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  1. 1. Quality and the Health Information Technology Movement: Could Louisiana Become A Leader in Technology Modernization Efforts? Quality and the Health Information Technology Movement: Could Louisiana Become A Leader in Technology Modernization Efforts?
  2. 2. Anthony Keck Anthony Keck BSI&OE, M.P.H. Tulane University School of Public Health & Tropical Medicine Panelists: Roxane A. Townsend, M.D. Deputy Secretary, LA DHH Christopher B. Sullivan, Ph.D. Administrator, Office of HIT Florida Center for Health Information and Policy Analysis Agency for Health Care Administration Robert Olmedo Director of Technology Palm Beach County Community Health Alliance Panel Moderator:
  3. 3. Creating A Healthy Future for Louisiana Through the Power of Information
  4. 4. Health Information Technology  Develop systems for monitoring and reporting quality of care using recognized standards
  5. 5. Health Information Technology Pre-Katrina/Rita <ul><li>Initiatives </li></ul><ul><li>Health Information Technology Summit </li></ul><ul><li>HIFA 1115 Waiver – HIT Infrastructure </li></ul><ul><li>RFP for e-Prescribing </li></ul><ul><li>Electronic Medical Records </li></ul><ul><ul><li>Critical Access Hospital’s Grant </li></ul></ul><ul><li>Provider Decision Support Tool </li></ul><ul><li>Louisiana PHIN (Public Health Information Network) </li></ul><ul><li>DHH response to HHS/ONC RFP for NHIN </li></ul>
  6. 6. Health Information Technology Summit <ul><li>State CANNOT be the sole owner of the agenda </li></ul><ul><li>State CAN provide leadership and direction </li></ul><ul><li>State and Regional Collaboration </li></ul><ul><li>Must create a Value Proposition </li></ul><ul><li>Importance of assuring privacy and security </li></ul>
  7. 8. KATRINA… <ul><li>The most challenging issues had nothing to do with technology and everything to do with challenges regarding… </li></ul><ul><ul><li>Policy </li></ul></ul><ul><ul><li>Legal </li></ul></ul><ul><li>We were not prepared! </li></ul><ul><ul><li>Business </li></ul></ul><ul><li>Two areas that need critical attention were validated… </li></ul><ul><li>The “shelter” phase is very different from the “community” phase </li></ul>Accurately linking data about a patient Methods for… Securing authentication
  8. 9. Health Information in Katrina <ul><li>Environmental Factors – Human… </li></ul><ul><li>1.2 million people separated from their medical history </li></ul><ul><li>Most being cared for by providers they’ve never previously seen </li></ul><ul><li>Estimate 20% in shelters and emergency facilities with medical personnel available, dropping to 10% within 2 weeks (i.e., majority of dislocated people will be getting care in the community) </li></ul><ul><li>Significant concerns about coverage, access to current prescriptions </li></ul><ul><li>Likely continued mobility across U.S. </li></ul><ul><li>Many will have other documentation problems (property titles, vital records, insurance) as well </li></ul><ul><li>Physicians from affected areas may start to practice elsewhere; most records lost </li></ul><ul><li>No guarantee physicians or patients will return to affected areas </li></ul><ul><li>Uncertain level of trust in first response services </li></ul>
  9. 11. www.KatrinaHealth.org <ul><ul><li>Louisiana and Mississippi Medicaid </li></ul></ul><ul><ul><li>Commercial pharmacies </li></ul></ul><ul><ul><li>Pharmacy Benefit Managers </li></ul></ul><ul><ul><li>Veterans Health Administration </li></ul></ul><ul><li>Once authorized to use KatrinaHealth.org, health professionals were able to access an evacuee's medication history from the following sources… </li></ul><ul><li>KatrinaHealth.org allowed authorized health professionals with a secure means to assist Katrina evacuees who did not have access to or do not recall their medication histories </li></ul>
  10. 12. PMAC
  11. 17. LINKS: Unexpected Successes <ul><li>LINKS was successfully accessed from all 50 United States, Canada, Mexico, Ecuador, Guatemala and the United Kingdom </li></ul><ul><li>Over 56,000 records were successfully retrieved for Katrina evacuees OUTSIDE of Louisiana </li></ul><ul><ul><li>The Houston Harris County Immunization Registry (HHCIR) staff estimated that use of the HHCIR to retrieve LINKS data (via HL7 messaging) saved the Houston immunization program approximately $1.5 million dollars in vaccines </li></ul></ul><ul><ul><li>Total estimate of over $6.3 million in savings for vaccines due to the availability of vaccination records in LINKS </li></ul></ul>
  12. 18. Health Information Technology Post-Katrina/Rita <ul><li>Initiatives </li></ul><ul><li>KatrinaHealth.org </li></ul><ul><li>Louisiana Health Information Exchange (LaHIE) </li></ul><ul><ul><li>Contract between HHS and LA DHH </li></ul></ul><ul><ul><li>Prototype for Interoperable Health Information Exchange </li></ul></ul><ul><ul><li>Gulf Coast Information Technology Task Force </li></ul></ul><ul><li>HISPC </li></ul><ul><li>Medicaid HIT Transformation Grant </li></ul>
  13. 19. Louisiana Health Information Exchange (LaHIE) <ul><li>Primary focus to recover and recreate medical histories for Hurricane Evacuees </li></ul><ul><li>Contract between DHH and HHS/Office of National Coordinator Health Information Technology </li></ul><ul><li>Develop a prototype for health information exchange </li></ul>
  14. 20. <ul><li>Awarded Contract on Sep 30, 2005 </li></ul><ul><li>One –Year Implementation Timeline </li></ul><ul><li>Using Proven Technology </li></ul><ul><li>Following all Standards and Privacy Policies </li></ul><ul><li>Public, Private, and Educational Project Team </li></ul><ul><li>Primary Focus – Electronic Health Records </li></ul><ul><ul><li>Not Electronic Medical Records </li></ul></ul><ul><li>Start Small - 2 Markets </li></ul><ul><ul><li>New Orleans (Recovery) </li></ul></ul><ul><ul><li>Baton Rouge </li></ul></ul>Louisiana Health IT Project Overview
  15. 21. <ul><li>Project Will Demonstrate: </li></ul><ul><ul><li>Health Information Exchange Between Providers </li></ul></ul><ul><ul><li>Timely Access to Patient Continuity of Care Information </li></ul></ul><ul><ul><ul><li>Trauma </li></ul></ul></ul><ul><ul><ul><li>Emergency Room </li></ul></ul></ul><ul><ul><ul><li>Provider Facilities </li></ul></ul></ul><ul><ul><ul><li>Long-Term – Personal Health Records </li></ul></ul></ul><ul><li>First Functional Demonstration – Target July 2006 </li></ul><ul><li>Begin Requirements Gathering – February 2006 </li></ul><ul><li>Proven Provider Credentialing </li></ul>Louisiana Health IT Project Overview
  16. 22. Guiding Principles <ul><li>Healthcare costs will be reduced by minimizing waste and improving efficiency </li></ul><ul><li>Patients and their doctors will retain control over how their data is used </li></ul>
  17. 23. Project Goals <ul><li>To design, develop, and implement the necessary infrastructure to demonstrate functional interoperability in collaboration with Louisiana healthcare providers through the standardized exchange of patient information by September 30, 2006 </li></ul>
  18. 24. LA HIE High Level Architecture Vendor Applications Baton Rouge Market New Orleans Recovery Record Locator MPI Privacy Mgr. Consent Account Mgr. SSO LSU/MCL BC/BS of Louisiana PATH Partners Ochsner Health System I/E Data Cache I/E Data Cache Our Lady of the Lake Baton Rouge General Louisiana Medicaid Baton Rouge Primary Care Consent App. Core Electronic Health Record Viewer CDA Level 2 Document
  19. 26. Louisiana Medicaid - Pay for Performance - <ul><li>Vaccines for Children Program </li></ul><ul><li>Utilizing LINKS in the office </li></ul><ul><li>Achieving State average for toddler immunizations </li></ul><ul><li>Achieving National average for toddler immunizations </li></ul>
  20. 27. HbA1c Test in Past Year, HEDIS, Adjusted Denominator: HEDIS Diabetes 0 .1 .2 .3 .4 .5 .6 .7 .8 .9 1 Fraction of Patients Graph shows only CC PCPs with 10+ patients overall level = 65%, red = stat sig diff > .05 from overall level symbol size proportional to # of patients, range 10 to 335
  21. 30. Regional HgbA1c Averages 0 20 40 60 80 100 120 Region II Region III Region IV Region VI Region VII Region VIII Region IX HgbA1c < 7% HgbA1c > 7%
  22. 31. Health Information Security and Privacy Collaborative <ul><li>Awarded Contract from RTI in May 2006 </li></ul><ul><li>Identifying barriers to electronic health information sharing </li></ul><ul><ul><li>Legal </li></ul></ul><ul><ul><li>Business Practices </li></ul></ul><ul><ul><li>Policies </li></ul></ul><ul><li>Workgroups formed </li></ul><ul><li>Solutions to barriers being sought </li></ul>
  23. 32. Medicaid Transformation Grant <ul><li>Goal… </li></ul><ul><ul><li>To provide incentives to physicians for HIT adoption </li></ul></ul><ul><li>Target New Orleans area </li></ul><ul><li>325 providers </li></ul><ul><li>Technical assistance with EMR adoption </li></ul><ul><li>Software and hardware purchase </li></ul><ul><li>Announcement of awards pending </li></ul>
  24. 33. Health Care Redesign Collaborative <ul><li>Medical Home Model </li></ul><ul><li>Health Information Technology </li></ul><ul><li>Louisiana Quality Forum </li></ul>
  25. 36. Anthony Keck BSI&OE, M.P.H. Tulane University School of Public Health & Tropical Medicine Panelists: Roxane A. Townsend, M.D. Deputy Secretary, LA DHH Christopher B. Sullivan, Ph.D. Administrator, Office of HIT Florida Center for Health Information and Policy Analysis Agency for Health Care Administration Robert Olmedo Director of Technology Palm Beach County Community Health Alliance Panel Moderator:
  26. 37. Developing the Florida Health Information Network through a Grants Program for Regional Health Information Organizations
  27. 38. The Florida Health Information Network is the Result of… <ul><li>Funding from the Legislature for grants to R egional H ealth I nformation O rganizations ( RHIO s) </li></ul><ul><li>Leadership from the Governor’s Health Information Infrastructure Advisory Board </li></ul>Policy Decisions Funding Leadership <ul><li>Health policy decisions in the Florida Legislature and Governor’s Office endorsing the Florida Health Information Network (FHIN) </li></ul>
  28. 39. The Florida Health Information Network Strategy <ul><li>Integrate the RHIOs with a state-level server that will manage data exchange among RHIOs and other state and federal databases </li></ul><ul><li>Create a not-for-profit organization to maintain the FHIN and set standards of interoperability for the RHIOs </li></ul><ul><li>Build out health information networks using a grants program to leverage the development of local RHIOs </li></ul>
  29. 40. Florida’s Governor Jeb Bush signed Executive Order Number 04-03 on May 4, 2004 addressing the need for state leadership in the area of health information technology infrastructure development Executive Order Initiates the Florida Health Information Network
  30. 41. The Governor’s Health Information Infrastructure Advisory Board <ul><li>Advisory Board formed to create… </li></ul><ul><ul><li>“ a plan to promote the development and implementation of a Florida health information infrastructure” </li></ul></ul><ul><li>The Board’s 2005 Interim Report of the GHIIAB called for the creation of the Florida Health Information Network </li></ul>
  31. 42. Health Information Networks Included as an “Innovative Idea” in 2007 <ul><li>Idea 85 of Speaker Marco Rubio’s 100 Innovative Ideas addresses health information exchange </li></ul><ul><li>“ Improve patient care through technology by expanding electronic health records and regional health information networks” </li></ul>
  32. 43. Definition Florida Health Information Network - the statewide network that will integrate the Regional Health Information Networks to enable statewide health information exchange
  33. 44. Functions of the Florida Health Information Network <ul><li>The Florida Health Information Network will facilitate communications and data exchange among the RHIOs by coordinating requests for medical records inside and outside of Florida </li></ul><ul><li>“ The Florida Health Information Network will specify and maintain technical standards for interoperability among the RHIOs </li></ul>
  34. 45. Florida Health Information Network Medicaid Florida Center DOH SHOTs Vital Statistics Certification of Physicians with DOH Licensing Database
  35. 46. Florida Health Information Network 1. Big Bend RHIO 2. Tampa Bay RHIO 3. Palm Beach County Community Health Alliance 4. South Florida HII 5. Escambia HIN 6. JaxCare, Inc. 7. Community Health Information Organization 8. Central Florida RHIO 9. Pinellas RHIO 10. Space Coast RHIO
  36. 47. The Florida Health Information Network White Paper <ul><li>Originally written to address… </li></ul><ul><ul><li>The technical architecture of the Florida Health Information Network </li></ul></ul><ul><ul><li>The requirements of interoperability among the RHIOs and the Florida Health Information Network </li></ul></ul><ul><ul><li>The needed security precautions to ensure confidentiality of data exchange </li></ul></ul><ul><li>Has become an ongoing strategic document to address new technical issues as they arise </li></ul>
  37. 48. Technical Standards for the FHIN
  38. 49. The Florida Health Information Network Begins at the Local Level <ul><li>The Florida Health Information Network is being built from the local community up </li></ul><ul><li>An essential element of the strategic plan is to empower local stakeholder collaborations focused on health information exchange </li></ul><ul><li>The driver of this plan is the FHIN Grants Program and Regional Health Information Organizations in the local community </li></ul>
  39. 50. What Is A Regional Health Information Organization? Web- based Portal Clinical Source Systems Patient Portal Physician Portal Business Convener Security Management Identity Management Information Management Physician s Inpatient Lab Rx Bring together health care stakeholders. Manage Business Associate Agreements. Enable data-sharing among providers. Certify providers to access health care records. Authorize access to records. Log record access activity. Identify patient records with MPA. Match patient records with an RLS. Gathers patient data into Minimal Clinical Dataset. Provide data access through a Web-based portal. Provide access to the FHIN. RHIO Infrastructure
  40. 51. Grants Program to Develop Regional Health Information Organizations <ul><li>Planning Grants: Support engaging local health care stakeholders to develop a strategic plan for health information exchange </li></ul><ul><li>Implementation Grants: Support projects that demonstrate health information exchange among two or more competing providers </li></ul><ul><li>Training Grants: Support practitioner training designed to increase physician and dentist use of electronic health record systems </li></ul>
  41. 52. Grants Program … 2006-2007 <ul><li>In 2005 the Legislature appropriated $1.5 million for grants which the Agency awarded to nine projects </li></ul><ul><ul><li>5 Planning Grants </li></ul></ul><ul><ul><li>3 Implementation Grants </li></ul></ul><ul><ul><li>1 Training Grant </li></ul></ul><ul><li>In 2006 the Agency awarded seven grants with another $2 million appropriated by the Legislature </li></ul><ul><ul><li>7 Implementation Grants </li></ul></ul>
  42. 53. Geography of the FHIN <ul><li>Florida RHIOs… </li></ul><ul><li>Big Bend RHIO </li></ul><ul><li>Central Florida RHIO </li></ul><ul><li>3. Community Health Information Organization </li></ul><ul><li>4. Escambia HIN </li></ul><ul><li>5. JaxCare, Inc. </li></ul><ul><li>6. Palm Beach County Community Health Alliance </li></ul><ul><li>7. Pinellas RHIO </li></ul><ul><li>8. Space Coast RHIO </li></ul><ul><li>9. South Florida HII </li></ul><ul><li>10. Tampa Bay RHIO </li></ul>FHIN Server
  43. 54. Florida RHIA Example All-Care Health Record System Palm Beach County Community Health Alliance Glades West Palm Beach
  44. 55. Palm Beach County Community Health Alliance PBC Community Health Alliance (An Alliance of Funders and Providers Serving Health Care Consumers) Care Expansion Language Access Common Eligibility Shared EHR Project Access Private Funders Hospitals Public Funders Health Dept. Free Clinics Social Services Partners Partners Collaborative Projects
  45. 56. Western Palm Beach County Health Information Infrastructure Operations and Evaluation Project <ul><li>28% uninsured rate </li></ul><ul><li>Glades General Hospital is only Acute Care facility </li></ul><ul><li>17,753 ER visits; 1,900 Medicaid discharges in 2002 </li></ul><ul><li>Prevent duplication between hospital and clinics </li></ul>
  46. 57. All-Care Shared Health Record <ul><li>Real-time electronic interface to existing data systems used by… </li></ul><ul><ul><li>Hospitals </li></ul></ul><ul><ul><li>Clinics </li></ul></ul><ul><li>Free clinics, Federally Qualified Health Centers, Palm Beach County Medical Society Project Access and key competitor safety net hospitals are participating </li></ul><ul><li>Viewable via the Web … after patients have signed authorizations </li></ul><ul><ul><li>Mental Health Centers </li></ul></ul><ul><ul><li>Other safety net providers </li></ul></ul>
  47. 58. All-Care Clinical Data List <ul><li>Date of Visit and Encounter Type </li></ul><ul><li>Clinic and Provider Names </li></ul><ul><li>Diagnosis and CPT code(s) </li></ul><ul><li>(Hospital) Discharge code </li></ul><ul><li>Prescribed and Filled drugs </li></ul><ul><li>Lab results </li></ul><ul><li>Radiology Results </li></ul>
  48. 59. All-Care Encounter Summary
  49. 60. All-Care Encounter Summary
  50. 61. Next Steps for the Florida Health Information Network <ul><li>Establish a statutory entity … </li></ul><ul><ul><li>Florida Health Information Network Corporation </li></ul></ul><ul><li>to implement the state level network </li></ul><ul><li>As a not-for-profit organization, the Florida Health Information Network Corporation would be accountable to the public and responsive to health care providers </li></ul>
  51. 62. The Florida Health Information Network Will… <ul><li>Specify standards to ensure interconnectivity and maintain security </li></ul><ul><li>Develop uniform policies regarding confidentiality of patient records and patient authorization </li></ul><ul><li>As a public-private partnership, will develop the critical mass of information resources to achieve a sustainable statewide system of regional networks </li></ul>
  52. 63. The Future of the Florida Health Information Network <ul><li>The Florida Health Information Network vision will integrate clinical health information exchange in Florida through a network architecture that will empower physicians to access timely and accurate medical records in order to deliver high quality medical care for their patients </li></ul>
  53. 64. Christopher B. Sullivan, Ph.D. Agency for Health Care Administration Florida Center for Health Information and Policy Analysis Office of Health Information Technology 2727 Mahan Drive Tallahassee, FL 32309 sullivac @ ahca . myflorida .com
  54. 65. Anthony Keck BSI&OE, M.P.H. Tulane University School of Public Health & Tropical Medicine Panelists: Roxane A. Townsend, M.D. Deputy Secretary, LA DHH Christopher B. Sullivan, Ph.D. Administrator, Office of HIT Florida Center for Health Information and Policy Analysis Agency for Health Care Administration Robert Olmedo Director of Technology Palm Beach County Community Health Alliance Panel Moderator:
  55. 66. Questions and Answers Questions and Answers

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