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Agenda:. Health IT Around the Nation Health IT in Michigan Health IT and Healthcare Reform. 2004 – Executive Order Goal : Nationwide Interoperable Infrastructure by 2014 Established the Office of the National Coordinator for HIT (ONC) 2009 - American Recovery & Reinvestment Act (ARRA)

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Agenda
Agenda:

  • Health IT Around the Nation

  • Health IT in Michigan

  • Health IT and Healthcare Reform


The u s health it era

2004 – Executive Order

Goal: Nationwide Interoperable Infrastructure by 2014

Established the Office of the National Coordinator for HIT (ONC)

2009 - American Recovery & Reinvestment Act (ARRA)

Goal: promote health IT as a component of healthcare reform

Single biggest Health IT investment ~$40 billion

Strengthens Privacy & Security Policies

The U.S. Health IT Era…


Government health it spending history

15,000% Budget Increase

Government Health IT Spending History

Amount of Funding Authorized for HIT in ARRA:

$45 Billion

2009

2004

Amount of Funding for HIT before ARRA:

$300 million


Arra funding for hit
ARRA Funding for HIT

Program

Agency

Recipients

Cost

Beacon Community

Statewide HIE

States

$550 million

ONC

Non-Profits

Regional Extension Centers

$640 Million

$250 Million

Advanced HIEs

HIT Workforce

$68 Million

Community Colleges

MedicaidIncentives

CMS

Medicaid Agencies

$40 Billion

Medicare Incentives

Hospitals & Providers

Source: INPUT

5


Agenda

“Meaningful Use” is the Key

Regional Extension Centers

Workforce Training

Programs

Necessary Action

Intended Outcomes

ADOPTION

Improved Individual &

Population Health

Outcomes

Increased

Effectiveness &

Efficiency

Improved

Ability to Study &

Improve Care Delivery

MEANINGFUL USE

Medicare and Medicaid

Incentives and Penalties

State Grants forHealth Information Exchange

Standards & Certification Framework

Privacy & Security Framework

EXCHANGE

6



Meaningful use1
Meaningful Use

  • Meaningful Use is using certified EHR technology to:

    • Improve quality, safety, efficiency, and reduce health disparities

    • Engage patients and families in their health care

    • Improve care coordination

    • Improve population and public health

    • Maintain privacy and security


Agenda

Stage 3

2015+

Stage 2

2013-2014

Stage 1

2011-2012

Meaningful Use

Currently in Draft Form – Public Input Closed

Defined July 13, 2010

9


Agenda

Meaningful Use Stage 1

10

Slide content adapted from CMS (EHR_Incentive_Program_EP_Training_Final ONC changes 8 10 10.pptx)


Privacy and security in arra
Privacy and Security in ARRA

Bans sale of health information

Requires ongoing audit trail

Strengthens civil and criminal enforcement of HIPAA

Expands patient rights to access their information

Requires innovative encryption technology to prevent breaches

Requires HHS Office for Civil Rights (OCR) to provide consumer education about protected health information


Hit in michigan

44%

EHR Adoption Rate for office-based physicians in 2010, 26.4% plan to adopt in the next 12 months, and 16.4% in the next 18 months

94%

Michigan providers without an EHR say cost is a major concern

90%

Michigan Hospitals planning to participate in the Medicare and Medicaid Meaningful Use Incentives in 2011

#2

Michigan’s ranking in the nation for e-Prescribing with over 11 million prescriptions ordered through e-Prescribing

HIT in Michigan

1. Advancing Healthcare in America, 2010 National Progress Report on E-prescribing, Surescripts,

2. MHA 2010 Member Survey

3. Michigan State Medicaid HIT Plan


History of hit in michigan
History of HIT in Michigan

  • 2005

    • Federal Hot Topic translates to issue of interest in Michigan Executive Office and legislature

  • 2006

    • Focus Groups, Planning Process, Statewide Roadmap called “MiHIN Conduit to Care”

    • Michigan HIT Commission created

  • 2007

    • HIE Grants to seven communities around the state

  • 2008

    • HIE Grants to two more communities to cover every county in the state

  • 2009

    • The American Reinvestment & Recovery Act changes the game


Mi arra funding for hit
MI ARRA Funding for HIT

Program

Agency

Recipients

Cost

Statewide HIE

MDCH

$14.9 Million

ONC

CMS

M-CEITA

Regional Extension Centers

$19 Million

Beacon Community

$16.2 Million

Southeast Michigan

HIT Workforce

~ $1 million

4 Community Colleges

MedicaidIncentives

MDCH

> $200 Million

14


Statewide hie cooperative agreement
Statewide HIE Cooperative Agreement

  • Goal: an interoperable statewide health information exchange

  • Michigan’s Approach:

    • Convene Stakeholders for planning

    • Develop a new not-for-profit entity to implement

    • Thin centralized services to enable statewide HIE

    • Emphasis on local (sub-state) initiatives

    • Connect with state of Michigan public health systems

    • Designed to meet Meaningful Use criteria

    • Committed to connecting nationwide


Statewide hie cooperative agreement1
Statewide HIE Cooperative Agreement

MiHIN Shared Services Board


Statewide hie cooperative agreement2
Statewide HIE Cooperative Agreement

Phase 1

MiHIN Shared Services

- Inter-HIE Gateway

- Master Provider Index

- Network Index

- Interoperability with Statewide Resources

- Supports MU Stages 1&2


Statewide hie cooperative agreement3
Statewide HIE Cooperative Agreement

Phase 2

MiHIN Shared Services

  • Expanded Services

  • Focus on National Connection

  • Query/Pull Functionality

  • Supporting MU Stage 3 in 2015



Beacon community1
Beacon Community

Must produce Measurable & Reproducible Outcomes


Southeast michigan beacon community
Southeast Michigan Beacon Community

  • Goal: Improve continuity, quality and safety of care for underserved patients with chronic diabetes in:

    • Detroit, Hamtramck, Highland Park, Dearborn and Dearborn Heights, Michigan

  • Why?

    • Diabetes has a very high prevalence among the target population: 12.8 percent of adults, or 93,000 people


Southeast michigan beacon community1
Southeast Michigan Beacon Community

  • Aggressive 31 month timeline

  • Implementing a technology Infrastructure

  • Target specific clinical interventions

    • Example: Patient Navigators

  • Specific Measure Examples

    • Cost: Unscheduled acute care 30 day re-hospitalization

    • Quality:HbA1c, LDL, Eye exam within 12 months

    • Population Health: Disparity ratios for quality of care and population health measures


For more information
For more information…

Terrisca Des JardinsProgram DirectorSoutheast Michigan Beacon Community CollaborativeSEMHAtdesjardins@semha.orgph: 313.873.9302

Gary PetroniDirector, Center for Population Health Director

SEMHAInterim Beacon Directorgpetroni@semha.orgph: 313.873.9302


Hit workforce
HIT Workforce

  • Goal:

    • To expand medical health informatics education programs to ensure the rapid and effective utilization and development of HIT

  • Michigan is in a consortium of 10 states

    • Train 1,100 citizens in two years

    • Credit bearing, non-degree certificate

  • Four Locations in Michigan

    • Lansing Community College

    • Macomb Community College

    • Delta College

    • Wayne County Community College


Hit workforce1
HIT Workforce

  • Six “roles” for training

    • Practice workflow and information management redesign specialists

    • Clinician/practitioner consultants

    • Implementation support specialists

    • Implementation managers

    • Technical/software support staff

    • Trainers

  • Most classes are online or hybrid

  • More information at: http://www.mwhit.org/


Medicaid ehr incentives
Medicaid EHR Incentives

  • State Agency Responsibilities:

    • Administer the incentive payments to eligible professionals and hospitals

    • Conduct adequate oversight of the EHR incentive program

    • Pursue initiatives to encourage adoption of certified EHR technology to promote health care quality and the exchange of health care information


Medicaid ehr incentives1
Medicaid EHR Incentives

  • In order to receive payments:

    • Be an “eligible” provider

    • Use “certified” EHR technology

    • Meet the “meaningful use” criteria


Medicaid ehr incentives2
Medicaid EHR Incentives

  • Who is eligible?

    • Eligible Professionals: (Non-hospital based with at least 30% Medicaid volume)

      • Physicians

      • Dentists

      • Certified Nurse Mid-wives

      • Nurse Practitioners

      • Physician Assistants (PA) practicing in a PA-led FQHC or Rural Health Clinic

    • Hospitals:

      • Acute care -- at least 10% Medicaid volume

      • Children’s hospitals -- no volume requirement

      • Critical access hospitals -- currently excluded


Medicaid ehr incentives3
Medicaid EHR Incentives

Requirements

  • Successfully interface with federal registration system (NLR)

  • Have approval from CMS for State Medicaid HIT Plan (SMHP)

  • Be capable of accepting provider attestations

  • Be capable of paying EHR incentive payments to providers

  • Have proper audit and oversight

ASAP

Ongoing


Medicaid ehr incentives4
Medicaid EHR Incentives

  • Estimated enrollment by fiscal year


Medicaid ehr incentives5
Medicaid EHR Incentives

  • Estimated Payments by fiscal year in Millions



The accountable care act hit1
The Accountable Care Act & HIT

  • Accountable Care Organizations:

    • Guiding Principle: If physicians and hospitals work together to prevent readmissions, duplicate tests and other unnecessary costs, healthcare will be less expensive and safer.

    • Health IT needs:

      • Capture patient data electronically - EHR

      • Gather patient data from all levels of care – HIE

      • Population data for care management - Registry

      • Real time decision support, alerts, patient access

      • Quality data warehouse



Key challenges opportunities
Key Challenges Opportunities

  • Money – Too much

  • Money – Not enough

  • Time

  • Coordination

  • Collaboration

  • Adoption

  • Trust