State of Tennessee The Governor’s eHealth Council ahdi Association for Healthcare Documentation Integrity

1. State of Tennessee The Governor’s eHealth Council ahdi Association for Healthcare Documentation Integrity

2. Executive Order # 35 Governor Phil Bredesen Signed Executive Order # 35 on April 6, 2006 to establish the Governor’s eHealth Council.

3. The Council shall advise and support the State of Tennessee as it develops and implements an overall strategy for the adoption and use of the electronic medical records and create a plan to promote its use by all healthcare stakeholders. • The Council shall identify obstacles to the implementation of an effective health information infrastructure and provide recommendations to remove or minimize those obstacles. • The Council shall advise appropriate parties within State government on issues related to the development and implementation of the health information infrastructure. • The Council shall use best practices in minimizing and eliminating redundant efforts and duplicative initiatives.

4. eHealthCouncil Members • CIGNA HealthCare • Caremark Rx, Inc. • Eastman Chemical Company • FedEx Corporation • SharedHealth • CenterStone • Dell • Nissan North America • HCA Healthcare • BlueCross BlueShield of Tennessee • Vanderbilt University Medical Center • State of Tennessee, Bureau of TennCare • The State RHIO organizations

5. Our Focus • To convene, facilitate and incubate regional stakeholders to use health information technology to improve the quality of care delivered by providing necessary information at the point of care. • Patient data will be used for treatment and other uses as permitted by HIPAA • Focus on Tennessee’s 95 counties - Urban and Rural • Secondary focus on contiguous states, especially contiguous counties

6. State of Tennessee: Population Population: Aprox. 6.1 Million

7. eHealth Council Framework • Coordinating organization facilitates rules of engagement: • Data-sharing Agreement • Legal Framework • Standards • Interoperability • Transparency • Value • Quality/Cost Common Portal H.I.E. EMR / EHR/PHR Implementation Structured Notes & Paper Records Administrative Transactions (claims…) Secure Clinical Messaging (labs, imaging, TeleHealth…) ePrescribing Roll Out Broadband % of Access, Stakeholders, Automation Framework for Trust and Collaboration County-by-County Implementation that Progresses in Stages

8. Goal: Broadband Connectivity in 95 Counties Source: Federal Communications Commission, http://www.universalservice.org/rhc/tools/rhcdb/Rural/2005/result.asp

9. Goal: Broadband Connectivity in 95 Counties • URBAN: • Practices: 1,335 • Licensed M.D.s: 7,302 • Primary Care/Pediatrics: 3,019 • Hospitals: 160 • Physician Practices: 3,779 • Licensed M.D.s: 15,387 • Primary Care/Pediatrics: 6,992 • SEMI-RURAL • Practices: 1,362 • Licensed M.D.s: 6,695 • Primary Care/Pediatrics: 3,085 • RURAL • Practices: 887 • Licensed M.D.s: 1,390 • Primary Care/Pediatrics: 888 Sources: Federal Communications Commission, http://www.universalservice.org/rhc/tools/rhcdb/Rural/2005/result.asp; 2007 Tennessee Healthcare Technology Readiness Assessment, TNHIMSS, www.TennesseeAnytime.org/eHealth; Tennessee Dept. of Health 2007.

10. FCC Designations Source: Federal Communications Commission, http://www.universalservice.org/rhc/tools/rhcdb/Rural/2005/result.asp

11. eHealth Council Framework • Coordinating organization facilitates rules of engagement: • Data-sharing Agreement • Legal Framework • Standards • Interoperability • Transparency • Value • Quality/Cost Common Portal H.I.E. EMR / EHR/PHR Implementation Structured Notes & Paper Records Administrative Transactions (claims…) Secure Clinical Messaging (labs, imaging, TeleHealth…) ePrescribing Roll Out Broadband % of Access, Stakeholders, Automation Framework for Trust and Collaboration County-by-County Implementation that Progresses in Stages

12. We have a good start • 29% physician practices already have T-1 connectivity • 67% hospitals already have T-1 connectivity Source: 2007 Tennessee Healthcare Technology Readiness Assessment, TNHIMSS, www.TennesseeAnytime.org/eHealth

13. Connectivity: Disparities from Urban to Rural URBAN SEMI-RURAL RURAL Source: 2007 Tennessee Healthcare Technology Readiness Assessment, TNHIMSS, www.TennesseeAnytime.org/eHealth

14. Current EMR Usage Source: 2007 Tennessee Healthcare Technology Readiness Assessment, TNHIMSS, www.TennesseeAnytime.org/eHealth

15. EMR: Disparities from Urban to Rural URBAN SEMI-RURAL RURAL Source: 2007 Tennessee Healthcare Technology Readiness Assessment, TNHIMSS, www.TennesseeAnytime.org/eHealth

16. eHealth Council Framework • Coordinating organization facilitates rules of engagement: • Data-sharing Agreement • Legal Framework • Standards • Interoperability • Transparency • Value • Quality/Cost Common Portal H.I.E. EMR / EHR/PHR Implementation Structured Notes & Paper Records Administrative Transactions (claims…) Secure Clinical Messaging (labs, imaging, TeleHealth…) ePrescribing Roll Out Broadband % of Access, Stakeholders, Automation Framework for Trust and Collaboration County-by-County Implementation that Progresses in Stages

17. Scripts Per Capita Tennesseans rank 3rd in the nation in prescriptions per person in 2006 Source: The Kaiser Family Foundation, 2007.

18. High Prescription Drug Use Has Consequences • Consequences of high prescription drug use include medication errors, adverse effects, accidental poisoning, antibiotic resistance, and prescription abuse • Tennessee’s accidental poisoning rate is 26% above the national average and cost about $593 million in 2003 • Tennessee has some of the highest rates of antibiotic resistance in the nation • Tennessee is among the top 5 states for use of prescription • Hydrocodone is the number one prescribed drug in Tennessee, making up almost 3% of all prescriptions Source: The Tennessee Prescription Safety Program of the Tennessee Medical Association 2007.

19. TN Drug Snapshot: BCBST Commercial * Courtesy of Dr. Bruce Taffel, Shared Health

20. Current ePrescribing Source: 2007 Tennessee Healthcare Technology Readiness Assessment, TNHIMSS, www.TennesseeAnytime.org/eHealth

21. Why Is eHealth Important? • 1.5 million Americans suffer from medication mistakes each year. • Each year 800,000 preventable ADEs occur in long-term care facilities. • 530,000 preventable ADEs occur among the general population.

22. eHealth Council Framework • Coordinating organization facilitates rules of engagement: • Data-sharing Agreement • Legal Framework • Standards • Interoperability • Transparency • Value • Quality/Cost Common Portal H.I.E. EMR / EHR/PHR Implementation Structured Notes & Paper Records Administrative Transactions (claims…) Secure Clinical Messaging (labs, imaging, TeleHealth…) ePrescribing Roll Out Broadband % of Access, Stakeholders, Automation Framework for Trust and Collaboration County-by-County Implementation that Progresses in Stages

23. Steps • Standards • Formats • Segments Discharge Summary Dictation Transmission Transcription Data Access Quality Assurance

24. Health Reform Needed • 1999 Institute of Medicine Report “To Err is Human” reported that 44,000-98,000 people die each year from medical errors • Medical errors are the 8th leading cause of death. Higher than: • Motor vehicle accidents (43,000) • Breast cancer (42,297) • AIDS (16,516) Source: Institute of Medicine (1999). To Err is Human: Building a Safer Health System. Retrieved May 20, 2006 from http://www.iom.edu/CMS/8089/5575.aspx.

25. But TennesseeIs No Healthier! Tennessee Ranks 47th in Overall Health Status Source: United Health Foundation and Public Health Association

26. Existing HIEs • Shared Health • Statewide • Claims based data • Exchanging information since June 2006 • Already includes more than 2.2 million people (1/3 of Tennessee’s population) • MidSouth eHealth Alliance • Shelby, Tipton and Fayette counties (Memphis area) • Clinical data • Exchanging information since June 2006 • Already includes almost 1 million records • CareSpark • 7 counties in Upper East Tennessee and 7 counties in Virginia • Expected to go live by the end of 2007 • Administrative and clinical data

27. Emerging Initiatives • TeleHealth • $1.6 million grant to Community Health Network to organize, equip and maintain a TeleHealth network • Up to 45 community health centers including federally qualified health centers • Making specialty care available to rural and underserved areas • Serving ~100,000 patients • Middle Tennessee Rural Health Information Network • $1.6 million HRSA grant to connect 3 critical access hospitals and the regional tertiary hospital and implement EMR with information exchange • Public health services • Goal: Expose medical care and medication dispensed in public health facilities where there are no payers billed • Department of Health • 89 County Health Departments + 6 subcontracted counties • ~1,000,000 patient encounters per year • Department of Mental Health • 5 Regional Mental Health Hospitals

28. Next StepsOn The Road Map • Connectivity • Utilize existing TNII network to extend broadband connectivity to physicians across the state • Already private, secure network • Infrastructure already exists in every county • Makes broadband available to physicians at state negotiated rates • ePrescribing • Currently designing pilot projects for each grand division

29. How Can I Learn More? www.TennesseeAnytime.org/eHealth