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  1. Welcome to the Commonwealth of Virginia Health Information Technology Grant Applicant Conference Office of Health Information Technology August 31, 2006
  2. Our Purpose Today <ul><li>Overview the Commonwealth’s strategy for information technology improving health care for all Virginians </li></ul><ul><li>Continue and expand the marketplace dialogue around electronic health records </li></ul><ul><li>Describe near term action steps </li></ul>
  3. Agenda <ul><li>Opening Remarks </li></ul><ul><li>Electronic Health Records Context and Vision </li></ul><ul><li>Project Organization </li></ul><ul><li>Request For Information (RFI) Desired Outcomes </li></ul><ul><li>Our Process </li></ul><ul><li>Lunch </li></ul><ul><li>Discussion </li></ul>
  4. Opening Remarks The Honorable Aneesh P. Chopra Secretary of Technology The Honorable Marilyn B. Tavenner Secretary of Health and Human Resources August 31, 2006
  5. Virginia’s Approach A Lofty (National) Goal Healthcare IT Investment Atop the National, State Agenda <ul><li>President Bush calls for most Americans to have an electronic health record by 2014 </li></ul><ul><li>Goal to develop a nationwide interoperable health information technology infrastructure </li></ul><ul><li>House passed “Health Information Technology Promotion Act” on July 27 th , 2006 following similar passage in the Senate in 2005 </li></ul>Warner Report in Brief Establish an ongoing statewide Virginia Health Care Innovations Group, Establish incentives for EHR adoption in the state’s role as a purchaser Appropriate state monies to facilitate increased eHealth initiatives, Identify and support the implementation of a master patient index, Address the health information management workforce shortage <ul><li>The Legislature has elevated the importance of this issue by calling for the creation of an Advisory Committee on Electronic Health Records </li></ul><ul><li>Allocates $1.5 Million over the biennium for encouraging Electronic Medical Records Adoption through grants issued to providers </li></ul><ul><li>The Governor has signed Executive Order 29 which creates the “Health Information Technology Council” </li></ul>
  6. Public-Private Partnerships to Drive Physician Adoption Rate Communities develop innovative solutions with the private sector to lower the cost, maximize marketing communication to area physicians, and boost adoption Virginia Health Information Network Commonwealth establishes standard to ensure data interoperability with sufficient protections for patient privacy, including the consideration of a master patient index Pilot Projects to Lower Health Care Costs Commonwealth invests in pilot projects to demonstrate cost savings in its capacity as a large employer, with particular emphasis on rewarding quality healthcare Myriad Opportunities to Spur the Adoption of Healthcare IT
  7. Framing Virginia’s 2007 Health IT Investment Agenda I Improving Virginia’s Health IT Infrastructure # Office of Health Information Technology: Virtual Office combining staff from both the Health and Technology Secretariats; serves as support staff for the Health IT Council in its mission to review proposals for funding from $1.5 Million appropriation II Extending the Enterprise III Seeding Global Reform #Medicaid Transformation Grants: Proposing to fund web-based PHR populated by claims data and electronic billing for smaller providers #Electronic Master Patient Index: Seed capital available for developing a statewide Electronic Master Patient Index in current biennial Budget #Virginia Department of Health EMR: Electronic Medical Record to serve Health Department clinics approved by IT Investment Board #Department of Mental Health, Mental Retardation, and Substance Abuse Services EMR: Medication Management and EMR Systems – Also approved
  8. Governor’s Health IT Council Membership <ul><li>Corporate </li></ul><ul><ul><li>Gil Minor, Owens and Minor </li></ul></ul><ul><ul><li>Bob Johnson, Sprint Nextel </li></ul></ul><ul><ul><li>Balan Nair, AOL </li></ul></ul><ul><li>Home Healthcare </li></ul><ul><ul><li>Ron DeCesare, Professional Healthcare Resources </li></ul></ul><ul><li>Hospital Members </li></ul><ul><ul><li>Barbara Baldwin, UVA </li></ul></ul><ul><ul><li>Golden Bethune, Riverside </li></ul></ul><ul><ul><li>Joe Roach, Martinsville Memorial Hospital </li></ul></ul><ul><li>Insurance </li></ul><ul><ul><li>Megan Philpotts Padden, Sentara Health Plans </li></ul></ul><ul><li>Legislative </li></ul><ul><ul><li>Hon. Janet Howell, VA Senate </li></ul></ul><ul><ul><li>Hon. Sam Nixon, VA House of Delegates </li></ul></ul><ul><ul><li>Hon. John O’Bannon, VA House of Delegates </li></ul></ul><ul><li>Long-Term Care </li></ul><ul><ul><li>Elizabeth Brown, Sentara Healthcare </li></ul></ul>
  9. <ul><li>Patient Advocate </li></ul><ul><ul><li>Nancy Davenport-Ennis, Patient Advocate Foundation </li></ul></ul><ul><li>Pharmacy </li></ul><ul><ul><li>Michele Vilaret, National Association of Chain Drug Stores </li></ul></ul><ul><li>Physician Members </li></ul><ul><ul><li>Dr. Gopinath Jadhav, Southside Gastroenterology, Richmond </li></ul></ul><ul><ul><li>Dr. Keith Newby, Cardiology and Arrhythmia Consultants, Norfolk </li></ul></ul><ul><ul><li>Dr. Larry T. Wilson, Holston Medical Group, Gate City </li></ul></ul><ul><li>Privacy Expert </li></ul><ul><ul><li>Anna Slomovic, Revolution Health Group </li></ul></ul><ul><li>Thought Leaders </li></ul><ul><ul><li>David Merritt, Center for Health Transformation </li></ul></ul><ul><ul><li>Chas Roades, Advisory Board Co. </li></ul></ul><ul><ul><li>Don Detmer, American Medical Informatics Association / UVA </li></ul></ul>Governor’s Health IT Council Membership
  10. Our Process Greg Walton Executive Advisor
  11. Office of Health Information Technology - A Virtual Team <ul><li>Betty Jolly – Department of Health Professions </li></ul><ul><li>Heidi Dix – Asst. Sec. of Health and Human Resources </li></ul><ul><li>Thomas Gates – Assistant Secretary of Technology </li></ul><ul><li>Tristen Pegram – Special Assistant for Technology </li></ul><ul><li>Kim Barnes – Virginia Department of Health </li></ul><ul><li>Greg Walton – Executive Advisor to the Council </li></ul>
  12. Health & Human Resources Priorities <ul><li>Medicaid Reform </li></ul><ul><li>Healthy Virginians </li></ul><ul><li>Health Workforce Issues </li></ul><ul><li>Uninsured in Virginia </li></ul><ul><li>Quality Health Initiatives </li></ul>
  13. Our Process <ul><li>Subcommittees of the Technology Council </li></ul><ul><li>Regional Approach </li></ul><ul><li>Project Sweet Spots </li></ul><ul><li>Guidelines to the Statement of Interest </li></ul><ul><li>Applicant Dialogue </li></ul>
  14. Technology Council Sub Committees <ul><li>Business Case and Partnerships </li></ul><ul><li>Privacy and Security </li></ul><ul><li>Physician Communications </li></ul><ul><li>Order of Merit Confirmation </li></ul>
  15. Economic Development Regions
  16. VIRGINIA’S EHR ADOPTION IN PHYSICIAN OFFICES “ Given that physicians in small practices account for 88 percent of all outpatient visits and four-fifths of physicians work in small practices, this group represents a sizable adoption gap.” From “Information Technologies. When Will They Make It into Physicians’ Black Bags?” Medscape General Medicine 6, no. 4 (2005)
  17. Health Regions in Virginia
  18. Number of MD’s by Health Region <ul><li>Total licensed MD’s </li></ul><ul><li>3346 = Central Region </li></ul><ul><li>4167 = Eastern Region </li></ul><ul><li>7966 = Northern Region </li></ul><ul><li>2464 = Southwest Region </li></ul>Source: Department of Health Professions BOM, 2006 data
  19. <ul><ul><li>33% of respondents in a recent Virginia survey of physician offices said they have an EHR in use today. </li></ul></ul><ul><ul><li>Of those who said they had an EHR, 36.6% utilized 3 components or fewer . 12% reported 3 components or fewer; 17% reported 4 to 6 components; 4% reported 7 or more components </li></ul></ul><ul><ul><li>Those in a hospital setting (60%) were more likely than those in large group practice (3 or more doctors; 33%) and small group practice (2 or less doctors; 17%) to have and EHR. </li></ul></ul>Source: VDH Survey, 2005 Physician Adoption
  20. Most Adopted Feature of an EHR <ul><li>Receipt of lab results = 62% </li></ul><ul><li>Entry of progress notes = 57% </li></ul><ul><li>Decision support such as online material = 56% </li></ul><ul><li>Images = 55% </li></ul><ul><li>Lab ordering = 50% </li></ul><ul><li>Alerts to drug interactions = 40% </li></ul><ul><li>Image ordering = 38% </li></ul><ul><li>Records transmitted/received from other offices = 38% </li></ul><ul><li>Electronic Prescriptions = 24% </li></ul><ul><li>Alerts to deviations from patient care protocol = 14% </li></ul><ul><li>Patients can access part or all of the record = 5% </li></ul>Source: VDH Survey, 2005
  21. On average, how many patient records are currently in your system? Source: VDH Survey, 2005
  22. How many years have you had your current electronic health record system? Source: VDH Survey Early Adopters, 2005
  23. Virginia’s Hospitals
  24. Virginia Hospital Statistics Compared Nationally Note: Data based on most recent hospital Medicare cost reports; access from http://www.ahd.com/state_statistics.html on August 30 , 2006. $1,265,638,838 155,432,732 32,748,037 650,143 3,886 U.S. $26,119,057 3,592,628 738,588 14,759 81 Virginia Gross patient revenues (hundred thousands) Patient days Total discharges Staffed beds Number of hospitals
  25. Acute Care Hospitals Source: Virginia State Planning Grant Phase One , Final Report to the Secretary of Health and Human Services, September 2005 * FP-Proprietary Hospitals; NFP—Not-for-Profit Hospitals 76 Acute Care Hospitals (2003) Source: Department of Health Professions BOM, 2006 data
  26. Trauma Centers Serving Virginians
  27. Additional Providers <ul><li>Other Hospitals: </li></ul><ul><ul><li>4 State or Locally Owned Hospitals </li></ul></ul><ul><ul><li>6 Psychiatric Hospitals </li></ul></ul><ul><ul><li>4 Rehabilitation Hospitals </li></ul></ul><ul><ul><li>36 Ambulatory Surgery Centers </li></ul></ul><ul><li>Other Providers: </li></ul><ul><ul><li>245 Licensed Nursing Facilities </li></ul></ul><ul><ul><li>4 Health Regions (Northern, SW, Central, and Eastern) </li></ul></ul><ul><ul><li>35 Local Health Districts </li></ul></ul>Source: Virginia State Planning Grant Phase One , Final Report to the Secretary of Health and Human Services, September 2005 and Virginia Department of Health: www.vdh.virginia.gov/LHD Full list of Virginia Hospitals available at: http://www.ahd.com/states/hospital_VA.html
  28. Virginia Local Health Districts Source: Virginia Department of Health, http:// www.vdh.virginia.gov/LHD/LocalHealthDistricts.asp
  29. Project Sweet Spots Demonstrate Innovate Automate Validate Key Attributes
  30. Guidelines to the Statement of Interest <ul><li>Contact Information </li></ul><ul><li>Project Overview </li></ul><ul><li>Partnership History </li></ul><ul><li>Timeline and Work plan </li></ul><ul><li>Description of Technical Approach </li></ul><ul><li>Special Commonwealth Considerations </li></ul><ul><li>Business Model </li></ul>
  31. Guidelines to the Statement of Interest - Contact Information <ul><li>Recommended Length: 1 Paragraph </li></ul><ul><li>Required Information </li></ul><ul><ul><ul><li>Organization(s) </li></ul></ul></ul><ul><ul><ul><li>Contact Person’s Name, Address, Phone Numbers & E-mail </li></ul></ul></ul><ul><li>Suggested </li></ul><ul><ul><ul><li>Company Web Site </li></ul></ul></ul>
  32. Guidelines to the Statement of Interest - Project Overview <ul><li>Recommended Length: 3 Pages </li></ul><ul><li>Suggested </li></ul><ul><ul><ul><li>What Will Be Done </li></ul></ul></ul><ul><ul><ul><li>Roles of the Partners </li></ul></ul></ul><ul><ul><ul><li>Regional Orientation and Impact </li></ul></ul></ul>
  33. Guidelines to the Statement of Interest - Partnership History <ul><li>Recommended Length: 2 Pages </li></ul><ul><li>Suggested </li></ul><ul><ul><ul><li>Virginia Partnership Activity </li></ul></ul></ul><ul><ul><ul><li>Institutional & Physician </li></ul></ul></ul><ul><ul><ul><li>Challenges Overcome </li></ul></ul></ul>
  34. Guidelines to the Statement of Interest - Timeline and Work Plan <ul><li>Recommended Length: 2 Pages </li></ul><ul><li>Required </li></ul><ul><ul><ul><li>Start Date from Award </li></ul></ul></ul><ul><ul><ul><li>Project Phases </li></ul></ul></ul><ul><li>Suggested </li></ul><ul><ul><ul><li>Project Sub-phases </li></ul></ul></ul><ul><ul><ul><li>Work Load by Partner </li></ul></ul></ul>
  35. Guidelines to the Statement of Interest - Description of Technical Approach <ul><li>Recommended Length: 1 Page </li></ul><ul><li>Required </li></ul><ul><ul><ul><li>Multiple Choice/Fill in the Blank Questions </li></ul></ul></ul>
  36. Guidelines to the Statement of Interest - Description of Technical Approach <ul><ul><li>Network, Systems Architecture, Hardware, Operating Environment, Database, etc. </li></ul></ul><ul><ul><li>What deployment models are available for your product? (check all that apply </li></ul></ul><ul><ul><ul><li>o Application Service Provider (Vendor Hosted) </li></ul></ul></ul><ul><ul><ul><li>o Software Product (User Hosted) </li></ul></ul></ul><ul><ul><ul><li>o Third Party Site </li></ul></ul></ul><ul><ul><li>What operating system(s) does your product use? (check all that apply) </li></ul></ul><ul><ul><ul><li>o Windows </li></ul></ul></ul><ul><ul><ul><li>o Linux </li></ul></ul></ul><ul><ul><ul><li>o Unix </li></ul></ul></ul><ul><ul><ul><li>o Mac OS </li></ul></ul></ul><ul><ul><ul><li>o Other </li></ul></ul></ul><ul><ul><li>What minimum client application does your product require? </li></ul></ul><ul><ul><ul><li>o Thick client </li></ul></ul></ul><ul><ul><ul><li>o Browser-based </li></ul></ul></ul><ul><ul><ul><li>o Rich Browser-based (e.g., Applets) </li></ul></ul></ul>
  37. Guidelines to the Statement of Interest - Description of Technical Approach <ul><ul><li>What other client applications does your product provide? (check all that apply) </li></ul></ul><ul><ul><ul><li>o Thick client </li></ul></ul></ul><ul><ul><ul><li>o Browser-based </li></ul></ul></ul><ul><ul><ul><li>o Applet-based </li></ul></ul></ul><ul><ul><li>What underlying database management software is supported? (check all that apply) </li></ul></ul><ul><ul><ul><li>o Oracle </li></ul></ul></ul><ul><ul><ul><li>o Microsoft SQL Server </li></ul></ul></ul><ul><ul><ul><li>o Open Source (MySQL, Firebird, Ingres) </li></ul></ul></ul><ul><ul><ul><li>o DB2 </li></ul></ul></ul><ul><ul><ul><li>o OODBMS </li></ul></ul></ul><ul><ul><ul><li>o Other </li></ul></ul></ul><ul><ul><ul><li>List other required 3rd party software____________ </li></ul></ul></ul>
  38. Guidelines to the Statement of Interest - Description of Technical Approach <ul><ul><li>Scalability features (check all that apply) </li></ul></ul><ul><ul><ul><li>Database/Server Replication </li></ul></ul></ul><ul><ul><ul><li>Server Clustering </li></ul></ul></ul><ul><ul><ul><li>SMP computing </li></ul></ul></ul><ul><ul><ul><li>Grid Computing </li></ul></ul></ul><ul><ul><ul><li>Other [please fill in] _______________________ </li></ul></ul></ul><ul><ul><li>What types of access points does your product support for physicians, nurses, other caregivers and non-clinical reviewers (check all that apply) </li></ul></ul><ul><ul><ul><li>Desktop computers </li></ul></ul></ul><ul><ul><ul><li>Laptop computers </li></ul></ul></ul><ul><ul><ul><li>Wireless tablet computers </li></ul></ul></ul><ul><ul><ul><li>Text message </li></ul></ul></ul><ul><ul><ul><li>Cell phone </li></ul></ul></ul><ul><ul><ul><li>IM </li></ul></ul></ul><ul><ul><ul><li>Remote Access </li></ul></ul></ul><ul><ul><ul><li>Other </li></ul></ul></ul>
  39. Guidelines to the Statement of Interest - Description of Technical Approach <ul><ul><li>What additional data entry mechanisms are supported (check all that apply) </li></ul></ul><ul><ul><ul><li>o Bar code readers </li></ul></ul></ul><ul><ul><ul><li>o OCR </li></ul></ul></ul><ul><ul><ul><li>o Scanning (?) </li></ul></ul></ul><ul><ul><ul><li>o Web forms </li></ul></ul></ul><ul><ul><ul><li>o Patient monitoring equipment </li></ul></ul></ul><ul><ul><ul><li>o Laboratory analysis equipment </li></ul></ul></ul><ul><ul><ul><li>o Voice </li></ul></ul></ul><ul><ul><ul><li>o Handwriting recognition </li></ul></ul></ul><ul><ul><ul><li>o RFID </li></ul></ul></ul><ul><ul><ul><li>o Biometrics </li></ul></ul></ul><ul><ul><ul><li>o Smart Cards </li></ul></ul></ul><ul><ul><ul><li>o Proximity Badges </li></ul></ul></ul><ul><ul><ul><li>o Other [fill in] </li></ul></ul></ul>
  40. Guidelines to the Statement of Interest - Description of Technical Approach <ul><ul><li>Data and System Security Requirements </li></ul></ul><ul><ul><li>What provisions are made for compliance with Privacy standards and regulatory requirements (fill in URL or less than 50 words) _______________________________________ </li></ul></ul><ul><ul><li>What provisions are made for compliance with requirements for legally sound medical records (fill in URL or less than 50 words)) ______________________________________ </li></ul></ul><ul><ul><li>What features exist for data protection and disaster recovery (fill in URL or less than 50 words) ___________________________ </li></ul></ul><ul><ul><li>What data security measures does your system support (check all that apply)? </li></ul></ul><ul><ul><li>SSL </li></ul></ul><ul><ul><li>3 rd party SSL accelerators </li></ul></ul><ul><ul><li>Event logging to support auditing and strict user accountability </li></ul></ul><ul><ul><li>Rollback </li></ul></ul>
  41. Guidelines to the Statement of Interest - Description of Technical Approach <ul><ul><li>Data and System Security Requirements </li></ul></ul><ul><ul><li>All information is time-stamped (Y/N) </li></ul></ul><ul><ul><li>All data entry is associated with a particular user (Y/N) </li></ul></ul><ul><ul><li>Users have unique login (Y/N) </li></ul></ul><ul><ul><li>Users can be assigned particular roles (Y/N) </li></ul></ul><ul><ul><li>Provides unique patient identifier (Y/N) </li></ul></ul><ul><ul><li>Supports electronic signature where permitted by Virginia law (Y/N) </li></ul></ul><ul><ul><li>Routine Maintenance Procedures </li></ul></ul><ul><ul><li>What is the expected downtime per week for maintenance under normal utilization? </li></ul></ul><ul><ul><li><1 hr o 1-4 hrs o 4-8 hrs o > 8 hrs </li></ul></ul>
  42. Guidelines to the Statement of Interest - Description of Technical Approach <ul><ul><li>Tools for Computer Operators and Support Staff </li></ul></ul><ul><ul><li>What tools does your product support (check all that apply)? </li></ul></ul><ul><ul><li>Data migration from legacy medical records systems </li></ul></ul><ul><ul><li>Workflow management? </li></ul></ul><ul><ul><li>Customizable (Y/N) </li></ul></ul><ul><ul><li>Statistical Data Analysis </li></ul></ul><ul><ul><li>OLAP </li></ul></ul><ul><ul><li>Custom Reports </li></ul></ul><ul><ul><li>Data Mining Tools </li></ul></ul><ul><ul><li>Flat file import (CSV, etc.) </li></ul></ul><ul><ul><li>XML input </li></ul></ul><ul><ul><li>XML export </li></ul></ul>
  43. Guidelines to the Statement of Interest - Description of Technical Approach <ul><ul><li>Required or Suggested Staffing </li></ul></ul><ul><ul><li>Requires dedicated administrator (Y/N) </li></ul></ul><ul><ul><li>Use of standards </li></ul></ul><ul><ul><li>What standards are supported for information exchange (check all that apply)? </li></ul></ul><ul><ul><li>HL7 2.3.1 HL7 2.4 CVX MVX </li></ul></ul><ul><ul><li>NCDCP ICD-9 CDISC CABIG </li></ul></ul><ul><ul><li>IEEE 1073 IHE PIX X12N ELINCS </li></ul></ul><ul><ul><li>DICOM HUGN NDF-RT HIPAA </li></ul></ul><ul><ul><li>LOINC SNOMED RXNORM </li></ul></ul><ul><ul><li>Other (list): _______________________________ </li></ul></ul>
  44. Guidelines to the Statement of Interest - Description of Technical Approach <ul><ul><li>What underlying database management software is supported? (check all that apply) </li></ul></ul><ul><ul><ul><li>Oracle </li></ul></ul></ul><ul><ul><ul><li>Microsoft SQL Server </li></ul></ul></ul><ul><ul><ul><li>Open Source (MySQL, Firebird, Ingres) </li></ul></ul></ul><ul><ul><ul><li>DB2 </li></ul></ul></ul><ul><ul><ul><li>OODBMS </li></ul></ul></ul><ul><ul><ul><li>Other </li></ul></ul></ul><ul><ul><li>List other required 3rd party software requirements: ________________ </li></ul></ul><ul><ul><li>Scalability features (check all that apply) </li></ul></ul><ul><ul><ul><li>Database/Server Replication </li></ul></ul></ul><ul><ul><ul><li>Server Clustering </li></ul></ul></ul><ul><ul><ul><li>SMP computing </li></ul></ul></ul><ul><ul><ul><li>Grid Computing </li></ul></ul></ul><ul><ul><ul><li>Other [please fill in] _______________________ </li></ul></ul></ul>
  45. Guidelines to the Statement of Interest - Special State Considerations <ul><li>Recommended Length: 1 Page </li></ul><ul><li>Required </li></ul><ul><ul><ul><li>Highlight commitments to any of the following, S mall(SBE), W omen (WBE), and M inority owned (MBE) businesses ((SWAM)). </li></ul></ul></ul>
  46. Guidelines to the Statement of Interest - Business Model <ul><li>Recommended Length: 1 Page </li></ul><ul><li>Required </li></ul><ul><ul><ul><li>State your dollar request for the Grant </li></ul></ul></ul><ul><ul><ul><li>State any assumptions/plans about other funding sources you expect to pursue </li></ul></ul></ul>
  47. Guidelines to the Statement of Interest - Diagrams and Pictures <ul><li>Suggested </li></ul><ul><ul><ul><li>High-level Architecture </li></ul></ul></ul><ul><ul><ul><li>High-Level Systems/Applications </li></ul></ul></ul><ul><ul><ul><li>Project Organization Chart </li></ul></ul></ul>
  48. Applicant Dialogue <ul><li>Web Postings from OHIT www.healthitcouncil.vi.virginia.gov </li></ul><ul><li>Frequently Asked Questions FAQs </li></ul><ul><li>Staff Dialogue and Coaching </li></ul><ul><li>Weekly Project Updates </li></ul><ul><li>Supporting Material </li></ul><ul><li>SOI applicant survey and Proposal Repository on-line as of Sept 11 th </li></ul>
  49. Time Table <ul><li>RFI issued - August 21st </li></ul><ul><li>Applicant Conference - August 31st </li></ul><ul><li>Statements of Interest Due - September 15th </li></ul><ul><li>Technology Council Meetings - September 15th, 29th and October 12th </li></ul><ul><li>Order of Merit List Ranking Released October 15th -30th </li></ul><ul><li>Stage #2 Begins </li></ul>
  50. LUNCH
  51. Discussion
  52. ADJOURN http://www.healthitcouncil.vi.virginia.gov

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