Oregon Health Lawyers Association 2010 Health Law CLE October 8, 2010

1. Oregon Health Lawyers Association2010 Health Law CLEOctober 8, 2010 Carol Robinson Director, Health Information Technology Oversight Council Oregon State Coordinator, Health IT

2. Presentation Objectives • Progress to Date – HB2009 Health Information Technology Update • Identify potential areas for legislation • Provide an overview of Health Information Exchange (HIE) planning in Oregon • Identify future directions where HIE can accelerate health reform goals

3. Health Information Technology Oversight Council Chair Steve Gordon, M.D., Eugene System Senior Director, HITECH Implementation, PeaceHealth Bob Brown, Portland Consumer Advocate Brian DeVore, Hillsboro Director of State Health Policy, Intel Greg Fraser, M.D., Sublimity Medical Director of Information Systems and Informatics, Mid-Valley IPA Bridget Haggerty, Portland VP, CIO, Oregon Health & Sciences University Bill Hockett, Portland Director, Web Strategy, ODS Companies Vice Chair Rick Howard, Salem CIO, Oregon Department of Human Services Marie Laper, Corvallis Behavioral Health Clinical Coordinator, OCHIN Robert Rizk, Hermiston Director, Information Technology, Good Shepherd Health System Sharon Stanphill, Roseburg Clinic Director, Cow Creek Band of Umpqua Tribe of Indians Dave Widen, Dayton Adjunct Professor, Pacific University

4. Progress to Date Progress to Date • HB2009 established Health Information Technology Oversight Council (HITOC) • American Recovery and Reinvestment Act (ARRA) has been a game changer • HITOC has focused on: • Responsible stewardship of federal funds • Reasonable phased approach to HIT and HIE implementation • Strong public/private partnership • HB2009 Established Health Information Technology Oversight Council (HITOC) • American Recovery and Reinvestment Act (ARRA) has been a game changer • HITOC has focused on: • Responsible stewardship of federal funds • Reasonable phased approach to HIT and HIE implementation • Strong public/private partnership

5. “To improve the quality of our health care while lowering its cost, we will make the immediate investments necessary to ensure that within five years, all of America’s medical records are computerized … It just won’t save billions of dollars and thousands of jobs – it will save lives.” (January 5, 2009) Progress to Date • HB2009 Established Health Information Technology Oversight Council (HITOC) • American Recovery and Reinvestment Act (ARRA) has been a game changer • HITOC has focused on: • Responsible stewardship of federal funds • Reasonable phased approach to HIT and HIE implementation • Strong public/private partnership

8. (illustrating intrastate HIE gaps) Oregon HIE Landscape

9. Health Referral Region (illustrating interstate HIE needs)

10. Federal Health IT/HIE Funding Opportunities in Oregon

11. Medicaid and Medicare EHR Incentives • Incentives for Providers achieving “meaningful use” • of Certified Electronic Health Records (EHRs): • Medicaid: • Up to $63,750 for individual providers (6 years) • Medicaid patient volume requirements • Do not have to meet Meaningful Use in Year 1 • Medicare: • Up to $44,000 for individual providers (4 years) • Minimal Medicare patient volume requirements • Must meet Meaningful Use in Year 1 • Potential for $236 million to Oregon hospitals

12. Medicaid EHR Incentives Basics • Medicaid Eligible Professionals: • Physicians, Nurse Practitioners, Cert. Nurse Midwifes, Dentists, Physician Assistants in certain settings • Medicaid patient volume requirements: 30% for most, 20% for Pediatricians • Year 1 ($21,250): Adopt, implement, upgrade to certified EHR • Years 2-6 ($8,500/year): Meaningful use • 2016 is last year to begin program for Medicaid incentives • Hospitals: • Acute care hospitals (including Critical Access Hospitals) – with 10% Medicaid patient volume, and limits on average length of stay • Payments are over 3-5 years, and based on a formula

13. Timeline for Incentive Program

14. Core Components of HIE Strategic Plan • Incremental Phased Approach • Support Local Health Information Organizations • Light Central Services • Standards & Certification • Role of State • Communicate • Coordinate • Facilitate (evolving through the phases) • Oversight • Risk Mitigation and Coverage of Gaps

15. HITOC Workgroups & Advisory Panels * Please note that the HIO Executive Panel will comprise of CEO or equivalent from the HIOs.

16. Health Information Exchange and Health Reform Goals • Better information in the hands of providers at the point of care • Provide infrastructure and capabilities for providers to achieve meaningful use and receive incentive payments • Enable comprehensive quality reporting and data analysis, including both claims and clinical information • Support Public Health surveillance initiatives • Provide data to the Oregon Health Authority, stakeholders and to Legislators to inform policy choices to increase quality, improve patient safety and contain rising health care costs

17. Possible Legislation • Consent policies for information exchange will be key to maximize patient safety, increase the quality and coordination of care • Data security and breach remediation policies will be key to ensuring provider and consumer confidence in HIE • Requirements for the designation of a non-profit public/private entity to run operations of statewide HIE • Accreditation and regulations to define “rules of the road”

18. Key Next Steps • Determine how to maximize use of electronic health data for quality improvement • Define the benefits and impacts of HIE, including elements of public good • Lay the foundation in a rapidly evolving environment with great potential to help meet the goals of public health, higher quality, patient safety and lower costs

19. Resources • HITOC: http://www.oregon.gov/OHPPR/HITOC/index.shtml (HIE Strategic and Operational Plans, meeting materials, list serve, other reports) • O-HITEC: http://o-hitec.org/ (Oregon’s Regional Extension Center for technical assistance relating to EHR adoption and meeting Meaningful Use) • Oregon Health Network: http://www.oregonhealthnet.org/ (Executing on FCC Grant for Broadband expansion) • Oregon Medicaid HIT:http://www.oregon.gov/DHS/mhit/index.shtml (Planning for State Medicaid HIT Plan with 90/10 funding for HIT/HIE) • CMS Incentives: http://www.cms.gov/EHrIncentivePrograms/ (Medicaid and Medicare payment incentive programs for Meaningful Use of EHRs • Office of the National Coordinator for Health IT: http://healthit.hhs.gov/portal/server.pt/community/healthit_hhs_gov__home/1204

20. Questions or Comments: Carol Robinson State Coordinator, Health Information Technology Director, HITOC carol.robinson@state.or.us 503-373-1817 (office) 503-856-6662 (cell)