Transitions in Healthcare : Migration from Paper to Digital and Managing Legacy Data

1. 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.)

2. 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

3. 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

4. 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.

5. 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

6. 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)

7. 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

8. Transitions in the Business Model Fee for Service Payment for Outcomes Wellness Transactions

9. Challenges for North Carolina: • Multiple, Strong IDNs • EHR Landscape

10. Major IDNs - Statewide Landscape

11. in North Carolina         Indicates primary service area

13. Other EHR Vendors Include: RPMS VistA

14. Ambulatory Systems Include: Chart courtesy of NC HIE

15. Transitions Create Legacy Data • Anticipating future needs and uses: • Clinical care of patients • Business requirements • Billing • Auditing • Legal (eDiscovery) • Research

16. 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 ???

19. 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

20. 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.

21. 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

22. Business Associates Workshop Tentative Agenda - June 5, 2014 at UNC-C Center City

23. Questions ??? Contact: Holt@nchica.org www.nchica.org