Open Source HIT

2. Open Source HIT Richard Thoreson Substance Abuse Mental Health Services Administration U.S. Department of Health & Human Services Regional HIT Conference San Francisco, CA  Thursday, July 21, 2011

3. Getting to Meaningful Use, 2015 • Better health, better health care, with spending limits • Service & Informationsystems integration • Specialty MH and SA together? b. With primary care/health homes? c. With other safety net services? d. With criminal justice?

4. State Health & Human Services Information Network Needs, Utilization/Payments, & Outcomes 5. Other Specialty Health 6. Hospital 7. State Information Exchange/ONC 4. Specialty Behavioral Health/SAMHSA 8. State Insurance Exchange/ONC 9. State Medicaid/CMS 3. FQHC/HRSA Un-Silo 10. Medicare/CMS 2. Primary Care 11. Children & Family Agency/ACF 1. Health Home Family & Individual History • Public Health /CDCP 20. Oversight/ GAO & IGs Research 13. Pharma-Medical Device Vender/FDA 19. Tax & Other Adm. Agencies/IRS 14. School/DOE 15. Housing Agency/HUD 18. Criminal Justice/DoJ 17. Income Maintenance/SSA 16. Other Safety-Net Agencies/DoA-WIC

5. Electronic Health Record systems (EHRs) • The technology foundation for incremental quality improvement (doing more with less!) • Get better information to clinicians & patients when they need it • Develop knowledge faster We can’t improve what we don’t measure!

6. Standard Terminology ASAP!! • SNOMED-CT • LOINC • RxNorm • Core Data Sets to measure needs, quality, & outcomes

7. Services Oriented Architecture (SOA) • Centrally-hosted Web-based services • User communities drive system requirements • Venders compete around replaceable Web services • Low barriers to vender entry into markets

8. State Health & Human Services Information Network Public Sector IT Spending Plans & Expectations 5. Other Specialty Health 6. Hospital 7. State Information Exchange/ONC 4. Specialty Behavioral Health/SAMHSA 8. State Insurance Exchange/ONC Service Systems Integration 9. State Medicaid/CMS 3. FQHC/HRSA 10. Medicare/CMS 2. Primary Care • SAMHSA: • Primary Behavioral Health Care • Care Integration $15M 2011 • OBHITA/REM $3.2M/yr 2009-13 • ONC Privacy Project $2.77M 2011 • Quality Measures $100Ks/yr • Suicide Hotline w/DOD $0 • Other Federal • Medicaid $10Bs/yr • HRSA $B’s/yr • ACF $Bs/yr • IHS $10Ms/yr • Reusable Open Source • VA/DOD $Bs/yr 11. Children & Family Agency/ACF 1. Health Home • Public Health /CDCP 20. Oversight/ GAO & IGs 13. Pharma-Medical Device Vender/FDA 19. Tax & Other Adm. Agencies/IRS 14. School/DOE 15. Housing Agency/HUD 18. Criminal Justice/DoJ 17. Income Maintenance/SSA 16. Other Safety-Net Agencies/DoA-WIC Federal IT Investments

9. Performance Measurement • Encounter & episode quality measures • Priority needs met first? • Patient self-reports • Automated EHRs extracts • 3rd Party verification (needs & Outcomes): • Cross-check records from different providers • Cross check safety net beneficiary records across State agencies

10. State Health & Human Services Information Network Public Spending for Performance Monitoring 5. Other Specialty Health 6. Hospital 7. State Information Exchange/ONC 4. Specialty Behavioral Health/SAMHSA 8. State Insurance Exchange/ONC 9. State Medicaid/CMS • SAMHSA* • GPRA Data Warehouse • $10M/yr, 5 yrs • Block Grant/DASIS-TEDS • $ Ms/yr • Prescription Drug Monitoring • $Ms before 2011, $0 after 3. FQHC/HRSA 10. Medicare/CMS • Other Federal* • CMS $? • CDCP $? • FDA $? • HRSA $? • ACF $? • IHS $? • VA/DOD $? 2. Primary Care 11. Children & Family Agency/ACF 1. Health Home • Public Health /CDCP 20. Oversight/ GAO & IGs 13. Pharma-Medical Device Vender/FDA 19. Tax & Other Adm. Agencies/IRS * Tank sizes not to scale relative to each other 14. School/DOE 15. Housing Agency/HUD 18. Criminal Justice/DoJ 17. Income Maintenance - SSA 16. Other Safety-Net Agencies/DoA-WIC Federal IT Investments San Francisco Regional meeting

11. Open Source Advantages? • Share all best practices & lessons learned, no black box technology • Build once, re-use software at no cost, minimize vender lock-in • User-driven software development based on common, public sector needs

12. SAMHSA Open Behavioral Health Information Technology Architecture Project • Next Generation Open Source EHR can be used for meaningful use quality measure pilots • Fully Meaningful Use Compliant • Integrated Primary & Behavioral Health Services • Reference Electronic Health Record Model (REM) • Standards derived model EHR application • HL7 Reference Information Model • HL7 Clinical Document Architecture • Common Terminology Server (CTS), U.S. standard • SNOMED-CT, LOINC, ICD, etc.

13. SAMHSA’s 3 Largest HIT Investment Projects in 2011 GPRA Data Warehouse (draft RFC) • Contract to automate reporting, storage, and analysis of performance data from SAMHSA’s discretionary grantees. Primary Behavioral Health Care Integration (PBHCI) HIT Enhancement Grants • $500k for 4 years + one time $200K IT Supplement per grantee (64 grantees) • $500k Grants to 5 States to integrate specialty behavioral health into State Health Information Exchange (HIE) Open Behavioral Health Information Technology Architecture (OBHITA) • Contract to develop open source EHRs and HIE systems & related terminology & quality measures • Health Home Reference Electronic Health Information Model (REM) • Safety Net Information Banking Service (SIBS) for Personal History Records • Partnerships with VA and leading States