigate this through advance preparation

    • Education and Training

    • From broad and general (“What is an EHR?”)

    • To focused and specific (e.g., choose a privacy option; or enter a chosen option for a consumer)


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Prototype of an EHR?

  • Build systems to provide some of the services to some of the stakeholders

    • Focus on opportunities

      • Leverage existing systems -- extending or combining

    • Focus on gaps

      • What pieces aren’t being addressed elsewhere?

      • Where is there a “failure to communicate”?

      • Champion a complete, balanced solution

    • Focus on standardization


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Begin to Address Legal Environment of an EHR?

  • Slow process

    • Need leaders, perseverance and constituency

  • Goals: Clarity and Balance

    • Uncertainty can be a serious impediment

    • Build on South Dakota’s advantage – a relatively small, agile, cooperative environment for health care information systems among the industry, consumers, and government


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Recommendations Review of an EHR?

  • Develop a center to lead the effort.

  • Conduct more research to understand the challenges and possibilities.

  • Develop and deliver education to prepare both consumers and service providers.

  • Prototype systems to design, combine, and extend functionality.

  • Address health care information law to bring greater clarity and certainty to the environment.


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Thank you! of an EHR?


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