Health Information Technology Summit August 23, 2007 Ramkota Hotel Sioux Falls, SD

1. Health Information Technology Summit August 23, 2007Ramkota HotelSioux Falls, SD

2. Laurie Gill Deputy Secretary South Dakota Department of Health 600 East Capitol Avenue Pierre, SD 57501 605-773-3361 Laurie.gill@state.sd.us

3. Driving Force • Governor Rounds • Health Care Commission • Electronic Health Record Subcommittee

4. First steps….

6. 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

7. 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

8. 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

9. 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.

10. 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.

11. 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

12. 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

13. Dakota State University 820 North Washington Avenue Madison, SD 57042

14. Data Collection • Survey Instruments • Provider • Consumer • Payer • Focus Groups • Legal Analysis

15. Survey Development • Consumer Survey • AARP (national/state) • Payer Survey • SD Division of Insurance • Provider Survey • RHIO task force • Selected providers • Kick-Off Conference attendees

16. 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

17. Provider Surveys

18. Provider Respondents

19. Does your facility currently have an electronic health record (EHR)?

20. When do you plan to implement an EHR?

21. Providers with no current plans to implement an EHR

22. What was a driving force in implementing an EHR?

23. What are the major barriers to your plans for implementation of an EHR?

24. Provider IT Infrastructure • 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

25. Consumer Surveys

26. Consumer Surveys (age)

27. Consumer Surveys (income)

28. Do you have a personal health record?

29. EHR Benefits

30. EHR Accuracy

31. EHR Confidentiality

32. Focus Groups

33. Locations

34. Scenarios • Treatment/patient care • Payment • Regional health information organizations • Law enforcement • Prescription drugs • Operations/marketing • Public health/bioterrorism • Employee health information • State government oversight

35. Focus Group Assignment • 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

36. Ideal Practice Recommendations • Easy, secure access to patient information • Interoperability (between computer systems) • Medication prescribing • Standardized regulations

37. Easy, secure access to patient information • 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

38. Interoperability (between computer systems) • Universal or standardized formats • Use of a Computerized Physician Order Entry (CPOE) system by all healthcare practitioners

39. Medication prescribing • Online formulary list of all third party payers • Computerized alert system when ordering medications to prevent interactions, overdosing, etc.

40. Standardized regulations • Uniformity of laws between states • Federal laws do not conflict with state laws

41. Common Barriers Identified • Lack of resources • Technology issues • Legislation • Interoperability • Consumer issues

42. Lack of resources • 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

43. Technology issues • 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

44. Legislation • State-to-state differing regulations • Conflict with federal and state laws • Ownership of the medical information • Legal medical record

45. Interoperability • Many EHR vendors and lack of interoperability between the systems • Lack of universal standards for different systems communicating with each other

46. Consumer issues • Consumer education • Internet availability in rural areas • Security and confidentiality concerns • Ability to opt out of a Regional Health Information Organization (RHIO)

47. Legal Analysis

48. Information Reviewed • SDHIMA Legal Manual • Focus Group Scenarios • Relevant journal and Law Review articles • Additional information from related websites

49. Findings • 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.

50. Recommendations