Presentation Learning Objectives:

1. Leveraging Health Information Technology to Improve Care: Early Lessons from the ONC HITECH Programs Mat Kendall, MPHDirector, Office of Provider Adoption Support (OPAS)Office of the National Coordinator for Health ITU.S. Department of Health & Human Services

2. Presentation Learning Objectives: • Overview of the Health Information Technology for Economic and Clinical Health Act (HITECH) • How ONC is Supporting Providers to Achieve Meaningful Use of Health IT • Who is Working To Achieve Meaningful Use and What Challenges They Are Facing • How Meaning Use of Health IT is Supporting Providers to Improve the Care They Deliver to Their Patients Office of the National Coordinator for Health Information Technology

3. HITECH: Catalyst for Transformation Ultimate Goals : Better Healthcare Better Health Reduced Costs Paper Records HITECH Act Electronic Health Records Pre 2009 2009 2014 EHR Incentive Program and 62 Regional Extension Centers A system plagued by inefficiencies Widespread adoption & meaningful use of EHRs Office of the National Coordinator for Health Information Technology 2

4. Meaningful Use as a Building Block Use information to transform Improved population health Improve access to information Enhanced access and continuity Data utilized to improve delivery and outcomes Data utilized to improve delivery and outcomes Patient self management Patient engaged, community resources Utilize technology to gather information Care coordination Care coordination Patient centered care coordination Patient informed Evidenced based medicine Team based care, case management Basic EHR functionality, structured data Structured data utilized Registries for disease management Registries to manage patient populations Privacy & security protections Privacy & security protections Privacy & security protections Privacy & security protections PCMHs 3-Part Aim ACOs Stage 3 MU Office of the National Coordinator for Health Information Technology Stage 1 MU Stage 2 MU 3 3

5. OPAS Strategic Priorities Goal: Assist All Providers to Achieve Meaningful Use of EHR Systems Regional Extension Centers (REC) Harness MU to Achieve Three-Part Aim Goals HealthIT.gov Optimization Provider Adoption Services Leverage Business Intelligence Catalyze IT Workforce Development Office of the National Coordinator for Health Information Technology

6. 62 Regional Extension Centers (RECs) Cover 100% of the USA Initial Program Goal: 100,000 priority primary care providers achieve meaningful use (MU) by 2014 • Every REC: • Has a defined service area and • specific number of providers • Provides unbiased, practical support throughout process • Serves as two-way pipeline to federal and local resources • Approach differs by REC: • Independent operations • Affiliation with QIOs and universities • Partnership with other ONC grantees (Beacon and HIE) • Variety of hospital and payer partnerships Office of the National Coordinator for Health Information Technology 5

7. Comprehensive Support Beyond the EHR Implementation Process Plan: Improve Care Quality: 5 1 • Assess ACO, PCMH models • Prepare for future pay for performance • Empower patients in their own health care • Conduct readiness assessment • Identify tools needed for change (i.e. EHR system, workflow changes, etc) Primary goal: Give providers as much support as possible Transition: 4 2 Operate & Maintain: • Redesign practice workflow • Perform HIT education & training • Continuous quality improvement • MU Stages 1,2,3 3 Implement: • Provide technical assistance • Partner with local stakeholders, HIEs Office of the National Coordinator for Health Information Technology 6

8. Health IT Dashboard for the Medicare and Medicaid Electronic Health Record Incentive Programs http://dashboard.healthit.gov/meaningfuluse • Map & Dashboard Created by: • U.S. Department of Health and Human Services • Office of the National Coordinator for Health Information Technology • Office of Economic Analysis, Evaluation, and Modeling Program Administered & Data Provided by: U.S. Department of Health and Human Services Centers for Medicare & Medicaid Services Office of E-Health Standards and Services http://healthit.gov http://dashboard.healthit.gov/ Email: ONCRequest@HHS.GOV http://cms.gov http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms Office of the National Coordinator for Health Information Technology

9. Where We Are Today: Who Are RECs Helping? > 131,000 Priority Primary Care Providers (PPCPs) are enrolled with RECs > 10,000 specialists also enrolled ONC CRM data as of May 1, 2013 *Proportional decrease is due to an increase in providers enrolled in this practice type. 8/9/2014 Office of the National Coordinator for Health Information Technology Office of the National Coordinator for Health Information Technology 8

10. Who RECs Are Helping: PPCPs by Specialty Priority Primary Care Providers (PPCPs)Enrolled with RECs > 132,000 Priority Primary Care Providers (PPCPs) are enrolled with RECs which is more than 43% of the 303,000 Primary Care Providers in the U.S. Data Source: ONC CRM, September 17, 2012; SK&A Office-based Providers Database. Q4, 2011 Office of the National Coordinator for Health Information Technology 9

11. REC Enrolled Providers by Credential Office of the National Coordinator for Health Information Technology ONC CRM data as of March 19, 2013.

12. RECs are Getting NPs Registered and Paid NPs Paid by CMS RR=1.59* RR=1.59* *p<0.0001. ONC CRM data as of March 19, 2013, merged with CMS EHR Incentive Funds data through January 31, 2013. Office of the National Coordinator for Health Information Technology

13. Who Are RECs Helping?Specialists • RECs are working with more than 10,000 Specialists in 38 different specialties in addition to 132,000 enrolled PCPs • Opportunity: • Already working in the settings (FQHCs, practice consortiums) • Some states are paying RECs to work with Medicaid Specialists using 90/10 funds SOURCE: ONC CRM, 12/7/2012 8/9/2014 Office of the National Coordinator for Health Information Technology Office of the National Coordinator for Health Information Technology 12

14. REC Success:  • A GAO report found that Medicare providers working with RECs were over 2.3 times more likely to receive an EHR incentive payment then those who were not partnered with an REC2 • REC enrollment rates are higher for small rural (non-CBSA, 56%) and micropolitan areas (47%) compared to urban or metropolitan areas3 • Since November, 2011 more than 25,000 MU challenges have been documented by RECs at approximately 18,000 sites to help identify common challenges providers are facing Data Source: ONC CRM Data March 26, 2013 1Source: Customer Relationship Management (CRM) Tool, maintained by the Office of Provider Adoption and Support (OPAS) at ONC, data as of March, 26th 2013. Provider denominators obtained from the SK&A Office-based Providers Database, Q4, 2011. 2GAO, Electronic Health Records: Number and Characteristics of Providers Awarded Medicare Incentive Payments for 2011, GAO-12-778R (Washington, D.C.: July 26, 2012). 3 Furukawa M, Samuels C, King J, Adetosoye F, Samy L. Engaging Providers in Underserved Areas to Adopt Electronic Health Records. AJMC, In Press, 2013. CBSA indicates Core Based Statistical Area. HPSA indicates Health Professional Shortage Area. 8/9/2014 Office of the National Coordinator for Health Information Technology 13 13

15. REC are also collecting specific practices level data on challenges that providers are experiencing Primary and Secondary Challenges Categories Being Tracked by RECs Complete list of Challenges categories, including tertiary categories and descriptions of the categories, is available at healthit.gov/data. Office of the National Coordinator for Health Information Technology

16. Top Ten Secondary Category Challenges • Overall Top Ten Challenges • Top Ten Newly Reported Challenges Office of the National Coordinator for Health Information Technology Data from the ONC CRM as of January 7, 2013. N=number of challenges reported.

17. Top Five Challenges by Practice Type MU Measures Attestation Process Practice Issue VendorIssue Office of the National Coordinator for Health Information Technology Top five based on number of challenges submitted. Data as of December 31, 2012, pulled from the ONC CRM. Non-priority hospitals did not report any challenges.

18. What We are Hearing: Health IT Workforce Shortage will Stunt Sector Growth Worker shortage: America’s next healthcare epidemic.Today’s epidemic is tomorrow’s pandemic. Health IT worker shortage will stunt sector growth, study says Office of the National Coordinator for Health Information Technology Office of the National Coordinator for Health IT 17

19. Address WorkForce Needs: Community College Consortia Number of students who successfully completed the Community College Consortia Program by state: Last updated: March 2012 Office of the National Coordinator for Health Information Technology

20. Ways that Health IT Can Be Meaningfully Optimized to Improve Patient Health Health Information Technology Office of the National Coordinator for Health Information Technology

21. New/ Improved Ways of Delivering Care New Opportunity New Needs: Office of the National Coordinator for Health Information Technology

22. New Payment Models New Opportunity New Needs: 8/9/2014 Office of the National Coordinator for Health Information Technology Office of the National Coordinator for Health Information Technology 21

23. Population Health Awareness New Opportunity New Needs: 8/9/2014 8/9/2014 Office of the National Coordinator for Health Information Technology Office of the National Coordinator for Health Information Technology Office of the National Coordinator for Health Information Technology 22 22

24. Training for an Evolving Health IT Landscape • Sound educational models need to be developed for different stages of training • Professional schools to select, support and train PCMH ready clinicians • Team work/interdisciplinary training • Life-long learning of key skills for all health care workers (IOM Report) • New education models on-line • New efforts to collect and disseminate curricula Office of the National Coordinator for Health IT

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