Prescription for Reform: The Leadership Role of States in Healthcare IT K. Meredith Taylor, MPH Director, HIMSS Congre

1. Prescription for Reform: The Leadership Role of States in Healthcare IT K. Meredith Taylor, MPHDirector, HIMSS Congressional Affairs

2. advocacy@himss.org 2 Agenda Background on HIMSS Health IT on the National-level State Health IT Activities State Employee Health Benefits Programs Medicaid Public Health Where are We Going?: Healthcare Reform and Health IT

3. advocacy@himss.org 3 HIMSS The Healthcare Information and Management Systems Society (HIMSS) is the healthcare industry's membership organization exclusively focused on providing global leadership for the optimal use of healthcare information technology (IT) and management systems for the betterment of healthcare.

4. advocacy@himss.org 4 Society Today 20,000 Individual Members of which 73% work in the field (non-vendors, non-consultants) 330 Corporate Members 90+ committees, task forces, & work groups 47 Chapters 3 corporations, over 175 staff Top 5 largest healthcare conference in US Top 50 largest conference of any kind in US

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6. advocacy@himss.org 6 Healthcare Landscape � 1999 IOM �to Err is Human� noted that there were 1.3 million injuries a year and nearly 100,000 deaths from medical error alone Healthcare now represents 16% of GDP 2 trillion individuals in the U.S. lack health insurance 70% of healthcare transactions are in paper today Paper administrative costs can be 20 cents on the dollar Healthcare only invests 2-3% of revenue on IT vs 10- 15% in other industries (retail, grocery)

7. advocacy@himss.org 7 What�s Driving Action? Quality Patient Safety Medication Errors Efficiency Administrative Costs Accountability � facilitating improved reporting of outcomes Bio-preparedness Disaster Management

8. advocacy@himss.org 8 What is Health IT? Healthcare Information Technology: �Healthcare Information Technology�, �Health Information Technology�, �Health IT�, and �HIT� The use of electronic technology (computers and computer programs) to store, protect, retrieve, and transfer clinical, administrative, and financial information electronically within health care settings Used in various care settings: � In-patient (hospital, medical/surgical, long-term care, etc.) � Out-patient (ambulatory, specialty (e.g., pediatric, cardiac, mental health) Examples: � Electronic Health/Medical Records � Personal Health Records (PHRs) � Computerized Physician Order Entry Systems (CPOE) � Computerized Decision Support Systems (CDSS) � Computerized Electronic Alert Systems (e.g., drug interactions) � Medical Devices, Handheld Computers, Imaging, etc � Financial/Billing/Administrative Systems � Electronic Communications with Patients � On-line data sources for Patients

9. advocacy@himss.org 9 The Value of Interoperability and Electronic Health Records � January 2005 CITL Study1: Standardized, encoded, electronic healthcare information exchange would: Save the US healthcare system $337B over a 10-year implementation period, and $78B in each year thereafter September 2005 RAND Study2: Widespread adoption and effective use of electronic medical record systems (EMRs) and other health information technology (HIT) improvements would: Save the US healthcare system $162B annually Potential health and safety benefits could double savings Improve quality and efficiency of the healthcare system 1. J Walker et. al. Health Affairs, January 2005. 2 R Hill t d t Al H lthAffiS t b /O t b 2005

10. advocacy@himss.org 10 Federal Government Action President George W. Bush Executive Order 13355 HIT mentioned in State of the Union � 5 Years Running! ONC funding has decreased, but finally stabilized Federal Landscape: Dr. Kolodner permanent 2nd National Coordinator Secretary of Health and Human Services � Still Big HIT Proponent Agencies Meeting Executive Order Requirements HITSP established CCHIT established AHIC transitioning to AHIC 2.0 Race to implement initiatives before end of Bush Administration

11. advocacy@himss.org 11 Prominent Nationwide HIT Initiatives Health Information Security and Privacy Collaboration (HISPC) National Governors Associations� State Alliance for e-Health National Conference of State Legislatures� Project Health Information Technology Champions American Health Information Management Association�s (AHIMA) State-level HIE Consensus Project

12. advocacy@himss.org 12 Action on Capitol Hill No significant action during 110th Congress E-prescribing only success story Currently tracking over 100 separate pieces of HIT related legislation What to expect during final days of 2nd Session (2008)? S. 1693 (Wired for Health Care Quality Act) H.R. 6898, The Health-e Information Technology Act of 2008 H.R. 6357, PRO(TECH)T Act of 2008 H.R. 1467 (10,000 Trained by 2010) Passed House Track all HIT legislation at the HIMSS Legislative Tracker at: www.himss.org/advocacy/actioncenter.asp�

13. advocacy@himss.org 13 Fiscal State of the States For states, overall revenue growth slowed in 2007 and tighter fiscal conditions are expected in 2008 States� single largest expenditure in 2007 was healthcare Medicaid comprises 22% of state spending Challenges in expanding SCHIP Strains of the aging population Reduction in federal funding *The Fiscal Survey of States, National Governors Association. December 2007.

14. advocacy@himss.org 14 The Climate for HIT States recognize role in driving HIT to transform healthcare Role of states as conveners, purchasers, payers, and regulators of healthcare. States are leveraging publicly funded health programs to drive HIT.

15. advocacy@himss.org 15 The Climate for HIT Newly Elected Governors in 2008 Governor Bobby Jindal, Louisiana Governor Steve Beshear, Kentucky State of the State Addresses Over 1,000 pieces of HIT related state legislation Federal assistance

16. advocacy@himss.org 16 General HIT Landscape �eHealth Progress Across the States in 2007� Report developed by the NGA, HMA, and made possible by the Commonwealth Fund 1st of its kind survey of state officials and their eHealth activities 25 states reported operations of electronic health information exchanges that involved a publicly funded health program Disease Registries most commonly reported eHealth Activities underway within Public Health Quality and Transparency issues drive the need and reasoning for state Health Initiatives Collaboration among competitive entities and the coordination of multiple efforts into a statewide strategy as some of the leading challenges surround state involvement in eHealth activities

17. advocacy@himss.org 17 Role of States Convener, payer, purchaser, and regulator of healthcare Leveraging publicly funded health programs Medicaid Public Health State Employee Health Benefits Programs Streamlining multiple efforts through the use of certified health information technologies

18. advocacy@himss.org 18 State EmployeesMinnesota As of January 2008, all providers that contract with the Minnesota Advantage Health Plan, the state employee health benefits program, are required to conduct pharmacy transactions through a single Pharmacy Benefits Manager, Navitus Health Solutions. The Minnesota Department of Employee Relations (DOER) expects the initiative to improve the quality of healthcare, while lowering health plan costs paid by employees and taxpayers. *Electronic Health Records for Minnesota by 2015?�. HIMSS Fact Sheet. 2007.

19. advocacy@himss.org 19 MedicaidTennessee TennCare, Tennessee�s Medicaid Program, utilizes Shared Health�s Clinical Health Record for all Medicaid beneficiaries in the state. TennCare and Shared Health are sponsoring an ePrescribing Pilot Program among rural healthcare providers in the state. *Shared Health. Press Releases. Accessible at: www.sharedhealth.com

20. advocacy@himss.org 20 Public Health Connecticut S1484, Requires Commissioner of Public Health to engage with eHealth Connecticut in the development of a state-wide HIT plan (Signed into law) Indiana S551, Established the Indiana Health Informatics Corporation to develop and operate a state-wide system for the electronic HIE. Requires the inclusion of public health informatics (Signed into law)

21. advocacy@himss.org 21 Certified Health Information Technologies Vermont Vermont Information Technology Leaders, Inc. (VITL) release of the Pre-Screened Electronic Health Record Product List Virginia Governor�s Health Information Technology Council encouraging HIT vendors in the state to build-on standards developed by CCHIT HB2198, HIT that is purchased by a state agency must be certified by a recognized certification body or to adhere to standards for interoperability and data exchange (Signed into law) *�State Policy and Certified Health Information Technologies�. HIMSS Fact Sheet. 2008

22. advocacy@himss.org 22 Where are We Going?Healthcare Reform and Health IT Healthcare Reform will be a priority issue for the 111th Congress and the new Administration To date, healthcare reform legislation includes provisions for health IT Presidential Candidates and Party Platforms include health IT as a tool to transform healthcare

23. advocacy@himss.org 23 Where are We Going?Healthcare Reform and Health IT McCain vs. Obama Provide citizens with choices of different health insurance plans Encourage Personal Responsibility Tax credit to individuals and families to increase incentive to purchase health insurance No mandate for health insurance coverage No HIT component yet Universal coverage utilizing a mix of private and public modalities Quality, affordable and portable coverage for All Children required to have insurance, no mandate for adults Lower costs by modernizing the U.S. healthcare system Up to $10B per year for HIT

24. advocacy@himss.org 24 Where are We Going?Healthcare Reform and Health IT Massachusetts SB 2863 (Enacted, August 2008) Requires residents to obtain healthcare coverage and establishes subsidies for low income residents to obtain coverage Establishes Massachusetts e-Health Institute to plan and oversee state health IT activities Authorizes $25 million for the Institute

25. 25 Questions? Contact Your HIMSS Government Relations Team David W. Roberts, FHIMSS, Vice President, Government Relations, 703-562-8811 K. Meredith Taylor, Director, Congressional Affairs, 703-562-8847 Blair Hedgepeth, Senior Manager, Congressional Affairs, 703-562-8810 Kathie Westpheling, Manager, Public Policy, 703-562-8831 Wayne Humphries, Manager, Public Policy Initiatives, 703-562-8870 Mary Walker, Executive in Residence, 703-562-8835  Tom Leary, FHIMSS, Senior Director, Federal Affairs, 703-562-8814 Jonathan French, Manager, Federal Affairs, 793-562-8823 Stephanie Tsoucalas, Coordinator, Federal Affairs, 703-562-8800  Tom Keefe, Senior Director, State Government Relations, 703-562-8813 TBD, Manager, State Government Relations, 703-562-8847 Arnol Simmons, Coordinator, State Government Relations, 703-562-8826 Sharolyn Rosier Hyson, Senior Manager, Public Policy Communications, 703-562-8819  HIMSS Arlington Office 4300 Wilson Boulevard, Suite 250 Arlington, VA 22203 advocacy@himss.org