Health Information Technology : Federal Support for Adoption

Michael Mirro MD : Chair James Tcheng MD : Vice-Chair

ACC-HIT Committee

Agenda• ACC HIT Efforts• Federal Financial Incentives a) PQRI b) e-Prescribing c) American Recovery Reinvestment Act• HIT : IC3 Workflow Solutions• Summary

ACC Informatics Committee Efforts

• Health IT website (www.acc.org/healthIT)• Updated with ARRA information of relevance to members• EHR Toolkit: helpful hints, advice on contract negotiations,

selection tools, educational resources, and Federal EHR incentive program information

• E-Prescribing Initiative: overall benefits, minimum functional criteria, and CMS e-Prescribing Incentive Program information

• Unique Patient Identifiers Principles Document• Stance: mandatory UPI vital to increasing quality of care,

outweighs privacy concerns• Target: ACC advocacy efforts on Capital Hill• Position: Currently reaching out to peer organizations for notice

and possible collaboration

ACC Informatics Committee Efforts

• ACC Data Definitions for Cardiovascular EHR• List of data elements that are essential for care in the

cardiology domain• Consolidates definitions from multiple data

dictionaries• Receiving comments from other ACC committees

• CardioPath™ Pilot Project• Translates ACC/AHA clinical guidelines into clinical

decision support• Guideline Adherence Tool web application available• Working with EHR vendors to test proof of concept

8UC Project for Global InequalityUC Project for Global Inequality

The Cost of a Long LifeThe Cost of a Long Life

U.S.

Accelerating EHR Adoption: Government Role

• Financial Incentives • PQRI• ARRA• e-Prescribing

HIT : Federal Incentives• PQRI $3,000-5,000/year

– 2007: 1.5%– 2008: 2.0%– 2009: 2.0%

• E-Prescribing $3,000-5,000/year• ARRA EHR Funding : $44,000 – 5 years

(plus 10% Bonus $48,400 :Medicaid)

PQRI Requirements• Report on PCPI/NQF Endorsed Performance

Measures• Claims-Based Quality Data : Quality Data

Codes (QDC)• Maximum Financial Incentive achieved if 3

measures reported on > 80% of eligible encounters

• Use of CCHIT-certified EHR : 2009 performance measure

American Recovery & Reinvestment Act (ARRA):

02/17/09• Total: $790 Billion• Healthcare (total): $59 Billion• HITECH: $34 Billion (net ~$19 Billion)

– Key Components1.Leadership2.Funding and incentives3.Standards4.Certification5.Research and development6.Education and outreach7.Privacy and security

Health IT in ARRA1. Leadership

• Established Office of National Coordinator• David Blumenthal, MD• $2B in appropriations

• Established 2 Federal Advisory Committees• HIT Policy Committee – recommendations to

ONC regarding e-exchange, use of health information

• HIT Standards Committee – recommendations to ONC regarding standards, implementation specifications, and certification criteria

Health IT in ARRA• $20.8 billion – Medicare & Medicaid incentives to

providers for EHR adoption• $4.7 billion – NTIA broadband technology• $2.5 billion – USDA distance learning, telemedicine,

broadband technology• $2 billion – ONCHIT• $1.5 billion – HRSA for health centers• $1.1 billion – comparative effectiveness research

(AHRQ, NIH, HHS)• $500 million – Social Security Administration• $85 million – Indian Health Service health IT• $50 million – VA information technology

2. Funding and Incentives ($34 billion)

Medicare EHR Incentives and Penalties

Adoption Year 1 Year 2 Year 3 Year 4 Year 5 PaymentYear Incentive Incentive Incentive Incentive Incentive Reduction

2011/12 $18,000 $12,000 $8,000 $4,000 $2,000 -

2013 $15,000 $12,000 $8,000 $4,000 - -

2014 $15,000 $12,000 $8,000 - - -

2015 - - - - - 1%

2016 - - - - - 2%

2017 - - - - - 3%

2018 - - - - - 3-4%

2019+ - - - - - 3-5%

Definition of Qualified Electronic Health Record

• Certified as meeting standards pursuant to ARRA applicable to the specific type of solution

• Includes demographic & clinical health info– Medical history, problem lists

• Has the capacity to:– Provide clinical decision support– Support order entry– Capture, query, report on health care quality (process)– e-Exchange, integration of health information from

other sources

© 2008 | Slide 17 | Nov 10, 2008

Role of Certification in theNational Health IT Strategy

StandardsHarmonization

HITSP CCHIT:CertifyingStandards

Complianceof Health IT

Privacy & SecurityPolicies, Laws, Regulations

Office of the National Coordinator

American Health Information Communityand AHIC Workgroups

NHIN Prototype& Implementation

Projects

HarmonizedStandards

NetworkArchitecture

PrivacyPolicies

Governance and Consensus Process EngagingPublic and Private Sector Stakeholders

Certificationof EHRsand HIEs

Strategic Direction +Breakthrough Use Cases

Accelerated adoption of

robust, interoperable,

privacy-enhancing health

IT

Certification is a voluntary, market-based mechanism to accelerate the adoption of standards and interoperability

Definition of Meaningful Use

• Hospitals– Use qualified EHR technology– Implement e-Exchange of health information to

improve health care quality (e.g., care coordination)– Submit clinical quality measures data

• Physician Practices– All of the above, plus e-Prescribing

• Medicaid Requirements– As defined by the state (must align with Medicare

definitions)– Also includes dentists, certified nurse-midwives, mid-

level practices

Health IT in ARRA2. More Funding and Incentives Info

• Loans to Providers• ONC may award competitive grants for establishment of

programs for loans to healthcare providers

• $1.1B for comparative effectiveness research (AHRQ, NIH, and HHS)• To evaluate and compare clinical outcomes, effectiveness,

risk, and benefits of 2 or more medical treatments and services that address a particular medical condition

• NIH announced $200 million in FY 2009-2010 funds to support “Challenge Grants,” of which comparative effectiveness research funds are included. ACC NCDR is moving to submit application by April 27, 2009 due date.

Health IT in ARRA3. Standards

• Adopt an initial set of standards, implementation specifications, and certification criteria by 12/31/2009

4. Certification• The ONC shall recognize a program for the

voluntary certification of health IT

Health IT in ARRA5. Research and Development

• Assistance to institutions for centers for Healthcare Information Exchange integration

6. Education and Outreach• HHS health IT extension program to provide health IT

assistance services

• Grants for demonstration projects to develop academic curricula integrating certified EHR technology in the education of health professionals

• Support for health informatics training programs

Health IT in ARRA7. Privacy & Security

• Security Breach Notification – individual must be notified if unauthorized disclosure or use of their health information.

• New HIPAA Business Associate rules - new entities that were not contemplated when HIPAA was written (e.g., PHR, RHIO, HIE) are subject to the same privacy and security rules as providers and health insurers

HIT : e-Prescribing Requirements

• Electronic transmission of prescription data– bi-directional

• SureScripts / RxHub certified• Drug-drug interaction reconciliation• Drug allergy reconciliation• CCHIT, AHIC, HITSP Compliance• HIPPA Compliance• Surrogate prescriptive function (e-confirm)• Patient prescription eligibility / formulary

reconciliation

Next Steps• www.acc.org/healthIT• www.cchit.org• Organizational change assessment• Develop implementation team• Develop training, implementation plan• Vendor selection (CCHIT & IHE)

HIT : NCDR IC3 Adoption• First Office-Based Registry Designed to

Assess Physician Adherence to ACC/AHA Performance Measures

• Provides Powerful Tool to Assess Clinical Care for CAD and CHF patients

• A Potential Vehicle to Transform Performance Measurement to Quality Improvement at Point of Care

You could do this on paper• Requiring valuable FTE time and

introducing the opportunity for error• And sending it to the ACC where it will be

entered into a database (again introducing the opportunity for error)

Or you could do this electronically…

• The timing is ideal– Select EHR vendors now certified for IC3– IC3 satisfies PQRI requirements– EHR vendors also incorporate e-prescribing– Current CMS bonus payments help offset EHR

investment costs– EHR adoption incentives start in 2011 and total

$44,000 per physician • FOR IMPLEMENTED AND MEANINGFUL EHR USE• START NOW!

EHR with integrated IC3

• Simplified data collection and reporting– Existing data in EHR can populate collection

forms– As you document encounters in EHR, that

data can also populate collection form– At conclusion of encounter, completed

collection form is submitted and transmitted to ACC for entry into IC3 database

Certified EHR vendors

How will you spend your $44,000?

Consider a workhorse

Questions ??

Health IT in ARRA - Overview

• Includes over $20 billion to aid in the development of a robust IT infrastructure for healthcare and to assist providers and other entities in adopting and using health IT

• Key Economic Stimulus Components:1. Leadership2. Funding and Incentives3. Standards4. Certification5. Research and Development6. Education and Outreach7. Privacy and Security

Health IT in ARRA1. Leadership

• Established Office of National Coordinator - $2B in appropriations

• Established HIT Policy Committee – makes recommendations to ONC regarding implementation

• Established HIT Standards Committee - makes recommendations to ONC regarding standards, implementation specifications, and certification criteria

Health IT in ARRA2. Funding and Incentives

• Medicare incentives to non-hospital based physicians adopting & using certified EHRs

• Starting 2011, physicians receive up to $44K over 5 years• After 2013, physicians receive reduced incentives• After 2014, physicians are ineligible to receive incentives• Beginning in 2015 and after, physicians failing to adopt a

certified EHR are subject to reduced fee schedule amounts

• Medicaid incentives• $63,750 in Medicaid funding to a limited group of eligible

professionals to assist in the adoption and implementation of certified EHR technology.

Health IT in ARRA2. Funding and Incentives (Con’t)

• Loans to Providers• ONC may award competitive grants for establishment of

programs for loans to healthcare providers• $1.1B for comparative effectiveness research

(AHRQ, NIH, and HHS)• Used to conduct or support research to evaluate and

compare the clinical outcomes, effectiveness, risk, and benefits of 2 or more medical treatments and services that address a particular medical condition

• NIH announced $200 million in FY 2009-2010 funds to support “Challenge Grants,” of which comparative effectiveness research funds are included. ACC NCDR is moving to submit application by April 27, 2009 due date.

Health IT in ARRA3. Standards

• Adopt an initial set of standards, implementation specifications, and certification criteria by 12/31/2009

4. Certification• The ONC shall recognize a program for the

voluntary certification of health IT

Health IT in ARRA5. Research and Development

• Assistance institutions of higher education to establish Centers for Healthcare Information Enterprise Integration

6. Education and Outreach• Develop a health IT extension program to provide health IT

assistance services to be carried out through HHS• Grants to carry out demonstration projects to develop

academic curricula integrating certified EHR technology in the clinical education of health professionals

• Support Medical Health Informatics Education Programs

Health IT in ARRA7. Privacy & Security

• Security Breach Notification - Requires that an individual be notified if there is an unauthorized disclosure or use of their health information.

• New HIPAA Business Associates - Ensures that new entities that were not contemplated when HIPAA was written (such as PHR vendors, RHIOs, HIEs, etc.) are subject to the same privacy and security rules as providers and health insurers, by requiring Business Associate contracts

EHR : Payer Perspective

• Improved Documentation• Enhanced Clinical Transparency• Improved Billing/Coding/Claims • Data/Document Transfer• Pay-for-Performance Potential

Health Information Technology

• Automation

• Connectivity

• Clinical Decsion Support

• Data-Mining Capabilities

Initial EHR Adoption Steps• Organizational Change Assessment• Implementation Plan• Develop HIT Implementation Teams• Identify Physician Champions• Workflow : Focus on resistant users• HIT Vendor Selection (CCHIT & IHE)• Incremental Approach

HIT and Aviation• Complex Tool Sets• Training Essential to Success• Implementation Plan Key • Good Technology cannot Succeed without

Infrastructure Support• Technology Upgrades require Retraining• Good and Poor Technology Design Exist