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The Slippery Slope: The Regulatory Landscape and HIMSS Response for Ambulatory Care Providers

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The Slippery Slope: The Regulatory Landscape and HIMSS Response for Ambulatory Care Providers

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    1. The Slippery Slope: The Regulatory Landscape and HIMSS Response for Ambulatory Care Providers Sue Sutton, RN, PhD President and CEO

    2. 2 The Full Spectrum of Care Settings

    3. 3 Contrasts: Ambulatory Care vs. Acute Care

    4. 4 Comparing Health Expenditures

    5. 5 The IT Vendor Market

    6. 6 HIMSS Responds…. 2004 BOD allocates resources focused specifically on Ambulatory Care Creates the Ambulatory Care Steering Committee Hires Mark Leavitt as Director of Ambulatory Care 2005 Ambulatory Interoperability Showcase at National Meeting in Dallas Creates a Knowledge Resource Taskforce for Ambulatory Launches Ambulatory Section of HIMSS Website PACT Conferences Ambulatory Care Audio conferences 2006 Ambulatory IT Showcase More….

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    8. 8 What was the catalyst? IOM Report 2001 Crossing the Chasm Indicated that 45-90,000 patients were dying annually due to errors and omissions in hospital care Recommended the implementation of HIT to resolve problems of: Patient identification Errors in transcription Medication errors Suggested the implementation of EMRs would resolve many of the quality issues in HIT

    9. 9 What happened next? Not much! Slow adaptation of EMRs Why?

    10. 10 What is happening in US Healthcare Adoption of EHR moving rapidly in large organizations Slow adoption in rural/small provider locations Market is setting out to a few big vendors Healthcare costs are sky rocketing RHIO’s everywhere!

    11. 11 RHIOs Everywhere Regional Health Information Networks (RHIO) are forming in every region of the country Over 150 documented to date Attempting to create regional sharing of EHR between providers/organizations Key Barriers Interoperability Standardization Method of Identifying Patients

    12. 12 State of US Ambulatory Care 2005 survey of sicker adults in Australia, Canada, Germany, New Zealand, United Kingdom and US Sizable shares of patients in all 6 countries report that mistakes occur outside the hospital US stands out for inefficient care and errors and is an outlier on access/cost barriers

    13. 13 Key Drivers for Legislation Improve patient safety and patient outcomes Promote information and communication technology Create a system and culture of quality Enhance individual patient knowledge, responsibility and power to choose

    14. 14 Saving Lives and Saving Money Newt Gingrich’s Center for Healthcare Transformation Three parallel layers of health transformation Individual Change Institutional/Provider Change Science Changes Everything “We must begin to say YES,IF, not NO, BECAUSE”

    15. 15 It’s been a busy year for legislators…. Jan. 2005 President pushes the healthcare agenda – focus on an improving the health of Americans while keeping the economy competitive June 6, 2005 Secretary of Health and Human Services announced the formation of an American Health Information Community (AHIC) AHIC to serve as a national standards and policy body to recommend to the federal government how to achieve interoperable EMRs that assure privacy and security. We are “TURNING THE BIG WHEELS”

    16. 16 AHIC Announced the pending release of four RFP’s to address foundation issues: Standards Harmonization - single contract to develop, test and evaluate prototype standards Certification – single award contract to evaluate the feasibility of an EMR certification and inspection process Prototypes for an Internet-based NHIN Architecture – six awards for prototypes of interoperable nonproprietary NHIN architectures. Privacy and Security Solutions for Health Data Exchange – Determine challenges and solutions for achieving smoother transmission of healthcare data.

    17. 17

    18. 18 October 20th David Brailer, MD of HHS says: “There is a new debate about who will control health information. I want it to be the patient”.

    19. 19 October 4 - HIMSS Government Relations Roundtable Rep. Jon Porter (R-NV), is planning to introduce as legislation which would turn the Federal Employees Health Benefits Program (FEHBP) into the nation’s largest EHR demonstration project introduce a bill that would mandate the creation of an EHR for every person covered by FEHBP, which amounts to about 4 million current and retired federal employees. Each person covered would get a wallet-size EHR identification card within five years of the law’s enactment. The bill would phase in the EHR requirement, beginning with records of claims paid by the participating insurance companies. It is expected that the bill, to be called the Federal Family Health IT Act, also would provide for reductions in liability insurance premiums for physicians who use health IT systems.

    20. 20 October 31st - HHS Details Regulatory Agenda A final rule, expected in March 2006, giving safe harbor for certain electronic prescribing initiatives under the federal anti-kickback statute. This will enable hospitals and others to give physicians non-monetary remuneration--such as hardware, software and training--to assist in adopting electronic prescribing. A final rule, expected in October 2008, to create exceptions in the physician self-referral prohibition. This will enable hospitals and others to assist physicians with adopting electronic prescribing and other electronic medical records components. Federal officials recently said some rules to lift regulatory barriers would be delayed until certification programs were in place for various electronic records components.

    21. 21 October 31st - HHS Details Regulatory Agenda

    22. 22 October 31st - HHS Details Regulatory Agenda A proposed rule, expected in May 2006, to make annual modifications to the standard electronic transactions and code sets mandated by HIPAA. A final rule, slated for September 2008, to establish national electronic standards for claims attachments. A final rule, expected in December 2006, to implement requirements for electronic submission of Medicare claims and conditions upon which a waiver could be granted. A proposed rule, slated for September 2006, to permit release of Medicare beneficiary-specific information--upon patient consent--from quality improvement organizations to clinicians who are in a "treatment relationship" with the beneficiary.

    23. 23 AHIC Contracts Awarded – Nov. 11, 2005 $18.6 M in contracts awarded to four consortia to build prototypes for a nationwide health information network Govt. through DOD, Veterans Affairs and agencies such as the Centers for Medicare and Medicaid Services will develop an ARCHITECTURE based on the prototypes

    24. 24 The Winners - Four Consortiums Accenture working with vendors and partners in the Kentucky, Tenn. and West Virginia health market areas CSC working with vendors and partners in Indiana and California IBM working with vendors and partners in New York and North Carolina Northrup Grumman working with vendors and partners in Santa Cruz, Cincinnati, and Cleveland

    25. 25 Their Charge Design and implement a standards-based network prototype Test patient identification and information locator services; user authentication, access control and other security protections Test the feasibility of large-scale deployment Inform the deliberations of AHIC

    26. 26 HIMSS is responding… CMS Role on Developing the Personal Health Record (PHR) Physicians’ Referrals to Health Care Entities with Which They Have Financial Relationships; Exception for Certain Electronic Prescribing and Electronic Health Records Arrangements A response is required almost weekly…..

    27. 27 What can HIMSS Members Do? Understand how these initiatives affect you and your work environment Work with your local chapter to craft responses to the proposed legislation Watch the HIMSS news Attend PACT conferences Stay tuned!

    28. 28 Contact Information Sue Sutton, RN, PhD President and CEO 512-330-9584 ssutton@towerstrategies.com

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