Health Information Technology : Federal Support for Adoption

1. Health Information Technology : Federal Support for Adoption Michael Mirro MD : Chair James Tcheng MD : Vice-Chair ACC-HIT Committee

2. Agenda • ACC HIT Efforts • Federal Financial Incentives a) PQRI b) e-Prescribing c) American Recovery Reinvestment Act • HIT : IC3 Workflow Solutions • Summary

3. ACC Informatics Committee Efforts • Health IT website (www.acc.org/healthIT) • Updated with ARRA information of relevance to members • EHR Toolkit: helpful hints, advice on contract negotiations, selection tools, educational resources, and Federal EHR incentive program information • E-Prescribing Initiative: overall benefits, minimum functional criteria, and CMS e-Prescribing Incentive Program information • Unique Patient Identifiers Principles Document • Stance: mandatory UPI vital to increasing quality of care, outweighs privacy concerns • Target: ACC advocacy efforts on Capital Hill • Position: Currently reaching out to peer organizations for notice and possible collaboration

4. ACC Informatics Committee Efforts • ACC Data Definitions for Cardiovascular EHR • List of data elements that are essential for care in the cardiology domain • Consolidates definitions from multiple data dictionaries • Receiving comments from other ACC committees • CardioPath™ Pilot Project • Translates ACC/AHA clinical guidelines into clinical decision support • Guideline Adherence Tool web application available • Working with EHR vendors to test proof of concept

6. The Cost of a Long Life U.S. UC Project for Global Inequality

7. Accelerating EHR Adoption: Government Role • Financial Incentives • PQRI • ARRA • e-Prescribing

8. HIT : Federal Incentives • PQRI $3,000-5,000/year • 2007: 1.5% • 2008: 2.0% • 2009: 2.0% • E-Prescribing $3,000-5,000/year • ARRA EHR Funding : $44,000 – 5 years (plus 10% Bonus $48,400 :Medicaid)

9. PQRI Requirements Report on PCPI/NQF Endorsed Performance Measures Claims-Based Quality Data : Quality Data Codes (QDC) Maximum Financial Incentive achieved if 3 measures reported on > 80% of eligible encounters Use of CCHIT-certified EHR : 2009 performance measure

10. American Recovery & Reinvestment Act (ARRA): 02/17/09 • Total: $790 Billion • Healthcare (total): $59 Billion • HITECH: $34 Billion (net ~$19 Billion) • Key Components • Leadership • Funding and incentives • Standards • Certification • Research and development • Education and outreach • Privacy and security

11. Health IT in ARRA • Leadership • Established Office of National Coordinator • David Blumenthal, MD • $2B in appropriations • Established 2 Federal Advisory Committees • HIT Policy Committee – recommendations to ONC regarding e-exchange, use of health information • HIT Standards Committee – recommendations to ONC regarding standards, implementation specifications, and certification criteria

12. Health IT in ARRA 2. Funding and Incentives ($34 billion) • $20.8 billion – Medicare & Medicaid incentives to providers for EHR adoption • $4.7 billion – NTIA broadband technology • $2.5 billion – USDA distance learning, telemedicine, broadband technology • $2 billion – ONCHIT • $1.5 billion – HRSA for health centers • $1.1 billion – comparative effectiveness research (AHRQ, NIH, HHS) • $500 million – Social Security Administration • $85 million – Indian Health Service health IT • $50 million – VA information technology

13. Medicare EHR Incentives and Penalties Adoption Year 1 Year 2 Year 3 Year 4 Year 5 Payment Year Incentive Incentive Incentive Incentive Incentive Reduction 2011/12 $18,000 $12,000 $8,000 $4,000 $2,000 - 2013 $15,000 $12,000 $8,000 $4,000 - - 2014 $15,000 $12,000 $8,000 - - - 2015 - - - - - 1% 2016 - - - - - 2% 2017 - - - - - 3% 2018 - - - - - 3-4% 2019+ - - - - - 3-5%

14. Definition of Qualified Electronic Health Record • Certified as meeting standards pursuant to ARRA applicable to the specific type of solution • Includes demographic & clinical health info • Medical history, problem lists • Has the capacity to: • Provide clinical decision support • Support order entry • Capture, query, report on health care quality (process) • e-Exchange, integration of health information from other sources

15. Role of Certification in theNational Health IT Strategy American Health Information Communityand AHIC Workgroups Office of the National Coordinator Strategic Direction +Breakthrough Use Cases StandardsHarmonizationHITSP HarmonizedStandards CCHIT:CertifyingStandardsComplianceof Health IT Certificationof EHRsand HIEs Accelerated adoption of robust, interoperable, privacy-enhancing health IT NetworkArchitecture NHIN Prototype& ImplementationProjects PrivacyPolicies Privacy & SecurityPolicies, Laws, Regulations Governance and Consensus Process EngagingPublic and Private Sector Stakeholders Certification is a voluntary, market-based mechanism to accelerate the adoption of standards and interoperability

16. Definition of Meaningful Use • Hospitals • Use qualified EHR technology • Implement e-Exchange of health information to improve health care quality (e.g., care coordination) • Submit clinical quality measures data • Physician Practices • All of the above, plus e-Prescribing • Medicaid Requirements • As defined by the state (must align with Medicare definitions) • Also includes dentists, certified nurse-midwives, mid-level practices

17. Health IT in ARRA • More Funding and Incentives Info • Loans to Providers • ONC may award competitive grants for establishment of programs for loans to healthcare providers • $1.1B for comparative effectiveness research (AHRQ, NIH, and HHS) • To evaluate and compare clinical outcomes, effectiveness, risk, and benefits of 2 or more medical treatments and services that address a particular medical condition • NIH announced $200 million in FY 2009-2010 funds to support “Challenge Grants,” of which comparative effectiveness research funds are included. ACC NCDR is moving to submit application by April 27, 2009 due date.

18. Health IT in ARRA • Standards • Adopt an initial set of standards, implementation specifications, and certification criteria by 12/31/2009 • Certification • The ONC shall recognize a program for the voluntary certification of health IT

19. Health IT in ARRA • Research and Development • Assistance to institutions for centers for Healthcare Information Exchange integration • Education and Outreach • HHS health IT extension program to provide health IT assistance services • Grants for demonstration projects to develop academic curricula integrating certified EHR technology in the education of health professionals • Support for health informatics training programs

20. Health IT in ARRA • Privacy & Security • Security Breach Notification – individual must be notified if unauthorized disclosure or use of their health information. • New HIPAA Business Associate rules - new entities that were not contemplated when HIPAA was written (e.g., PHR, RHIO, HIE) are subject to the same privacy and security rules as providers and health insurers

21. HIT : e-Prescribing Requirements • Electronic transmission of prescription data • bi-directional • SureScripts / RxHub certified • Drug-drug interaction reconciliation • Drug allergy reconciliation • CCHIT, AHIC, HITSP Compliance • HIPPA Compliance • Surrogate prescriptive function (e-confirm) • Patient prescription eligibility / formulary reconciliation

22. Next Steps • www.acc.org/healthIT • www.cchit.org • Organizational change assessment • Develop implementation team • Develop training, implementation plan • Vendor selection (CCHIT & IHE)

23. HIT : NCDR IC3 Adoption • First Office-Based Registry Designed to Assess Physician Adherence to ACC/AHA Performance Measures • Provides Powerful Tool to Assess Clinical Care for CAD and CHF patients • A Potential Vehicle to Transform Performance Measurement to Quality Improvement at Point of Care

25. You could do this on paper • Requiring valuable FTE time and introducing the opportunity for error • And sending it to the ACC where it will be entered into a database (again introducing the opportunity for error)

27. Or you could do this electronically… • The timing is ideal • Select EHR vendors now certified for IC3 • IC3 satisfies PQRI requirements • EHR vendors also incorporate e-prescribing • Current CMS bonus payments help offset EHR investment costs • EHR adoption incentives start in 2011 and total $44,000 per physician • FOR IMPLEMENTED AND MEANINGFUL EHR USE • START NOW!

36. EHR with integrated IC3 • Simplified data collection and reporting • Existing data in EHR can populate collection forms • As you document encounters in EHR, that data can also populate collection form • At conclusion of encounter, completed collection form is submitted and transmitted to ACC for entry into IC3 database

37. Certified EHR vendors

38. How will you spend your $44,000?

39. Consider a workhorse

40. Questions ??

42. Health IT in ARRA - Overview • Includes over $20 billion to aid in the development of a robust IT infrastructure for healthcare and to assist providers and other entities in adopting and using health IT • Key Economic Stimulus Components: • Leadership • Funding and Incentives • Standards • Certification • Research and Development • Education and Outreach • Privacy and Security

43. Health IT in ARRA • Leadership • Established Office of National Coordinator - $2B in appropriations • Established HIT Policy Committee – makes recommendations to ONC regarding implementation • Established HIT Standards Committee - makes recommendations to ONC regarding standards, implementation specifications, and certification criteria

44. Health IT in ARRA • Funding and Incentives • Medicare incentives to non-hospital based physicians adopting & using certified EHRs • Starting 2011, physicians receive up to $44K over 5 years • After 2013, physicians receive reduced incentives • After 2014, physicians are ineligible to receive incentives • Beginning in 2015 and after, physicians failing to adopt a certified EHR are subject to reduced fee schedule amounts • Medicaid incentives • $63,750 in Medicaid funding to a limited group of eligible professionals to assist in the adoption and implementation of certified EHR technology.

45. Health IT in ARRA • Funding and Incentives (Con’t) • Loans to Providers • ONC may award competitive grants for establishment of programs for loans to healthcare providers • $1.1B for comparative effectiveness research (AHRQ, NIH, and HHS) • Used to conduct or support research to evaluate and compare the clinical outcomes, effectiveness, risk, and benefits of 2 or more medical treatments and services that address a particular medical condition • NIH announced $200 million in FY 2009-2010 funds to support “Challenge Grants,” of which comparative effectiveness research funds are included. ACC NCDR is moving to submit application by April 27, 2009 due date.

46. Health IT in ARRA • Standards • Adopt an initial set of standards, implementation specifications, and certification criteria by 12/31/2009 • Certification • The ONC shall recognize a program for the voluntary certification of health IT

47. Health IT in ARRA • Research and Development • Assistance institutions of higher education to establish Centers for Healthcare Information Enterprise Integration • Education and Outreach • Develop a health IT extension program to provide health IT assistance services to be carried out through HHS • Grants to carry out demonstration projects to develop academic curricula integrating certified EHR technology in the clinical education of health professionals • Support Medical Health Informatics Education Programs

48. Health IT in ARRA • Privacy & Security • Security Breach Notification - Requires that an individual be notified if there is an unauthorized disclosure or use of their health information. • New HIPAA Business Associates - Ensures that new entities that were not contemplated when HIPAA was written (such as PHR vendors, RHIOs, HIEs, etc.) are subject to the same privacy and security rules as providers and health insurers, by requiring Business Associate contracts

49. EHR : Payer Perspective • Improved Documentation • Enhanced Clinical Transparency • Improved Billing/Coding/Claims • Data/Document Transfer • Pay-for-Performance Potential

50. Health Information Technology • Automation • Connectivity • Clinical Decsion Support • Data-Mining Capabilities