Alaska Association of Tribal Health Directors

1. Alaska Association of Tribal Health Directors Indian Health Service Health Information Technology May 12, 2009

2. Agenda • ARRA HIT Funding • RPMS • Infrastructure • Non-IHS ARRA opportunities • Health IT Public Utility Act • “Meaningful use of Certified EHR” requirements • Status of IT Tribal Shares Restructuring Proposal & I/T/U IT Work Group • Future of RPMS • Collaboration with VA & other open source entities • Marketing of RPMS to non-IHS health providers • Pending legislation

3. The Goalof ARRA • As stated on www.recovery.gov website: “The American Recovery and Reinvestment Act is an unprecedented effort to jumpstart our economy, create or save millions of jobs, and put a down payment on addressing long-neglected challenges so our country can thrive in the 21st century.” • IHS/OIT will focus funding to modernize and extend electronic health information technology throughout Indian Country

4. ARRA Objectivesfor OIT IHS • Contribute to the revitalization of the American economy • Activities will require a significant expansion in the use of IT service companies and will also require significant purchases of hardware from U.S. based information technology companies • Job creation • Deploy a certified electronic health record that meets the requirements of “meaningful use” • Implement a personal health record tool • Upgrade the reliability, redundancy, and security of the IHS network • Ensure an adequate telemedicine infrastructure

5. Planned EHRImprovements • Use of Certified Electronic Health Record In A Meaningful Way • Comprehensive Health Information- Improving capabilities across the RPMS suite- including practice management • Provider Order Entry- Continued improvements to applications that support the communication of orders and consultations. • Clinical Decision Support- Creating and acquiring clinical decision support tools. • Quality and Performance Reporting- Expanding existing quality and performance reporting capabilities. • Health Information Exchange- Activities to ensure that RPMS meets national interoperability standards. • Certification- Ensuring that RPMS receives national certification as a qualified HER for ambulatory, inpatient and behavioral health • Deployment- Intensive support for the deployment of RPMS EHR in all Federal and Tribal inpatient facilities.

6. RPMS Training andsupport for Alaska sites • Final spending agreement includes goal of ensuring that all I/T/U sites that desire to use RPMS will have deployed a certified RPMS in a meaningful way by 2011 • OIT has commitment to ‘bring up’ Alaska sites onto RPMS if desired • Large commitment expected in the next 18 months- people on the ground to ensure that this goal can be reached

7. Personal HealthRecords • Initiatedevelopment and collaborations to create truly consumer-oriented tools for management and portability of personal health information • Develop a secure environment that enables patients to receive information from RPMS or other locations and enter additional personal health information • Utilizing national standards, create a bidirectional interface between the RPMS and a secure external database to enable consumers the opportunity to obtain, manage, and share their health information • Create a portal to enable patients to access functionality to improve healthcare communication between patients and clinicians and to receive improved access to services and resources • Create and evaluate health literacy appropriate tools that provide consumers with clinical decision support tools to improve preventative services and best practice care

8. Network InfrastructureImprovements • Improvements to the IHS network or support future telehealth initiatives.   • Complete refresh/upgrade of network routers • Complete refresh of agency domain controllers • Implementation of multi-factor authentication for remote users • Security upgrades for intrusion detection, vulnerability management, and log analysis • Upgrade/expansion of the storage area network • Upgrade of the video conferencing infrastructure for telemedicine • Installation of additional video conferencing devices for telemedicine • Vista Imaging support (equipment as well as technical)

9. Proposed Output andOutcome Measures Output Measure: Increase uptime of IHS data center network circuits • Uptime is a measure of the time a circuit is operational and available to carry data communications across the network.  • IHS-OIT plans to measure uptime quarterly to achieve our target of 99.9% by the end of fiscal year 2010. Outcome Measure: Percentage of all orders that are electronically entered into the EHR • This is a standard report that can be generated from every system operating the RPMS Electronic Health Record, and the results can be aggregated at a national level.  • IHS-OIT plans to measure a percentage of all orders entered electronically quarterly to achieve our target of 75% by the second quarter of fiscal year 2011.

10. Other ARRA-RelatedInitiatives • Expansion of broadband assistance for rural areas • Incentives for the meaningful use of electronic health records

11. Broadband Technology Opportunities Program (BTOP) • This is a collaborative effort between the FCC; Commerce’s National Telecommunications and Information Administration (NTIA); and UDSA Rural Utility Service (RUS) to provide rural broadband services. • The U.S. Congress has appropriated $4.7 billion to establish a Broadband Technology Opportunities Program (BTOP)

12. BTOP • Grants will be available for both wireless voice and broadband • Funds are to be used for both unserved and underserved areas • NTIA target is 25% for unserved areas and 75% for expanding service in underserved areas • Applicants will be able to apply for grants under either RUS or NTIA, but not both • NTIA plans to create a common application for both the NTIA and RUS. • Waiting for additional information on what has been defined as an eligible area for grants • IHS is working to determine the specific process Tribes will need to follow to apply for grants • More to follow as additional information is made available

13. Health Information Technology for Economic and Clinical Health Act (HITECH Act) • This bill accomplishes four major goals • Requiring the government to take a leadership role to develop standards by 2010 • Investing in health information technology infrastructure and Medicare and Medicaid incentives • Savings throughout the health sector, through improvements in quality of care and care coordination • Strengthening Federal privacy and security law to protect identifiable health information

14. HITECH Act • Beginning in 2011 and for the first five years, the Recovery Act will compensate physicians who are “meaningful EHR users” (not defined at this point) • No incentive payments will be made after 2016 • No incentives given to physicians who start after 2014 • Physicians who practice in an area of professional shortage shall receive an additional 10% • Hospital based Physicians are not eligible • Physicians who are not meaningful EHR users by 2015 will have their Medicare reimbursements reduced by 1% to 3% each year. • If the first payment year for an eligible hospital is after 2015 than the hospital is not eligible for any incentives • Either medicare OR medicaid incentive but not both

15. Meaningful Use • To be defined by CMS and ONC ( office of the national coordinator) • E prescribing • Interoperability as defined by?? • Medicare for Medicare Incentives • Medicaid (i.e. state) for Medicaid Incentives • Quality Measures

16. HITECH Act • Medicare Incentives • Sec. 4101 Incentives for eligible professionals • First year (if beginning in 2011 or 2012) $18,000 (after 2012) $15,000 • Second year $12,000 • Third year $8,000 • Fourth year $4,000 • Fifth year $2,000 • Sec. 4102 Incentives for hospitals (Base amount of $2 million if first payment is before 2013) • First year (full base amount) • Second year (3/4 base amount) • Third year (1/2 base amount) • Fourth year (1/4 base amount) • Medicaid Incentives • Sec. 4201 Medicaid provider HIT adoption and operation payments; implementation funding. • Eligibility: • Medicaid providers- at least 30% of patients are Medicaid • Medicaid hospitals- at least 30% of discharges are Medicaid • Pediatric providers—at least 20% of patients are Medicaid • Funding available based on average net cost to deploy EHR in these different settings • Providers capped at 25,000 annually not to exceed five years worth of payments with first beginning no later than 2016 • Hospitals capped at $2 million annually not to exceed five years worth of payments with first beginning no later than 2016

17. HITECH Act • Additional Potential Funding Opportunities through HITEC • Health information technology architecture... • Development and adoption of appropriate certified EHRs...*** • Training on and dissemination of information on best practices to integrate HIT... into a provider’s delivery of care... *** • Infrastructure and tools for the promotion of telemedicine... • Promotion of the interoperability of clinical data repositories or registries *** • Promotion of technologies and best practices that enhance the protection of health information... • Improvement and expansion of the use of HIT by public health departments. *** • Beginning January 1, 2010, the National Coordinator MAY award grants to states or Indian tribes to establish loan programs for health care providers to be used to support the following activities: • Facilitating the purchase of certified EHR technology. • Enhancing the utilization of certified EHR technology. • Training personnel in the use of certified EHR technology. • Improving the secure electronic exchange of health information

18. IHS\Tribal\Urban (ITU) OIT Shares Workgroup

19. Agenda The Establishment of the Workgroup Vision Statement of the Workgroup Objectives of the Workgroup Members Workgroup Meeting Schedule

20. The Establishment of the Workgroup October 23, 2008 OIT issued a proposal for reshaping IT support packages and invited formal comment from Tribal leaders and representatives at a Tribal consultation session held December 17, 2008, in Arizona In response to feedback received at the consultation session the current OIT proposal has been withdrawn ITU Workgroup was formed to review all comments and provide recommendations to the IHS Director Workgroup to operate under the guidance of the IHS Information Systems Advisory Committee (ISAC)

21. Proposed Vision Statement of the Workgroup In the spirit of Self-Determination, and to reaffirm Tribal right under ISDEAA to contract or compact with the IHS for all or portions of programs, services, functions, and activities (PSFAs), the I\T\U workgroup will ensure information technology support packages are available to all American Indian/Alaska Native (AI/AN) Tribal programs that choose to leave all or a portion of their shares with the IHS.

22. Objectives of the Workgroup To review current OIT Tribal Shares To review comments from the Tribal Consultation Report logs To develop information technology support packages that are consistent with the vision statement To provide advice and guidance to Regions/Areas as they conduct additional consultation sessions on the proposed restructuring of IHS OIT information technology support packages

23. Members The Workgroup will consist of the following: Co-Chairpersons - One Tribal representative from the ISAC Chuck Walt Assoc. Dir. of Human Services for Fond du Lac Reservation - One IHS Representative Richard Church, Pharm.D. Director Office of Public Health Support Additional IHS and/or Tribal staff may serve as technical advisors

24. Members continued The Workgroup will consist of 22 additional members: One Tribal representative from each Area chosen by the Area Director IHS OIT Chief Information Officer or delegate One representative from the Direct Service Tribes Advisory Committee One representative from the IHS Office of Urban Indian Health Programs One representative from the IHS Agency Lead Negotiators One representative from the IHS Office of Tribal Self Governance One representative from the IHS Office of Tribal Self Governance Advisory Committee One representative from the IHS Office of Tribal Programs Three Representatives from the ISAC

25. Workgroup Meeting Schedule First Workgroup meeting scheduled June 16 in Nashville Initial workgroup meeting will determine - protocols - final products - timeline for fulfilling their mission - OIT will reimburse members’ travel to formal meetings

26. Action Items Membership nominations were due last week Pending some submissions Director will send letters out with names and meeting times

27. Future of RPMS • Funding • Development in next 2 ½ years for new work/ deployment through ARRA • HIT funded in 2009 (2.5 mil)- waiting direction from new director; initial language for telemedicine not in final legislation • Presidents budget with proposed funding in 2010 • Open Source • HITEC requires an evaluation of the need for open source options by 2010 • IHS has proposed that RPMS be considered a solution for this ‘market space’ • Pending legislation • Rockefeller legislation for open source as part of HITEC 2010

28. Collaboration with VA and Others • National Health Information Network • Ongoing participant in interoperability and data sharing- may use the DOD solution • Current status of VHA collaboration • Ongoing work together on ‘gold’ applications • Need to assume responsibility for development of some ‘gold’ applications (i.e. lab) as VA transitions to commercial products • West Virginia – use of RPMS in CHC/ hospitals • University of Hawaii- use of RPMS in CHC/hospitals • ASU- development lab for knowledge management and evaluation of ROI • DOD- pilot site for knowledge management and NHIN work

29. Marketing ofRPMS • Trademark • U Hawaii already has OPEN RPMS • W VA has MedLynks (RPMS) • Potential to work under the National Health Information Network/ Federal Health Architecture • Potential for Tribal Entity to be the ‘lead’ • Dependent upon open source commitment

30. Questions?