conference.ppt

Office of Health Information TechnologyOffice of Health Information Technology

Office of Health Information Technology

August 31, 2006

Welcome to the Commonwealth of Welcome to the Commonwealth of VirginiaVirginiaHealth Information Technology Health Information Technology GrantGrantApplicant ConferenceApplicant Conference


Our Purpose TodayOur Purpose Today

• Overview the Commonwealth’s strategy for information technology improving health care for all Virginians

• Continue and expand the marketplace dialogue around electronic health records

• Describe near term action steps


AgendaAgenda

• Opening Remarks• Electronic Health Records Context and Vision• Project Organization• Request For Information (RFI) Desired

Outcomes• Our Process• Lunch• Discussion


The Honorable Aneesh P. ChopraSecretary of TechnologyThe Honorable Marilyn B. TavennerSecretary of Health and Human Resources

August 31, 2006

Opening RemarksOpening Remarks


Virginia’s ApproachA Lofty (National) Goal

Healthcare IT Investment Atop the National, State Agenda

• President Bush calls for most Americans to have an electronic health record by 2014

• Goal to develop a nationwide interoperable health information technology infrastructure

• House passed “Health Information Technology Promotion Act” on July 27th, 2006 following similar passage in the Senate in 2005

Warner Report in Brief

Establish an ongoing statewide Virginia Health Care Innovations Group, Establish incentives for EHR adoption in the state’s role as a purchaser Appropriate state monies to facilitate increased eHealth initiatives, Identify and support the implementation of a master patient index, Address the health information management workforce shortage

• The Legislature has elevated the importance of this issue by calling for the creation of an Advisory Committee on Electronic Health Records

• Allocates $1.5 Million over the biennium for encouraging Electronic Medical Records Adoption through grants issued to providers

• The Governor has signed Executive Order 29 which creates the “Health Information Technology Council”


Public-Private Partnerships to Drive Physician Adoption RateCommunities develop innovative solutions with the private sector to lower the cost, maximize marketing communication to area physicians, and boost adoption

Virginia Health Information NetworkCommonwealth establishes standard to ensure data interoperability with sufficient protections for patient privacy, including the consideration of a master patient index

Pilot Projects to Lower Health Care CostsCommonwealth invests in pilot projects to demonstrate cost savings in its capacity as a large employer, with particular emphasis on rewarding quality healthcare

Myriad Opportunities to Spur the Adoption of Healthcare IT


Framing Virginia’s 2007 Health IT Investment Agenda

I

Improving Virginia’s Health IT Infrastructure

#Office of Health Information Technology: Virtual Office combining staff from both the Health and Technology Secretariats; serves as support staff for the Health IT Council in its mission to review proposals for funding from $1.5 Million appropriation

#Office of Health Information Technology: Virtual Office combining staff from both the Health and Technology Secretariats; serves as support staff for the Health IT Council in its mission to review proposals for funding from $1.5 Million appropriation

II

Extending the Enterprise

III

Seeding Global Reform

#Medicaid Transformation Grants: Proposing to fund web-based PHR populated by claims data and electronic billing for smaller providers

#Electronic Master Patient Index: Seed capital available for developing a statewide Electronic Master Patient Index in current biennial Budget

#Virginia Department of Health EMR: Electronic Medical Record to serve Health Department clinics approved by IT Investment Board

#Department of Mental Health, Mental Retardation, and Substance Abuse Services EMR: Medication Management and EMR Systems – Also approved


Governor’s Health IT Council Membership

• Corporate– Gil Minor, Owens and Minor– Bob Johnson, Sprint Nextel– Balan Nair, AOL

• Home Healthcare– Ron DeCesare, Professional Healthcare Resources

• Hospital Members– Barbara Baldwin, UVA– Golden Bethune, Riverside– Joe Roach, Martinsville Memorial Hospital

• Insurance– Megan Philpotts Padden, Sentara Health Plans

• Legislative– Hon. Janet Howell, VA Senate– Hon. Sam Nixon, VA House of Delegates– Hon. John O’Bannon, VA House of Delegates

• Long-Term Care– Elizabeth Brown, Sentara Healthcare


• Patient Advocate– Nancy Davenport-Ennis, Patient Advocate Foundation

• Pharmacy– Michele Vilaret, National Association of Chain Drug Stores

• Physician Members– Dr. Gopinath Jadhav, Southside Gastroenterology, Richmond– Dr. Keith Newby, Cardiology and Arrhythmia Consultants, Norfolk– Dr. Larry T. Wilson, Holston Medical Group, Gate City

• Privacy Expert– Anna Slomovic, Revolution Health Group

• Thought Leaders– David Merritt, Center for Health Transformation– Chas Roades, Advisory Board Co.– Don Detmer, American Medical Informatics Association / UVA

Governor’s Health IT Council Membership


Our ProcessOur Process

Greg WaltonExecutive Advisor


Office of Health Information Technology - A Office of Health Information Technology - A Virtual TeamVirtual Team

• Betty Jolly – Department of Health Professions

• Heidi Dix – Asst. Sec. of Health and Human

Resources

• Thomas Gates – Assistant Secretary of Technology

• Tristen Pegram – Special Assistant for Technology

• Kim Barnes – Virginia Department of Health

• Greg Walton – Executive Advisor to the Council


Health & Human Resources PrioritiesHealth & Human Resources Priorities

• Medicaid Reform• Healthy Virginians• Health Workforce Issues• Uninsured in Virginia• Quality Health Initiatives


Our ProcessOur Process

• Subcommittees of the Technology Council

• Regional Approach• Project Sweet Spots• Guidelines to the Statement of

Interest• Applicant Dialogue


Technology Council Sub CommitteesTechnology Council Sub Committees

• Business Case and Partnerships• Privacy and Security• Physician Communications• Order of Merit Confirmation


Economic Development RegionsEconomic Development Regions


“Given that physicians in small practices account for 88 percent of all outpatient visits and four-fifths of physicians work in small

practices, this group represents a sizable adoption gap.”

From “Information Technologies. When Will They Make It into Physicians’ Black Bags?” Medscape General Medicine 6, no. 4 (2005)

VIRGINIA’S EHR ADOPTION IN PHYSICIAN VIRGINIA’S EHR ADOPTION IN PHYSICIAN OFFICESOFFICES


Health Regions in VirginiaHealth Regions in Virginia


Number of MD’s by Health Number of MD’s by Health Region Region

Total licensed MD’s• 3346 = Central Region• 4167 = Eastern Region• 7966 = Northern Region• 2464 = Southwest Region

Source: Department of Health Professions BOM, 2006 data


• 33% of respondents in a recent Virginia survey of physician offices said they have an EHR in use today.

• Of those who said they had an EHR, 36.6% utilized 3 components or fewer. 12% reported 3 components or fewer; 17% reported 4 to 6 components; 4% reported 7 or more components

• Those in a hospital setting (60%) were more likely than those in large group practice (3 or more doctors; 33%) and small group practice (2 or less doctors; 17%) to have and EHR.

36.6

51.2

12.2

0

10

20

30

40

50

60

1 to 3 4 to 6 7 or more

Source: VDH Survey, 2005

Physician AdoptionPhysician Adoption


Most Adopted Feature of an EHRMost Adopted Feature of an EHR

• Receipt of lab results = 62%• Entry of progress notes = 57%• Decision support such as online material = 56%• Images = 55%• Lab ordering = 50%• Alerts to drug interactions = 40%• Image ordering = 38%• Records transmitted/received from other offices =

38%• Electronic Prescriptions = 24%• Alerts to deviations from patient care protocol =

14%• Patients can access part or all of the record = 5%



On average, how many patient records are currently On average, how many patient records are currently in your system?in your system?

3.6

21.4

28.6

46.4

0

5

10

15

20

25

30

35

40

45

50

<1,000 1,000-4,999 5000-19,999 20,000+



How many years have you had your current How many years have you had your current electronic health record system?electronic health record system?

20.918.6

30.227.9

0

5

10

15

20

25

30

35

Less than 1year

1 year to lessthan 2 years

2 years toless than 5

years

More than 5years

Source: VDH Survey Early Adopters, 2005


Virginia’s HospitalsVirginia’s Hospitals


Virginia Hospital Statistics Compared Virginia Hospital Statistics Compared NationallyNationally

Number of

hospitals

Staffed beds

Total discharg

es

Patient days

Gross patient revenues (hundred thousands)

Virginia 81 14,759 738,588 3,592,628 $26,119,057

U.S. 3,886 650,143 32,748,037

155,432,732

$1,265,638,838

Note: Data based on most recent hospital Medicare cost reports; access from http://www.ahd.com/state_statistics.html on August 30, 2006.


Acute Care HospitalsAcute Care Hospitals

Rural45% Urban

55%

FP*18%

NFP*82%

Source: Virginia State Planning Grant Phase One, Final Report to the Secretary of Health and Human Services, September 2005

* FP-Proprietary Hospitals; NFP—Not-for-Profit Hospitals

76 Acute Care Hospitals (2003)

Source: Department of Health Professions BOM, 2006 data


Trauma Centers Serving Virginians


Additional ProvidersAdditional Providers• Other Hospitals:

– 4 State or Locally Owned Hospitals

– 6 Psychiatric Hospitals

– 4 Rehabilitation Hospitals

– 36 Ambulatory Surgery Centers

• Other Providers:– 245 Licensed

Nursing Facilities– 4 Health Regions

(Northern, SW, Central, and Eastern)

– 35 Local Health Districts

Source: Virginia State Planning Grant Phase One, Final Report to the Secretary of Health and Human Services, September 2005 and Virginia Department of Health: www.vdh.virginia.gov/LHD

Full list of Virginia Hospitals available at: http://www.ahd.com/states/hospital_VA.html


Virginia Local Health DistrictsVirginia Local Health Districts

Source: Virginia Department of Health, http://www.vdh.virginia.gov/LHD/LocalHealthDistricts.asp


Project Sweet SpotsProject Sweet Spots

Demonstrate Innovate

Automate Validate

Key Attributes


Guidelines to the Statement of Guidelines to the Statement of InterestInterest

• Contact Information• Project Overview• Partnership History• Timeline and Work plan• Description of Technical Approach• Special Commonwealth

Considerations• Business Model


Guidelines to the Statement of Guidelines to the Statement of Interest - Contact InformationInterest - Contact Information

• Recommended Length: 1 Paragraph

• Required Information1. Organization(s)2. Contact Person’s Name, Address,

Phone Numbers & E-mail

• Suggested1. Company Web Site


Guidelines to the Statement of Guidelines to the Statement of Interest - Project OverviewInterest - Project Overview

• Recommended Length: 3 Pages• Suggested

1. What Will Be Done2. Roles of the Partners3. Regional Orientation and Impact


Guidelines to the Statement of Guidelines to the Statement of Interest - Partnership HistoryInterest - Partnership History

• Recommended Length: 2 Pages• Suggested

1. Virginia Partnership Activity2. Institutional & Physician3. Challenges Overcome


Guidelines to the Statement of Guidelines to the Statement of Interest - Timeline and Work PlanInterest - Timeline and Work Plan

• Recommended Length: 2 Pages• Required

1. Start Date from Award2. Project Phases

• Suggested1. Project Sub-phases2. Work Load by Partner


Guidelines to the Statement of Guidelines to the Statement of Interest - Description of Technical Interest - Description of Technical ApproachApproach• Recommended Length: 1 Page• Required

1. Multiple Choice/Fill in the Blank Questions


Guidelines to the Statement of Guidelines to the Statement of Interest - Description of Technical Interest - Description of Technical ApproachApproach

• Network, Systems Architecture, Hardware, Operating Environment, Database, etc.

• What deployment models are available for your product? (check all that apply

o Application Service Provider (Vendor Hosted)o Software Product (User Hosted)o Third Party Site

• What operating system(s) does your product use? (check all that apply)o Windowso Linuxo Unixo Mac OSo Other

• What minimum client application does your product require? o Thick cliento Browser-basedo Rich Browser-based (e.g., Applets)



• What other client applications does your product provide? (check all that apply)

o Thick cliento Browser-basedo Applet-based

• What underlying database management software is supported? (check all that apply)

o Oracleo Microsoft SQL Servero Open Source (MySQL, Firebird, Ingres)o DB2o OODBMSo OtherList other required 3rd party software____________



• Scalability features (check all that apply)o Database/Server Replicationo Server Clusteringo SMP computingo Grid Computingo Other [please fill in] _______________________

• What types of access points does your product support for physicians, nurses, other caregivers and non-clinical reviewers (check all that apply)

o Desktop computerso Laptop computerso Wireless tablet computerso Text messageo Cell phoneo IMo Remote Accesso Other



• What additional data entry mechanisms are supported (check all that apply)

o Bar code readers o OCRo Scanning (?)o Web formso Patient monitoring equipmento Laboratory analysis equipmento Voiceo Handwriting recognitiono RFIDo Biometricso Smart Cardso Proximity Badges o Other [fill in]



• Data and System Security Requirements• What provisions are made for compliance with Privacy

standards and regulatory requirements (fill in URL or less than 50 words) _______________________________________

• What provisions are made for compliance with requirements for legally sound medical records (fill in URL or less than 50 words)) ______________________________________

• What features exist for data protection and disaster recovery (fill in URL or less than 50 words) ___________________________

• What data security measures does your system support (check all that apply)?

• SSL• 3rd party SSL accelerators• Event logging to support auditing and strict user accountability• Rollback



• Data and System Security Requirements • All information is time-stamped (Y/N)• All data entry is associated with a particular user (Y/N)• Users have unique login (Y/N)• Users can be assigned particular roles (Y/N)• Provides unique patient identifier (Y/N)• Supports electronic signature where permitted by Virginia

law (Y/N)

• Routine Maintenance Procedures

• What is the expected downtime per week for maintenance under normal utilization?

• <1 hr o 1-4 hrs o 4-8 hrs o > 8 hrs


Guidelines to the Statement of Interest - Guidelines to the Statement of Interest - Description of Technical ApproachDescription of Technical Approach

• Tools for Computer Operators and Support Staff

• What tools does your product support (check all that apply)?

• Data migration from legacy medical records systems

• Workflow management?

• Customizable (Y/N)

• Statistical Data Analysis

• OLAP

• Custom Reports

• Data Mining Tools

• Flat file import (CSV, etc.)

• XML input

• XML export



• Required or Suggested Staffing

• Requires dedicated administrator (Y/N)

• Use of standards

• What standards are supported for information exchange (check all that apply)?

• HL7 2.3.1 HL7 2.4 CVX MVX• NCDCPICD-9 CDISC CABIG• IEEE 1073 IHE PIX X12N

ELINCS• DICOM HUGN NDF-RT HIPAA• LOINC SNOMED RXNORM• Other (list): _______________________________



• What underlying database management software is supported? (check all that apply)

o Oracleo Microsoft SQL Servero Open Source (MySQL, Firebird, Ingres)o DB2o OODBMSo Other

• List other required 3rd party software requirements: ________________

• Scalability features (check all that apply)o Database/Server Replicationo Server Clusteringo SMP computingo Grid Computingo Other [please fill in] _______________________


Guidelines to the Statement of Guidelines to the Statement of Interest - Special State Interest - Special State ConsiderationsConsiderations• Recommended Length: 1 Page• Required

1. Highlight commitments to any of the following, Small(SBE), Women (WBE), and Minority owned (MBE) businesses ((SWAM)).


Guidelines to the Statement of Guidelines to the Statement of Interest - Business ModelInterest - Business Model

• Recommended Length: 1 Page• Required

1. State your dollar request for the Grant

2. State any assumptions/plans about other funding sources you expect to pursue


Guidelines to the Statement of Guidelines to the Statement of Interest -Interest -Diagrams and PicturesDiagrams and Pictures

• Suggested1. High-level Architecture2. High-Level Systems/Applications3. Project Organization Chart


Applicant DialogueApplicant Dialogue

• Web Postings from OHIT

www.healthitcouncil.vi.virginia.gov• Frequently Asked Questions FAQs• Staff Dialogue and Coaching• Weekly Project Updates• Supporting Material• SOI applicant survey and Proposal

Repository on-line as of Sept 11th


Time TableTime Table

• RFI issued - August 21st• Applicant Conference - August 31st• Statements of Interest Due - September 15th• Technology Council Meetings - September

15th, 29th and October 12th• Order of Merit List Ranking Released October

15th -30th• Stage #2 Begins


LUNCHLUNCH


DiscussionDiscussion


ADJOURNADJOURN

http://www.healthitcouncil.vi.virginia.gov

conference.ppt

Documents

virginias health

department of mental

health department clinics

revolution health group

tavenner secretary of

technology secretariatsserves

adoption of healthcare

chopra secretary of