HIT AND HIE IN THE STATEHIT AND HIE IN THE STATE
OF MICHIGANOF MICHIGAN
Meghan Sifuentes Vanderstelt
HIT Manager
Michigan ...
2
DEPARTMENT OF COMMUNITY HEALTH
2013 STRATEGIC PRIORITIES
MISSION
MDCH will protect, preserve, and promote the health and...
THE SIM OPPORTUNITY
(State Innovation Model)
•Collaborating to create meaningful system change in order
to
Improve Care
...
State Innovation Model (SIM) &
The State Healthcare Innovation Plan
(SHIP)
• Major deliverable – done by September
• SIM A...
Michigan’s Plan
• Multi-payer, multi-stakeholder, multi-system approach to develop and
test comprehensive system reform
• ...
Innovations being tested
• MiPCT
• Value Partnerships
• Care Bridge
• Health Information Exchange
• Trailblazers
• Communi...
7
The Health Information
Technology Commission
(HITC)
The Health Information Technology Commission is created
within the dep...
HITC Job Description
• Develop and maintain a strategic plan to guide implementation
of an interoperable health informatio...
2013 HITC Objectives
Objective: To recommend and advise the Michigan Department of Community Health on Policy
decisions, b...
Role of HIT and HIE Stakeholders
• Identify new and emerging best practices
• Provide input for evolving policy framework
...
Vision beyond HIT and HIE
• Research
• Quality improvement
• Inspire confidence and trust in health IT
• Empower the consu...
Roadmap For Reforming The
Healthcare System
13
14
Michigan Medicaid EHRMichigan Medicaid EHR
Incentive Program UpdateIncentive Program Update
June 5, 2013June 5, 2013
Jason...
Program Summary
This ARRA funded program provides financial
incentives (100% Federal) to eligible
Medicaid professionals a...
Eligible Professionals:
(Non-hospital based with at least 30% Medicaid volume)
• Physicians/Pediatricians (20%)
• Optometr...
Certified EHR
Technology
Office of National Coordinator (ONC)
maintains the list of complete EHRs and EHR
modules that hav...
Meaningful Use Timeline
  Meaningful Use Stage
1st year 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
2011 AIU 1 ...
Stage 1 vs. Stage 2
*Regardless of the stage of MU, all providers will complete this
number of CQMs in 2014
Stage I
15 Cor...
Core Objectives Comparison
Core Objective Stage 1 Stage 2
1 CPOE Use CPOE for >30% of
medications
Use CPOE for > 60% of me...
Core Objectives Comparison
Core Objective Stage 1 Stage 2
9 Preventive Measures Menu Objective in Stage 1;
Reminders for f...
Core Objectives Comparison
Core Objective Stage 1 Stage 2
14 Medication
Reconciliation
Menu Objective in Stage 1;
Medicati...
Stage 2 – EPs must select 3 our of 6
Menu
Menu Objective Stage 1 Stage 2
1 Imaging Results New for Stage 2 More than 20% o...
CQMs in 2014 and Beyond
CQM Changes in 2014
Provider Prior to 2014 2014 and Beyond*
EPs Complete 6 out of 44
•3 Core or 3 ...
Auditing
MDCH is responsible for the auditing
function including Meaningful Use (MU)
To help with the audit function relat...
What is this MU Repository?
Tool used by the Michigan Department of
Community Health (MDCH) to track providers
in the Stat...
Medicare?
CMS is running a similar program for
Medicare providers.
Professionals can only claim one incentive
program (eit...
Incentive Payment for
Eligible Professionals
First Calendar Year in which the EP receives an Incentive Payment
Calendar
Ye...
Incentive Payment for
Eligible Hospitals
Payments are formula driven and will vary
per hospital.
Most hospitals will recei...
Registrations/Payments
As of 5/29/2013
  Registered
Paid
Under
AIU
Paid
Under
MU
Total
Payments
Dollars Paid
(In Millions)...
What the rest of 2013 holds?
Launching Stage II of MU
Getting Registration System Ready
Getting Public Health Registries R...
www.MichiganHealthIT.org
Questions?
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State of Michigan HIE Update (without Tina Scott)

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Connecting Michigan for Health 2013 http://mihin.org/

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  • HIT and HIE related projects in DCH DCH strategic priorities State Innovation Model Trailblazers and work related to SIM Role of HITC in relation to HIT and HIE in MI Purpose 2013 goals Stakeholder involvement Coordination of all groups and how HIT and HIE foundational to combined endeavors Triple aim and intrinsic role of HIT and HIE
  • General overview of the DCH Strategic Priorities: Improve Population Health: Integrate services for physical health and mental health and increase coordination among care providers. Current Projects: Strengthen Public Health Infrastructure for Improved Health Outcomes, Maternal and Child Health initiatives, Community Linkages, etc…. Transform the system of care: Support the person centered medical homes and preserve the safety net. Bring the patient into their care by allowing more data available to them. Develop opportunities for persons with mental illness and substance abuse issues to receive early intervention services to prevent incarceration. Current Projects: MiPCT, Care Bridge, Health Information Exchange, etc… Reform the Health Care System: Improve fraud identification and prevention to reduce waste and increase accountability. Focus on quality and outcomes for fee for service and managed care rather than quantity. Develop a standardized method to provide services consistently through the state to improve the quality of care Current Projects: Trailblazers, Medicaid Data Hub, Data Warehouse, etc. Transform the Department of Community Health: Reinvent MDCH by creating an organizational structure that is effective, efficient, interactive, customer focused, and value driven. Establish standards and procedures to enhance customer experience. Ensure IT systems are unified, usable and meet future business needs. Current Projects: Dual Integration, Workforce Transformation, HIE efforts, SIM etc..
  • Value and Importance of the SIM planning grant and how incorporates with DCH Strategic Priorities 6 states with testing grants, 3 with pre-testing assistance, 16 with planning grants The outcome of the work of the next 5 months will be a comprehensive, state-wide State Healthcare Innovation Plan (SHIP) and a testing plan, which will be used to apply for CMMI support for testing. (The graphic is from the CMMI page describing the funding opportunity – original color.)
  • 1. Provide a Vision Statement for health system transformation. 2. Describe population demographic including Medicaid and CHIP populations. 3. Describe population health status and issues or barriers that need to be addressed. 4. Describe health system models “current as is” and “future to be” States, including the level of integration of behavioral health, substance abuse, developmental disabilities, elder care, community health, and home and community-based support services. 5. Report on opportunities or challenges to adoption of Health Information Exchanges (HIE) and meaningful use of electronic health record technologies by various provider categories, and potential strategies and approaches to improve use and deployment of HIT. 6. Describe delivery system payment methods both “current as is” and “future to be” payment methods. 7. Describe health care delivery system performance “current as is” and “future to be” performance measures. 8. Describe the current health care cost performance trends and factors affecting cost trends (including commercial insurance premiums, Medicaid and CHIP information, Medicare information, etc. ). 9. Describe the current quality performance by key indicators (for each payer type) and factors affecting quality performance. 10. Describe population health status measures, social/economic determinants impacting health status, high risk communities, and current health status outcomes and the other factors impacting population health. 11. Describe specific special needs populations (for each payer type) and factors impacting care, health, and cost. Health System Design and Performance Goals   12. Describe delivery system cost quality and population health performance targets that will be the focus of delivery system transformation. 13. State goals for improving care, population health and reducing health care cost. 14. Describe delivery system models and approaches including how public health care entities, such as publicly-supported university hospitals and faculty practices will transition to value-based business and clinical models. 15. Describe proposed payment and service delivery models.
  • key building blocks
  • Number of DCH initiatives that will contribute to SIM goals and overall DCH strategic goals for transforming health.
  • Alignment of DCH priorities with SIM goals and how Trailblazers will focus on the data, infrastructure, and quality measures to support the SIM efforts. Trailblazers: Alignment of health IT and care transformation activities at the state, local, and national levels Focus is to develop an infrastructure for electronic, streamlined state-level quality measurement, reporting, and feedback This infrastructure will allow for data-driven quality improvement, delivery system transformation, and value-based payment of health care services.
  • Founded in 2006 by the MI Legislature the 12 gubernatorial appointed members represent a variety of areas within health care system with an emphasis on IT. Includes a representative from DCH and DTMB (Nick Lyon and David Behen).
  • HITC job and relationship with DCH executive office: offers recommendations to be carried out by the Department on HIE and HIT related iniatives. Offers a venue for difficult and often complex HIT and HIE issues to be vetted and an opportunity for colloboration. Commission focus/oversight was related to ARRA funded groups: MihiN, MCEITA, EHR Incentive Program, Beacon and others but as the ARRA HITECH era draws to a close, what’s next? Continued oversight over
  • Established in early 2013, graphic overview of the Commission’s main objectives and strategic priorities relative to their four main assigned tasks of: -develop and maintain strategic plan -increase public awareness -ID critical issues -Adopt/create policies and measures to encourage the adoption of HIT Each color section of the plan directly relates to Public Act 137 which established the Commission and outlined the Commission’s main functions and goals.
  • CONSIDER ROLE OF EXTERNAL HIT AND HIE GROUPS…. HOW DO THEY FIT INTO THE ROADMAP? IMPORTANCE OF THEIR PARTICIPATION IN SEEING THE GOAL. Who doe we see as stakeholders? Stakeholders includes all involved within the HIT and HIE community. Includes all present that have an interest in HIE in Michigan and are committed to seeing this crucial and foundational project through across the State.
  • Improvements in technology, the accessibility of data, and the work of HIT and HIE in MI is foundational and intrinsic to meeting the goals of transforming MDCH and transforming the system of care. Which all fits into the Triple Aim of improving the experience of care, improving population health, and reducing per capita costs.
  • The process has already begun for certifying 2014 versions of EHR’s.
  • Track x – xxx day – 0000-0000
  • Track x – xxx day – 0000-0000
  • Track x – xxx day – 0000-0000
  • Track x – xxx day – 0000-0000
  • Track x – xxx day – 0000-0000
  • Track x – xxx day – 0000-0000
  • CDC loves this approach
  • These are per eligible professional.
  • State of Michigan HIE Update (without Tina Scott)

    1. 1. HIT AND HIE IN THE STATEHIT AND HIE IN THE STATE OF MICHIGANOF MICHIGAN Meghan Sifuentes Vanderstelt HIT Manager Michigan Department of Community Health 1
    2. 2. 2 DEPARTMENT OF COMMUNITY HEALTH 2013 STRATEGIC PRIORITIES MISSION MDCH will protect, preserve, and promote the health and safety of the people of Michigan with particular attention to providing for the needs of vulnerable and under-served populations. VISION Improving the experience of care, improving the health of populations, and reducing per capita costs of health care. STRATEGIC PRIORITIES Improve Population Health Transform the System of Care Reform the Health Care System Transform the Department of Community Health
    3. 3. THE SIM OPPORTUNITY (State Innovation Model) •Collaborating to create meaningful system change in order to Improve Care Improve Health Outcomes Reduce Costs •Create a State Healthcare Innovation Plan (SHIP) • Funding to bring together a broad base of stakeholders to plan an innovative, multi-payer and multi-sector health care delivery system transformation •Testing and implementation funding anticipated 3 Center for Medicare and Medicaid Innovation- CMS
    4. 4. State Innovation Model (SIM) & The State Healthcare Innovation Plan (SHIP) • Major deliverable – done by September • SIM Advisory Committee asked to provide input: • Consider Michigan’s health system, payment models, performance metrics “as is” and “to be” • Develop a roadmap for health system transformation 4
    5. 5. Michigan’s Plan • Multi-payer, multi-stakeholder, multi-system approach to develop and test comprehensive system reform • Invest in a lifetime of good health for people and communities 5
    6. 6. Innovations being tested • MiPCT • Value Partnerships • Care Bridge • Health Information Exchange • Trailblazers • Community Linkages • Strengthen Public Health Infrastructure for Improved Health Outcomes • Maternal and Child Health Initiatives • MI Healthcare Workforce Planning Team 6
    7. 7. 7
    8. 8. The Health Information Technology Commission (HITC) The Health Information Technology Commission is created within the department to facilitate and promote the design, implementation, operation, and maintenance of an interoperable health care information infrastructure in this state. HIT Commission Public Act 137-2006 8
    9. 9. HITC Job Description • Develop and maintain a strategic plan to guide implementation of an interoperable health information technology system • Perform activities within HIT scope as directed by MDCH and DTMB • ID strategies to improve ability to monitor health status • Provide recommendations on policy to achieve HIT adoption • ID critical issues that affect private/public adoption • Technical • Scientific • Economic • Governance • Other • Increase public’s understanding of HIT • Promote effective and efficient communication among health care providers: • Hospital, physicians, payers, employers, pharmacies, labs, and other health care entities 9
    10. 10. 2013 HITC Objectives Objective: To recommend and advise the Michigan Department of Community Health on Policy decisions, business and technical needs, and general oversight for the following HIT activities essential to the State of Michigan HIT and HIE landscape during 2013. 10
    11. 11. Role of HIT and HIE Stakeholders • Identify new and emerging best practices • Provide input for evolving policy framework • Collaborate and identify potential crossover opportunities • Coordinate and further advance HIT and HIE in Michigan 11
    12. 12. Vision beyond HIT and HIE • Research • Quality improvement • Inspire confidence and trust in health IT • Empower the consumer to be more actively involved in their health care • Improve population health 12
    13. 13. Roadmap For Reforming The Healthcare System 13
    14. 14. 14
    15. 15. Michigan Medicaid EHRMichigan Medicaid EHR Incentive Program UpdateIncentive Program Update June 5, 2013June 5, 2013 Jason Werner, MDCHJason Werner, MDCH
    16. 16. Program Summary This ARRA funded program provides financial incentives (100% Federal) to eligible Medicaid professionals and hospitals to meaningfully use (MU) a certified EHR technology. Program administration (90% Federal) is the responsibility of DCH.
    17. 17. Eligible Professionals: (Non-hospital based with at least 30% Medicaid volume) • Physicians/Pediatricians (20%) • Optometrists • 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 • Critical access hospitals Who Is Eligible to Receive the Medicaid Incentive Payments?
    18. 18. Certified EHR Technology Office of National Coordinator (ONC) maintains the list of complete EHRs and EHR modules that have been tested and certified. There are now 6 certifying bodies and over 3,000 certified products. Certified = Capable of meeting Meaningful Use (MU).
    19. 19. Meaningful Use Timeline   Meaningful Use Stage 1st year 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2011 AIU 1 1 2 2 3 TBD TBD TBD TBD TBD 2012   AIU 1 1 2 2 3 TBD TBD TBD TBD 2013     AIU 1 1 2 2 3 TBD TBD TBD 2014       AIU 1 1 2 2 3 TBD TBD 2015         AIU 1 1 2 2 3 TBD 2016           AIU 1 1 2 2 3
    20. 20. Stage 1 vs. Stage 2 *Regardless of the stage of MU, all providers will complete this number of CQMs in 2014 Stage I 15 Core 5 of 10 Menu 6 of 44 CQM’s Total of 26 Objectives Stage II 17 Core 3 of 6 Menu *9 of 64 CQM’s Total of 29 Objectives Effective 4/20/2012 Effective 1/1/2014
    21. 21. Core Objectives Comparison Core Objective Stage 1 Stage 2 1 CPOE Use CPOE for >30% of medications Use CPOE for > 60% of medications, 30% of laboratory and 30% of radiology 2 e-Rx e-Rx for >40% e-Rx for >50% 3 Demographics Record demographics for >50% Record demographics for >80% 4 Vital Signs Record vital signs for >50% Record vital signs for >80% 5 Smoking Status Record smoking status for >50% Record smoking status for >80% 6 CDS Interventions Implement 1 clinical decision support rule. Drug/drug and drug/allergy is separate Core Objective in Stage 1 Implement 5 clinical decision support interventions and drug/drug and drug/allergy 7 Labs Menu Objective in Stage 1; Incorporate lab results for >40% Incorporate lab results for >55% 8 Patient List Menu Objective in Stage 1; Must generate one report Generate patient list by specific condition
    22. 22. Core Objectives Comparison Core Objective Stage 1 Stage 2 9 Preventive Measures Menu Objective in Stage 1; Reminders for follow up care for >20% of patients ≤ 5 or ≥ 65 years of age Reminders for follow up care for >10% of patients with two or more office visits in the last 2 years 10 Patient Access Menu Objective in Stage 1; Provide online access to health information for >10% within 4 business days of EHR update Provide online access to health information for >50% with >5% actually accessing 11 Visit Summaries Provide summaries for >50% of office visits within 3 business days Provide summaries for >50% of office visits within 1 business day 12 Education Resources Menu Objective in Stage 1; Provide education resources for >10% of all unique patients Provide education resources for >10% of all unique patients 13 Secure Messages New for Stage 2 More than 5% of patients send secure messages to their EP
    23. 23. Core Objectives Comparison Core Objective Stage 1 Stage 2 14 Medication Reconciliation Menu Objective in Stage 1; Medication Reconciliation for >50% of transitions of care Medication Reconciliation for >50% of transitions of care 15 Summary of Care Menu Objective in Stage 1; Provide documents for >50% of transitions of care/referrals Provide documents for >50% of transitions of care/referrals with 10% sent electronically. At least one is sent to a recipient with a different EHR vendor or successfully testing with CMS test EHR 16 Immunizations Menu Objective in Stage 1; Perform one successful test transmission of immunization data Successful ongoing transmission of immunization data 17 Security Analysis Conduct or review security analysis and incorporate in risk management process Conduct or review security analysis and incorporate in risk management process
    24. 24. Stage 2 – EPs must select 3 our of 6 Menu Menu Objective Stage 1 Stage 2 1 Imaging Results New for Stage 2 More than 20% of imaging results are accessible through CEHRT 2 Family History New for Stage 2 Record Family History for >20% 3 Syndromic Surveillance Successful ongoing transmission of syndromic surveillance data Successful ongoing transmission of syndromic surveillance data 4 Cancer New for Stage 2 Successful ongoing transmission of cancer case information 5 Specialized Registry New for Stage 2 Successful ongoing transmission of data to specialized registry 6 Progress Notes New for Stage 2 Enter an electronic progress note for >30% of unique patients
    25. 25. CQMs in 2014 and Beyond CQM Changes in 2014 Provider Prior to 2014 2014 and Beyond* EPs Complete 6 out of 44 •3 Core or 3 Alternate core •3 Additional CQMs Complete 9 out of 64 Choose at least 1 measure from 3 of 6 NQS domains *Regardless of the stage of MU, all providers will complete this number of CQMs in 2014
    26. 26. Auditing MDCH is responsible for the auditing function including Meaningful Use (MU) To help with the audit function related to MU Public Health testing, MDCH has created a MU repository
    27. 27. What is this MU Repository? Tool used by the Michigan Department of Community Health (MDCH) to track providers in the State of Michigan that wish to meet electronic public health reporting meaningful use requirements.
    28. 28. Medicare? CMS is running a similar program for Medicare providers. Professionals can only claim one incentive program (either Medicaid or Medicare). Very similar eligibility criteria. 10,991 Medicare providers have registered with 8,121 having received a payment.
    29. 29. Incentive Payment for Eligible Professionals First Calendar Year in which the EP receives an Incentive Payment Calendar Year CY 2011 CY 2012 CY 2013 CY 2014 CY 2015 CY 2016 2011 $21,250 2012 $8,500 $21,250 2013 $8,500 $8,500 $21,250 2014 $8,500 $8,500 $8,500 $21,250 2015 $8,500 $8,500 $8,500 $8,500 $21,250 2016 $8,500 $8,500 $8,500 $8,500 $8,500 $21,250 2017 $8,500 $8,500 $8,500 $8,500 $8,500 2018 $8,500 $8,500 $8,500 $8,500 2019 $8,500 $8,500 $8,500 2020 $8,500 $8,500 2021 $8,500 Total $63,750 $63,750 $63,750 $63,750 $63,750 $63,750
    30. 30. Incentive Payment for Eligible Hospitals Payments are formula driven and will vary per hospital. Most hospitals will receive between $1-$3 million. Payments are made over 3 years at a 50%, 40%, 10% ratio. MDCH will utilize cost report data in deriving the incentive amount.
    31. 31. Registrations/Payments As of 5/29/2013   Registered Paid Under AIU Paid Under MU Total Payments Dollars Paid (In Millions) EP 3,756 2,516 431 2,947 $55.6 EH 117 93 50 143 $108.6 Totals 3,873 2,609 481 3,090 $164.2
    32. 32. What the rest of 2013 holds? Launching Stage II of MU Getting Registration System Ready Getting Public Health Registries Ready Getting MU Repository Ready (MSSS, Cancer, CDR) Increasing MU Adoption Rates Electronic Clinical Quality Reporting
    33. 33. www.MichiganHealthIT.org Questions?
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