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Florida’s Role in Developing Health Information Exchanges

Florida’s Role in Developing Health Information Exchanges. HIMSS RHIO/HIE Connecting Communities Regional Forum May 3, 2007. Lisa K. Rawlins, Director Florida Center for Health Information and Policy Analysis Agency for Health Care Administration.

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Florida’s Role in Developing Health Information Exchanges

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  1. Florida’s Role in Developing Health Information Exchanges HIMSS RHIO/HIE Connecting Communities Regional Forum May 3, 2007 Lisa K. Rawlins, Director Florida Center for Health Information and Policy Analysis Agency for Health Care Administration HIMSS RHIO/HIE Connecting Communities Regional Forum - May 3, 2007

  2. Action at the Federal Level: The Nationwide Health Information Network • Transform health care through adoption of health information technology to realize higher quality health care at a lower cost. • April 2004, President Bush signed an Executive Order establishing the position of the National Coordinator for Health Information Technology • July 2004, David J. Brailer M.D., proposes a Framework for Strategic Action, for national adoption of health information technology. HEALTH INFORMATION TECHNOLOGY LEADERSHIP PANEL FINAL REPORT The Lewin Group, Inc., March 2005 HIMSS RHIO/HIE Connecting Communities Regional Forum - May 3, 2007

  3. Framework for Strategic Action Health information technology (Health IT) allows comprehensive management of medical information and its secure exchange between health care consumers and providers. It will: • Improve health care quality • Reduce health care costs • Decrease paperwork • Expand access to affordable care http://www.hhs.gov/healthit/ HIMSS RHIO/HIE Connecting Communities Regional Forum - May 3, 2007

  4. Nationwide Health Information Network The NHIN will “link all health records through an interoperable system that protects privacy as it connects patients, providers and payers, resulting in fewer medical mistakes, less hassle, lower costs and better health.“ HHS Secretary Mike Leavitt http://www.hhs.gov/healthit/ HIMSS RHIO/HIE Connecting Communities Regional Forum - May 3, 2007

  5. Federal Sources of Startup Funding for Health Information Exchanges • Agency for Healthcare Research and Quality • Office of the National Coordinator for Health Information Technology • Health Resources and Services Administration • Centers for Medicare and Medicaid Services • National Library of Medicine HIMSS RHIO/HIE Connecting Communities Regional Forum - May 3, 2007

  6. Nationwide Health Information Network HIMSS RHIO/HIE Connecting Communities Regional Forum - May 3, 2007

  7. Action at the State Level: The Florida Health Information Network • The Florida Health Information Network is the result of: • Health policy decisions in the Florida Legislature and Governor’s Office endorsing the Florida Health Information Network • Funding from the Legislature for grants to Regional Health Information Organizations • Leadership from the Governor’s Health Information Infrastructure Advisory Board HIMSS RHIO/HIE Connecting Communities Regional Forum - May 3, 2007

  8. A Solution at the State Level: The Florida Health Information Network • The Select Committee on Affordable Health Care for Floridians studied health care issues and received testimony from numerous health care professionals across Florida • Its final report in 2004 recommended: • “compatible information technology that permits secure, private information sharing throughout health care” • “use of technology to create a single medical record that belongs to the patient and families” HIMSS RHIO/HIE Connecting Communities Regional Forum - May 3, 2007

  9. Executive Order Creates the Governor’s Advisory Board • Governor Jeb Bush signed an Executive Order in May, 2004, creating the Governor’s Health Information Infrastructure Advisory Board “to promote the development and implementation of a Florida health information infrastructure” • The Interim Report of the Governor’s Advisory Board in 2005 called for the creation of the Florida Health Information Network HIMSS RHIO/HIE Connecting Communities Regional Forum - May 3, 2007

  10. Strategy for Building the Florida Health Information Network • Develop the Florida Health Information Network infrastructure to enable the sharing of meaningful electronic patient data • Promote new reservoirs of electronic patient data on the network by developing regional health information organizations across Florida • Achieve a critical mass of electronic patient data in the network to drive value to healthcare providers HIMSS RHIO/HIE Connecting Communities Regional Forum - May 3, 2007

  11. The Florida Health Information Network Begins at the Local Level • The Florida Health Information Network is being built from the local community up • An essential element of the strategic plan is to empower local stakeholder collaborations focused on health information exchange • The driver of this plan is the FHIN Grants Program and Regional Health Information Organizations in the local community HIMSS RHIO/HIE Connecting Communities Regional Forum - May 3, 2007

  12. The Florida Health Information Network Strategy: • Build out health information networks using a grants program to leverage the development of local RHIOs • Integrate the RHIOs with a state-level server that will manage data exchange among RHIOs and other state and federal databases • Create a not-for-profit organization to maintain the Florida Health Information Network and set standards of interoperability for the RHIOs HIMSS RHIO/HIE Connecting Communities Regional Forum - May 3, 2007

  13. 2006 Legislation Authorizes the FHIN Grants Program • House Bill 7073 amended § 408.05 (4)(b), F.S., directing AHCA to: • … administer, manage, and monitor grants to not-for-profit organizations, regional health information organizations, public health departments, or state agencies that submit proposals for planning, implementation, or training projects to advance the development of a health information network. HIMSS RHIO/HIE Connecting Communities Regional Forum - May 3, 2007

  14. The Florida Health Information Network Florida’s Health Information Networks 1. Big Bend RHIO 2. Central Florida RHIO 3. Community Health Information Organization 4. Escambia HIN 5. Jacksonville Health Information Network 6. Palm Beach County Community Health Alliance 7. Pinellas RHIO 8. Space Coast Health Information Network 9. South Florida HII 10. Tampa Bay RHIO See: http://ahca.myflorida.com/dhit HIMSS RHIO/HIE Connecting Communities Regional Forum - May 3, 2007

  15. Developing Florida’s Regional Health Information Organizations with the FHIN Grants Program HIMSS RHIO/HIE Connecting Communities Regional Forum - May 3, 2007

  16. FHIN Grants Program Provides Funding to Local Health Information Exchange Initiatives • The FHIN Grants Program was developed in 2005 to help local health information network initiatives “get off the ground” • The Governor’s Advisory Board oversees grant evaluations and recommends grant awards to the Secretary of the Agency for Health Care Administration • All grants funds are matched dollar for dollar at the local level, indicative of a tremendous level of local volunteerism HIMSS RHIO/HIE Connecting Communities Regional Forum - May 3, 2007

  17. FHIN Grants Project Categories • Planning Grants: Support engaging appropriate health care stakeholders to develop a strategic plan for health information exchange in their communities. • Implementation Grants: Support projects that demonstrate health information exchange among two or more competing provider organizations. • Training Grants: Support practitioner training designed to increase physician and dentist use of electronic health record systems. HIMSS RHIO/HIE Connecting Communities Regional Forum - May 3, 2007

  18. FHIN Grants Program, 2005-2006 • The Agency for Health Care Administration started the FHIN grants program with a $1.5 million appropriation from the Legislature • The Governor’s Advisory Board recommended nine grants for FY 2005-06: • Five Planning Grants • Three Implementation Grants • One Training Grant HIMSS RHIO/HIE Connecting Communities Regional Forum - May 3, 2007

  19. FHIN Grants Program, 2005-2006 • Planning Grants • AccessEscambia • Central Florida RHIO • Pinellas County Health Department • South Florida Health Information Initiative • HealthFirst, Inc. • Implementation Grants • Big Bend RHIO • Palm Beach County Community Health Alliance • Tampa Bay RHIO • Training Grant • Florida Association of Family Practitioners HIMSS RHIO/HIE Connecting Communities Regional Forum - May 3, 2007

  20. FHIN Grants Program, 2006-2007 • The Legislature appropriated $2 million to the FHIN Grants Program in 2006 • A total of 18 proposals were received, amounting to $6 million in requested funds • The Governor’s Advisory Board evaluated all of the proposals and recommended six implementation grants for FY 2006-07 HIMSS RHIO/HIE Connecting Communities Regional Forum - May 3, 2007

  21. FHIN Grants Program, 2006-2007 • Implementation and Operations Grants in 2006-2007 were awarded to: • Big Bend Regional Healthcare Information Organization • Tampa Bay Regional Health Information Organization • Palm Beach County Community Health Alliance • South Florida Health Information Infrastructure • Escambia Health Information Network • Community Health Information Organization HIMSS RHIO/HIE Connecting Communities Regional Forum - May 3, 2007

  22. FHIN Grants Program, 2007-2008 • The 2007-2008 FHIN Grants Program was announced on April 2, 2007 • Due date for proposals is May 24, 2007 • The Agency has received eighteen letters of intent to apply for a FHIN Grant • The Legislature has appropriated $2 million for the 2007-2008 grants HIMSS RHIO/HIE Connecting Communities Regional Forum - May 3, 2007

  23. FHIN Grants Program Is Only Intended for Health Information Exchange Startup • The FHIN Grants Program has been successful in providing startup funding for RHIOs across Florida but is not intended as a long term solution to funding • Implementation grantees are expected to develop a sustainable model for ongoing activity • The Florida Center is also working on sustainable models of health information exchange HIMSS RHIO/HIE Connecting Communities Regional Forum - May 3, 2007

  24. Steps Taken by the Florida Center to Promote Sustainability Among RHIOs • Florida Health Information Network White Paper Core Functions and Services • Foundation for eHealth Initiative Summary Roadmap for Florida • Blue Cross Blue Shield of Florida Blueprint for Building a Sustainable Health Information Exchange Organization • Foundation for eHealth Initiative Value and Sustainability Model HIMSS RHIO/HIE Connecting Communities Regional Forum - May 3, 2007

  25. Florida Health Information Network White Paper Core Services • The Florida Health Information Network Architectural White Paperproposes a set of core functions and services that the network should provide • The core functions address activities that make up the core business operations of the network • The core services address business activities that should be developed first HIMSS RHIO/HIE Connecting Communities Regional Forum - May 3, 2007

  26. Florida Health Information Network White Paper Core Functions • Enterprise Master Patient Index • Record Locator Service • Data exchange interface with RHIOs • Registration/certification • Authentication • Secure communications • Audit trail and reporting for non-repudiation • Disaster recovery HIMSS RHIO/HIE Connecting Communities Regional Forum - May 3, 2007

  27. Florida Health Information Network White Paper Core Services • E-Prescribing • Interfaces with state agencies • Interfaces with Pharmacy Network • Interfaces with Laboratories • Minimal clinical dataset • Electronic Medical Record Lite • Personal Health Record Lite HIMSS RHIO/HIE Connecting Communities Regional Forum - May 3, 2007

  28. Foundation for eHealth Initiative Summary Roadmap for Florida • eHealth Initiative worked with the Florida Center to evaluate the state of RHIO development in Florida through an extensive set of interviews with RHIO representatives • eHealth Initiative provided a report on the status and future potential of health information exchange in Florida • eHI also published a roadmap for identifying and implementing exchange services that will drive utilization and long term sustainability HIMSS RHIO/HIE Connecting Communities Regional Forum - May 3, 2007

  29. eHealth Initiative Roadmap for Florida • The eHealth Initiative roadmap was written to assist the Florida RHIOs in building self sustaining business models • Identifying the Medical Trading Area (MTA), or geographic market, for the RHIO • Identifying potential functionalities and the targeted users, expected beneficiaries, and value expected to be derived by each beneficiary • Analyzing the potential revenue, costs, and risks of each functionality path • Creating financial projections and selecting functionalities for business plan update HIMSS RHIO/HIE Connecting Communities Regional Forum - May 3, 2007

  30. Blueprint for Building a Sustainable Health Information Exchange Organization • Blue Cross Blue Shield of Florida donated a business development team to work with the Florida Center in creating a business plan for the Florida Health Information Network • The BCBSF team created a revenue model based on subscription fees and transaction costs over a five year period • The revenue model showed the Florida Health Information Network becoming sustainable within five years, if initial funding of $25.8 million over the first three years were appropriated by the Legislature HIMSS RHIO/HIE Connecting Communities Regional Forum - May 3, 2007

  31. Objectives for the BCBSF Business Plan • Reduced RHIO startup and operational costs • Shared development and maintenance costs • Efficiency through common infrastructure and architecture • Flexibility to meet new market-driven products • Enable RHIO success • Flexibility to adapt to local needs • Support adoption • Generate sufficient profits to sustain operations and future development • Encourage participation by all stakeholders HIMSS RHIO/HIE Connecting Communities Regional Forum - May 3, 2007

  32. BCBSF Planning Guidelines • Leverage current RHIO progress • Avoid competition and enable RHIO growth • Leverage clinical-relevant data already stored and shareable. • State data (Medicaid and other) • Provider data (EMR, HIS, Labs, Rx) • Payer data (claims data and other data submitted to payers) • Leverage infrastructures currently in place and functional HIMSS RHIO/HIE Connecting Communities Regional Forum - May 3, 2007

  33. BCBSF Florida Health Information Network Business Concept • The FHIN should supply local RHIOs with technology and business services to achieve significant economies of scale • Infrastructure and software interface and integration services • Data mapping and standardization • Marketing support (e.g., marketing materials) • Data analysis services (reporting and data queries) • Discounted services/products (e.g., legal services, EMR light for physicians) HIMSS RHIO/HIE Connecting Communities Regional Forum - May 3, 2007

  34. BCBSF Florida Health Information Network Product Strategy • The FHIN should make available the critical data sets and infrastructure needed for them to establish health information exchanges • Develop the technical infrastructure backbone of the statewide exchange system • Access aggregated data sources • Secure Communications of clinical results • Leverage combined buying power to obtain discounts • Incremental approach to product development and product extensions for revenue opportunities HIMSS RHIO/HIE Connecting Communities Regional Forum - May 3, 2007

  35. Foundation for eHealth Initiative Value and Sustainability Model • eHealth Initiative is also working with the Florida Center and RHIOs to provide training in its Value and Sustainability Model • The model is based on a suite of tools, products, and services which provide analytical support, discipline, and rigor to planning • Market Readiness Assessment Tool • Value Tool • Risk Estimation • Business Plan Template and Pro Forma Tool © Foundation for eHealth Initiative HIMSS RHIO/HIE Connecting Communities Regional Forum - May 3, 2007

  36. eHealth Initiative Value and Sustainability Model • As part of the overall development and planning process of a RHIO, options need to be developed and evaluated as to what functionalities should be built and when • This evaluation needs to incorporate differences in cash flows, the underlying riskiness of proposed functionalities, their likely adoption rates, and their required investments • The final choice of functionalities and sequencing is the case that generates the highest financial returns, while minimizing risk © Foundation for eHealth Initiative HIMSS RHIO/HIE Connecting Communities Regional Forum - May 3, 2007

  37. eHealth Initiative Value and Sustainability Model • The Value and Sustainability Model employs a five step process: • Assess: Market readiness • Define: Decision framework • Evaluate: Net Present Value Model • Plan: Development of Business Plan • Execute: Acquire required starting capital, begin execution © Foundation for eHealth Initiative HIMSS RHIO/HIE Connecting Communities Regional Forum - May 3, 2007

  38. eHealth Initiative Value and Sustainability Model • The value and sustainability model addresses the challenges facing most RHIOs • Secure Upfront Funding • Develop a Sustainable Business Model • Address Privacy and Security Issues • Address Organization and Governance Issues • Address Technical Aspects © Foundation for eHealth Initiative HIMSS RHIO/HIE Connecting Communities Regional Forum - May 3, 2007

  39. Next Steps for Sustainability of Health Information Exchange in Florida • The Florida Health Information Network and the RHIOs must continue to work together on issues of common interest • Legislative appropriations for startup funding is still of great importance to the RHIOs • Developing a viable business model for the Florida Health Information Network and RHIOs is also essential for continued sustainability HIMSS RHIO/HIE Connecting Communities Regional Forum - May 3, 2007

  40. Next Steps for Sustainability • The Florida Center continues to work with the Legislature and the RHIOs across the state to create a viable approach to successful health information exchange • The Florida Center is negotiating with eHealth Initiative to beta test the value and sustainability tool among Florida’s RHIOs to assist their planning for sustainability • The business plan from Blue Cross Blue Shield of Florida will be implemented in stages to support RHIO services HIMSS RHIO/HIE Connecting Communities Regional Forum - May 3, 2007

  41. The Future of the Florida Health Information Network • The Florida Health Information Network vision anticipates integrating the Florida’s Regional Health Information Networks in a seamless health information exchange • The success of the statewide network depends on the sustainability of each local RHIO, and their ability to work together to achieve a common goal of exchanging medical records for the benefit of patients across the state HIMSS RHIO/HIE Connecting Communities Regional Forum - May 3, 2007

  42. Lisa K. Rawlins, Director Agency for Health Care Administration Florida Center for Health Information and Policy Analysis 2727 Mahan Drive Tallahassee, FL 32309 rawlinsl@ahca.myflorida.com HIMSS RHIO/HIE Connecting Communities Regional Forum - May 3, 2007

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