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Arizona Rural & Critical Access Hospitals

HIT/Quality Workshop

December 6, 2013

Connie K. IhdeRegional Extension Center Director ~ Programs Director

Arizona Health-e Connection

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Health IT Activities in Arizona:

An Update

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Agenda

• Overview of Health IT: The Arizona Landscape

– EHR Incentive Program– Arizona E-Prescribing Initiative– Arizona Regional Extension Center – Arizona HIE Marketplace

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National EHR Progress & Challenges

• As of July 2013:– 61% of CAHs had attested to Stage 1 MU (Figure 1). – 68% of other (non-CAH) eligible hospitals had attested to Stage 1 MU at this same

point in time.

• 89% of CAHs plan to attest to Stage 1 MU by the end of 2013

• Another 10% of CAHs plan to attest to MU by the end of 2014 or beyond

• Less than two percent do not have plans to attest to MU.

• Overall, 89% of CAHs reported that they currently use an EHR system

• 49% of CAHs planned to upgrade/install a new EHR within one year

• SOURCE: ONC analysis of HIMSS Analytics 2013 CAH Survey Supplement and Medicare and Medicaid EHR Incentive Program data Note: Attestation is based upon ONC analysis of Medicare and Medicaid EHR Incentive Program data

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Arizona EHR Progress

$Arizona Eligible Hospital Medicare And Medicaid Payments

January 2011 to September 2013AIU and MU

Total Payments to Hospitals:

$164,876,517

Program TypeAIU Count AIU Amount

MU Count MU Amount

Total Count Total Amount

Medicaid (AHCCCS) 2 $ 4,580,961 1 $ 1,409,960 3 $ 5,990,921

Medicare/Medicaid  64 $71,283,457 23 $18,412,316 87 $89,695,772

Medicare          48 $69,189,823Total           $164,876,517

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Arizona Health-e Connection

Arizona E-Prescribing Initiatives

Arizona Regional Extension Center

Arizona HIE Marketplace

Program Activities

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Arizona E-Prescribing Initiative

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AZ eRx Initiative:Areas of Focus

Education and Resources SafeRx Project

Provider & Pharmacy Technical

Assistance

Pharmacy Incentive Program

E-Prescribing of Controlled Substances

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AzHeC eRx Goals

By end of 2013, aim to achieve the following:

• 70% of all Arizona prescription electronically routed to pharmacies

• 60% of Arizona prescribers routing prescriptions electronically

• 100% of Arizona pharmacies with e-prescribing capabilities

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EPCS is LEGAL in Arizona

DEA’s Interim Final Rule for Electronic

Prescriptions for Controlled Substances was

published on March 31, 2010 at 75 FR 16236-

16319 and became effective on June 1, 2010.

CHAPTER 184HOUSE BILL 2369

CONTROLLED SUBSTANCES IN SCHEDULES II, III, IV AND V MAY BE DISPENSED AS

ELECTRONICALLY TRANSMITTED PRESCRIPTIONS IF THE PRESCRIBING MEDICAL

PRACTITIONER IS ALL OF THE FOLLOWING:

1. PROPERLY REGISTERED BY THE UNITED STATES DRUG ENFORCEMENT

ADMINISTRATION.2. LICENSED IN GOOD STANDING IN THE UNITED STATES JURISDICTION IN WHICH

THE MEDICAL PRACTITIONER PRACTICES.

3. AUTHORIZED TO ISSUE SUCH PRESCRIPTIONS IN THE JURISDICTION IN WHICH

THE MEDICAL PRACTITIONER IS LICENSED.

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Surescripts National SafeRx Ranking

Surescripts ranks Arizona as 29th in its annual SafeRx rankings

Arizona – 29th 2010 2011 2012

Total Prescriptions Routed Electronically 5.9M 10.8M 16.4M

% of Total Prescriptions Represented by Renewal Response 26% 27% 21%

Prescription benefit requests 9.6M 8.5M 22.4M

Rate of Response to Benefit Requests (Year-End) 115% 64% 62%

Total Responses to Medication History Requests (est) 2.7M 2.8M 5.2M

* Rankings are calculated to reflect new prescriptions plus responses to prescription renewal requests to mail order and retail pharmacies as a percentage of all prescriptions within a state that are able to be submitted electronically.

* Total number of physicians per state sourced from SK&A. In addition to physicians, nurse practitioners and physician assistants may also e-prescribe in the state.

Despite the number 29 ranking, Arizona experienced explosive growth in ePrescribing by nearly tripling the number of ePrescriptions from 2010 thru 2012

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SafeRx ProjectInitial Findings

• 21% of total transactions are Refill Responses– Above average, but number should be higher

• 50% of eligible prescriptions transmitted electronically– Top 5 average = 66%

• 70% of visits with Rx benefit eligibility requests– Top 5 average = 97%

• 26% of visits with medication history responses– Top 5 average = 49%

• 56% of patients with available Rx benefit & Med history data– Top 5 average = 73%

Surescripts ranks Arizona as 29th in its annual SafeRx rankings

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Strategy to Improve SafeRx Ranking

• Payer Outreach– Low percentage of visits for which eligibility, benefit and

medication history data is available• Targeted Prescribers

– Low percentage of requests medication history (EHR)– Low percentage of eligible prescriptions routed electronically

(prescriber)• Community Awareness

– Low percentage of eligible prescriptions routed electronically (patient)

The three components are complementary of one another, and the success of one will positively effect the others. The net result of the approach will increase the volume of SafeRx-measured transactions

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Technical Assistance Program

Need assistance with e-prescribing workflow or technical issues? AzHeC is available to provide

FREE assistance to solve your problems!

Contact AzHeC at 602-688-7200, ehr@azhec.org or visit http://www.azhec.org/?page=Provider_Assistance to get

assistance today!

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Arizona Regional Extension Center

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Arizona’s trusted, unbiased health IT and Meaningful Use resource…

assisting 18 CAHs/RHs and over 2,500 Arizona providers to achieve Meaningful Use and other health IT goals!

What is the REC?

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REC CAH/RHProgress to Date

M1 = Sign-up

M2 = Go-Live on certified EHR

M3 = Stage 1 Meaningful Use

Goal: 18 CAH to Stage 1 Meaningful Use

by April 5, 2014M1 M2 M3

0

6

12

18

18 18

16

CAHs & Rural Hospitals

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REC ProviderProgress to Date

M1 = Sign-up

M2 = Go-Live on certified EHR

M3 = Stage 1 Meaningful Use

M1 M2 M30

500

1000

1500

2000

2500

3000

REC Grant Memberships

Specialists

Non Grant Credit PPCPs

Grant Credit PPCPs

1,958

100% of Goal 100% of Goal 52% of Goal

2,500+

2,200+

1,020

1,958

Goal:1,958 PPCPs to Stage 1

Meaningful Use by April 5, 2014

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Arizona Health Information Exchange (HIE) Marketplace

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Arizona HIE Marketplace

HIE Marketplace

Robust Health Information Exchange

Direct Exchange

Phase 1 Phase 2

Basic Robust

PurposeProvide viable

options for health information

exchange (HIE) to Arizona health care providers.

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Who Uses Direct Exchange?

Direct Exchange

Users

Providers

Long term care

PatientsLaboratories

Hospitals

Direct Exchange

can be used by

multiple individuals

and entities for

health care

coordination

purposes.

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Health Information Network of Arizona

(HINAz)

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Current Participation

• Current participation includes 35 entities:

• 12 hospitals, including 4 CAHs

• 7 health plans

• 3 community health centers

• 1 reference lab

• 7 community providers

• 3 long term care facilities

• 2 county corrections departments

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Sample of Current Participants

• Banner Health

• Maricopa Integrated Health System

• Tucson Medical Center

• Carondelet Health Network

• Northern Arizona Healthcare

• Pima County Corrections

• El Rio Health Center

• Marana Health Center

• Villa Maria Care Center

• Cardiovascular Consultants

• Genesis Ob/Gyn

• Yuma Regional Medical Center

• Casa Grande Regional Medical Center

• Little Colorado Medical Center

• Copper Queen Community Hospital

• Sonora Quest Laboratories

• UnitedHealthcare

• Blue Cross Blue Shield of Arizona

• Care1st Arizona

• AND MORE!

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Participant Status

• Data suppliers status:• Banner Health – fully live

• Carondelet Health Network – fully live

• Sonora Quest Laboratories – fully live

• Benson Hospital – fully live

• Maricopa Integrated Health Systems – mostly live

• Multi-Specialty Interdisciplinary Clinics (Children’s Rehabilitation Services) – partially live

• Cardiovascular Consultants – partially live

• Data users status: • Pima County Detention Center

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Getting the Support You Need

• E-Prescribing Initiative– www.azhec.org/?page=eRx_Initiative

• Arizona Regional Extension Center– www.arizonarec.org

• HIE Marketplace– www.azhec.org/?page=HIE_Marketplace

• Health Information Network of Arizona– www.hinaz.org

Arizona Health-e Connection602-688-7200

ehr@azhec.org