The American Recovery and Reinvestment Act (ARRA)

1. The American Recovery and Reinvestment Act (ARRA) IHS Office of Information Technology March 15, 2010

2. American Recovery and Reinvestment Act of 2009 (ARRA) • As stated on www.recovery.gov website: • ARRA is an unprecedented effort to jumpstart our economy, create or save millions of jobs, and put a down payment on addressing long-neglected challenges so our country can thrive in the 21st century… preserve and improve affordable health care…”

3. ARRA FUNDING • Signed into law February 17, 2009 • Jumpstart economy • IHS received $500 million • Health facilities construction, maintenance, and improvements; sanitation facilities construction; and health equipment to help improve healthcare in Indian Country.

4. ARRA FUNDING –cont’d. • Modernization and extension of electronic health information technology used by IHS, Tribal, and Urban programs. • IHS received $85 million in ARRA funding for health information technology • The IHS Office of Information Technology (OIT) has focused this funding to modernize and extend electronic health information technology throughout Indian Country and to achieve Meaningful Use of EHR

5. “These Recovery Act funds will provide critical assistance to American Indian and Alaska Native communities… These funds will help improve healthcare, create jobs and make our native communities stronger.” Yvette Roubideaux Director IHS

6. ARRA Objectives for IHS Office of Information Technology Hire and deploy IT staff Deploy certified electronic health records that meet the requirements of “meaningful use” Implement a personal health record tool Upgrade the reliability, redundancy, and security of the IHS network Ensure an adequate telemedicine infrastructure

7. MEANINGFUL USE • Will be accomplished in three stages • Requirements for each subsequent stage build upon the requirements of previous stage. • Incentives will be given during each of the three stages that meet definition of meaningful use.

8. Meaningful Use cont’d • Stage 1: focus is on capturing data. Will begin in 2011. • Stage 2: focus on reporting health information and tracking key clinical conditions. Will begin in 2013. • Stage 3: focus on improving performance and health outcomes. Will begin 2015. Expected to add more requirements.

9. STAGE 1: Health IT Functionality Measures & Clinical Quality Measures DRAFT • Health IT Functionality: 25 provider measures and 23 hospital measures. Some measures show “interoperability” • Clinical Quality: Hospitals to report on a set of 35 Medicare inpatient measures

10. Functional & Interoperability Measures-Pharmacy specific DRAFT • Computerized Provider Order Entry • Ambulatory – at least 80% of all orders must be entered directly into EHR by the provider • Inpatient – at least 10% of all orders must be entered directly into EHR by the provider • Drug-drug, Drug-allergy, drug-formulary checks • All sites must implement these features of EHR

11. Functional & Interoperability MeasuresPharmacy Specific cont’d DRAFT • Medication Reconciliation • Perform medication reconciliation for at least 80% of inpatient/outpatient encounters and transitions of care • Documentation of Allergies • At least 80% of inpatients and outpatients must have drug allergies documented in the EHR (or notation of no allergies)

12. Functional & Interoperability Measurescont’d DRAFT • Problem Lists • At least 80% of patients (inpatient and outpatient) must have a current Problem List • Electronic Prescribing • At least 80% of prescriptions must be entered and transmitted electronically • Medication Lists • At least 80% of inpatient and outpatients must have a medication list documented in the EHR (or notation of no medications)

13. BOTTOM LINE • Achieving Meaningful Use does not simply mean installing a certified EHR. Rather, it is just the beginning. • A lot of work is required by the IHS OIT, the 12 Area Offices, and the hospitals and providers that will apply for the incentives. • The requirements for achieving Meaningful Use are not final yet and are subject to change. However, we cannot wait until they are released. Work must start now.

14. RESOURCE/CONTACTS • IHS Meaningful Use Website http://www.ihs.gov/recovery/index.cfm?module=dsp_arra_meaningful_use • IHS Meaningful Use Contacts • Theresa Cullen, MD, MS, CIO (301) 443-9848 Theresa.Cullen@ihs.gov • Stephanie Klepacki, Meaningful Use Project Lead (505) 821-4480 Stephanie.Klepacki@ihs.gov

15. ARRA PHARMACY CONSULTANTS • CAPT Mike Allen • CDR Mary Ann Niesen • LCDR Lori Moore • LCDR Carla Stearle

16. QUESTIONS??