GMCF the Georgia QIO

1. GMCF the Georgia QIO What is a QIO? President/ Governor Executive Order RHIO/HIE Summary Why Funding Support for GHIE?

2. What is a QIO? Quality Improvement Organizations (QIOs) are professionals working to improve the quality of health care in communities across America. QIOs share best practices with physicians, hospitals, nursing homes and home health agencies. QIOs coordinate and facilitate submission of data for public reporting for quality measure performance information available on CMS websites such as "Nursing Home Compare" and "Hospital Compare". QIOs monitor the appropriateness, effectiveness, and quality of care provided to Medicare beneficiaries. QIOs are private contractor extensions of the federal government working for the U.S. Centers for Medicare and Medicaid Services (CMS).

3. President / GovernorExecutive Order August 22 - President Bush Executive Order October 17 - Gov Perdue Executive Order Four Corner Stones of the Executive Order Increase Transparency in Pricing Increase Transparency in Quality Encourage Adoption of HIT Provide Options that promote Quality and Efficiency

4. Presidents Executive Order(continued) E-HI Conf. September 26, 2006 HHS Secretary Leavitt Support and Comments Craig Barrett, Chairman of Intel’s Board Linda Dillman, EVP WalMart Today’s Debate is about :”Who Will Pay?”

5. Presidents Executive Order(continued) Healthcare is a $2 Trillion Sector Growing at $138 Billion per year Average Healthcare cost per US citizen > $6,000 Federal Government is responsible for 46% Working with Top 100 Employers Base of Order is a Collaborative Effort of Physicians and Purchasers Tomorrow’s Debate is about :”How to achieve efficiency and value?”

8. RHIO/HIE Summary

10. RHIO / HIE Models Non-Technology Convener, Facilitator, Educator Technology Data Models Decentralized Model Central Data Storage (individual data source) Single Community EMR Pure Conduit Model Data Storage Model (by data type) Decentralized model (e.g., Record Locator Service) involves no data storage of clinical data but rather storage of patient demographic data and a pointer to indicate where that patient has data. Central data storage, but with individual “vaults” (files) of data by data source. For example: Hospital A data would be stored in Hospital A’s file and not commingled with Hospital B’s file. When the requests for data hit the system, the master patient index would pull the data from the various data source files and create a virtual health record for the patient. Single community EMR. For example, the data sources (e.g., hospital labs, pharmacies) transmit their information to one central site, and the data is combined and stored in one single EMR for the community. Pure conduit model stores no data at all about the patient. For example, the HIE functions more as a router or switchboard for directing incoming data to the appropriate destination, but does not store patient data in a repository for reuse. Data storage model that stores the data by type rather than source. For example, laboratory results from all data sources would be stored in a laboratory file, medication history would be stored in a medication history file, radiology would be stored in a radiology file, and so on. Decentralized model (e.g., Record Locator Service) involves no data storage of clinical data but rather storage of patient demographic data and a pointer to indicate where that patient has data. Central data storage, but with individual “vaults” (files) of data by data source. For example: Hospital A data would be stored in Hospital A’s file and not commingled with Hospital B’s file. When the requests for data hit the system, the master patient index would pull the data from the various data source files and create a virtual health record for the patient. Single community EMR. For example, the data sources (e.g., hospital labs, pharmacies) transmit their information to one central site, and the data is combined and stored in one single EMR for the community. Pure conduit model stores no data at all about the patient. For example, the HIE functions more as a router or switchboard for directing incoming data to the appropriate destination, but does not store patient data in a repository for reuse. Data storage model that stores the data by type rather than source. For example, laboratory results from all data sources would be stored in a laboratory file, medication history would be stored in a medication history file, radiology would be stored in a radiology file, and so on.

12. State-Level HIE Initiatives Most still in an early stage of development Differ in origins, drivers, and goals Uniqueness of their market characteristics Wide variety of approaches All rapidly evolving organizations Expect Change www.staterhio.org

13. Why Funding Support for GHIE? CMS QIO 8th Scope of Work Promote the use of EHR and HIE Demonstration projects through Medicare QIOs Improve the Quality of Healthcare Involvement as an Employer and a Consumer “The QIO shall be actively involved with or promote the convening of local multi-stakeholder organizations that seek to promote the production and use of electronic clinical information and healthcare information exchange necessary for improving clinical performance.” Acting CMS Administrator Leslie Norwalk on Wednesday in a keynote speech to the World Healthcare Innovation and Technology Congress said that without the enactment of legislation to promote health care information technology, CMS "might have to help forward health IT on a regulatory basis," CQ HealthBeat reports. CMS has taken regulatory action to exempt hospitals and health plans that donate health care IT hardware and software to physicians from prosecution under anti-kickback laws. In addition, according to Norwalk, CMS might seek to promote health care IT through demonstration projects that test new forms of reimbursement and health care delivery and through Medicare Quality Improvement Organizations. Norwalk said that "since Medicare pays for health care services and IT is simply not among them, we have to use things like demonstration authority or other approaches to help them pick up health IT." Norwalk added, "Basically, the Medicare program is not set up to pay for the adoption of health IT, but what we could be set up to do ultimately is to pay for performance. ... If health IT helps you get to determine what performance is relative to standard measures, then that's something that we'd like to move toward." Norwalk also discussed the need for interoperability standards to promote health care IT. "One of the things that can get in the way, of course, is ... if payers have all sorts of different standards across the board," she said, adding, "If we can help harmonize ... standards, it makes it easier for providers" (Reichard, CQ HealthBeat, 11/1). “The QIO shall be actively involved with or promote the convening of local multi-stakeholder organizations that seek to promote the production and use of electronic clinical information and healthcare information exchange necessary for improving clinical performance.” Acting CMS Administrator Leslie Norwalk on Wednesday in a keynote speech to the World Healthcare Innovation and Technology Congress said that without the enactment of legislation to promote health care information technology, CMS "might have to help forward health IT on a regulatory basis," CQ HealthBeat reports. CMS has taken regulatory action to exempt hospitals and health plans that donate health care IT hardware and software to physicians from prosecution under anti-kickback laws. In addition, according to Norwalk, CMS might seek to promote health care IT through demonstration projects that test new forms of reimbursement and health care delivery and through Medicare Quality Improvement Organizations. Norwalk said that "since Medicare pays for health care services and IT is simply not among them, we have to use things like demonstration authority or other approaches to help them pick up health IT." Norwalk added, "Basically, the Medicare program is not set up to pay for the adoption of health IT, but what we could be set up to do ultimately is to pay for performance. ... If health IT helps you get to determine what performance is relative to standard measures, then that's something that we'd like to move toward." Norwalk also discussed the need for interoperability standards to promote health care IT. "One of the things that can get in the way, of course, is ... if payers have all sorts of different standards across the board," she said, adding, "If we can help harmonize ... standards, it makes it easier for providers" (Reichard, CQ HealthBeat, 11/1).

14. GMCF “Making Health Care Better”.