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Transitions in Healthcare : Migration from Paper to Digital and Managing Legacy Data. ARMA International: Charlotte-Piedmont Chapter March 20, 2014 Presentation by: Holt Anderson, Executive Director NCHICA (NC Healthcare Information & Communications Alliance, Inc.). Agenda. About NCHICA

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transitions in healthcare migration from paper to digital and managing legacy data

Transitions in Healthcare:Migration from Paper to DigitalandManaging Legacy Data

ARMA International: Charlotte-Piedmont Chapter

March 20, 2014

Presentation by: Holt Anderson, Executive Director

NCHICA (NC Healthcare Information & Communications Alliance, Inc.)

agenda
Agenda
  • About NCHICA
  • Accelerants
  • Challenges at the State Level – One State’s Landscape and Activities
    • Health Systems
    • Applications
    • HIEs
  • Legacy Data Task Force
  • Vision of a Future Healthcare System
  • HIPAA - “Business Associates” and their subcontractors now covered by HIPAA
about nchica
About NCHICA
  • Established in 1994 as 501(c)(3) Nonprofit
  • ~300 organizations across healthcare spectrum
  • Serves as neutral, collaboration hub for developing consensus-based approaches to policy compliance and technology implementation
transition of mission
Transition of Mission
  • 1994
    • Improving health and healthcare in NC by accelerating the adoption of information technology and enabling policies.
  • 2011
    • Assisting NCHICA members in accelerating the transformation of the US healthcare system through the effective use of information technology, informatics and analytics.
nchica collaboration activities
NCHICA Collaboration Activities
  • CIO-CMIO Roundtable
  • Informatics & Analytics Roundtable
    • Legacy Data Task Force
  • Privacy & Security Officials Workgroup
  • Legal Workgroup
  • Transactions, Code Sets & Identifiers Workgroup
    • ICD-10 Task Force & Focus Groups
  • Enterprise Integration Workgroup
    • HIE Task Force
  • Technology Resources Workgroup
    • Telehealth Task Force
  • NC Consumer Advisory Council on Health Information
  • Educational Conferences and Workshops
transition accelerants
Transition Accelerants
  • 1996 – Health Information Portability and Accountability Act (HIPAA)
  • 1999 - To Err is Human
  • 2001 - Crossing the Quality Chasm
  • 2004 – HHS Office of the National Coordinator for Health Information Technology (ONC) established
  • 2005 – ONC initiation of eHealth Exchange (née NHIN or Nationwide Health Information Network) efforts
  • 2009 – American Recovery and Reinvestment Act (ARRA) & Health Information Technology for Economic and Clinical Health Act (HITECH) & Meaningful Use (MU = $)

MU = EHR + HIE + Reporting (Quality & Public Health)

  • 2010 - Patient Protection and Affordable Care Act (PPACA) or Affordable Care Act (ACA)
transition challenges
Transition Challenges
  • Standards
    • Policy (Federal, State, Local & Enterprise)
      • Privacy & Security - Accountability
    • Data elements
    • Technology (applications, systems, networks)
  • Transition from Fee-for-Service (transactions) to Payment for Outcomes
  • Emphasis on Wellness (Accountable Care Organizations - ACOs)
  • Business Models
    • Reimbursements
  • Legacy Systems: Data & Policies
transitions in the business model
Transitions in the Business Model

Fee for Service

Payment for Outcomes

Wellness

Transactions

challenges for north carolina

Challenges for North Carolina:

  • Multiple, Strong IDNs
  • EHR Landscape
in north carolina
in North Carolina

Indicates primary service area

ambulatory systems include
Ambulatory Systems Include:

Chart courtesy of NC HIE

transitions create legacy data
Transitions Create Legacy Data
  • Anticipating future needs and uses:
    • Clinical care of patients
    • Business requirements
      • Billing
      • Auditing
      • Legal (eDiscovery)
    • Research
nchica legacy data task force
NCHICA Legacy Data Task Force
  • Established in May 2013
  • Goal: Develop consensus approach to handling legacy data during and after system transition
  • Organizations involved in discussions include:
    • Carolinas HealthCare System
    • Novant
    • UNC Health Care
    • Legacy Data Access
    • Allscripts
    • Duke Health
    • Others ???
vision of a future healthcare system
Vision of a Future Healthcare System
  • Making appropriate clinical decisions at the point of care informed by a “Learning Health System”
    • Consolidates and updates the Patient’s health history from all sites across the continuum of care – create a profile
    • Profile includes the Patient’s family heath history and DNA
    • Develop search criteria based on Patient’s profile including complaint, current tests, and preliminary diagnosis
    • Initiate search in millions+ of records to match profile
    • Return results from treatments and outcomes for 1,000 profile matches
    • A decision support system organizes, prioritizes and presents best treatment options at point of clinical decision.
    • Now we have 1,001 profiles for future reference
hipaa not hippa
HIPAA (not HIPPA )

Health Insurance Portability and Accountability Act

  • HIPAA contains a set of federal standards to protect the privacy and security of patients' medical records and other health information maintained by Covered Entities and now Business Associates and their subcontractors.
  • Enforcement activities as of January 31, 2014
  • Since compliance date of April 2003:
    • 91,721 HIPAA complaints
    • 85,612 resolved
      • 21,148 through investigation and enforcement
      • 9,948 through investigation and finding no violation
      • 53,516 closure of cases not eligible for enforcement
    • Compliance issues in order of frequency
      • Impermissible uses and disclosures of protected health information;
      • Lack of safeguards of protected health information;
      • Lack of patient access to their protected health information;
      • Uses or disclosures of more than the minimum necessary protected health information; and
      • Lack of administrative safeguards of electronic protected health information.
business associates 45 cfr 160 103
Business Associates [45 CFR 160.103]
  • A “business associate” is a person or entity that performs certain functions or activities that involve the use or disclosure of protected health information on behalf of, or provides services to, a covered entity.
  • Business associate services are: legal; actuarial; accounting; consulting; data aggregation; management; administrative; accreditation; and financial.

http://www.hhs.gov/ocr/privacy/hipaa/understanding/coveredentities/businessassociates.html

business associates workshop
Business Associates Workshop

Tentative Agenda - June 5, 2014 at UNC-C Center City

questions

Questions ???

Contact:

Holt@nchica.org

www.nchica.org