oha’s technology strategic...

© CSOHIMSS 2009| Slide 0 Title of PresentationMay 8th , 2009

OHA’s Technology Strategic

Initiative


Scott Conaway

May 8, 2009

PACCAR Education Medical Center

Chillicothe, Ohio

OHA’s Technology Strategic Initiative


New England Journal of MedicineMarch 26, 2009(63.1% of hospitals surveyed responded)

Only 1.5% of U.S. hospitals have a comprehensive EHR

system in all clinical units

7.6% have a basic system in at least one clinical unit

17% of hospitals have implemented a computerized provider-

order entry for medications

Teaching and Larger hospitals were more likely to have

implemented an EHR.


Health Information Technology

One of the Greatest Changes and Challenges in Healthcare

Facing Small, Rural and Independent Healthcare Providers


OHA’s Strategic Directions

2009-2012


TechnologyStatement of Intent

Ohio hospitals promote the use of technology to increase efficiency, improve care and enhance

access to information.


TechnologyInitiative

HOSPITAL LEADERSHIP:

– OHA is positioned as a leader in data, information and technology in

order to maintain hospital control and influence.



STANDARDIZATION:

– Ohio hospitals proactively achieve standardization of health care

information and data exchange.



DATA EXCHANGE: – There is a comprehensive statewide information technology exchange

that allows interaction and data sharing among providers.



COLLABORATIONS: – Ohio hospitals participate in technology-based collaborations

designed to increase efficiency, increase affordability and decrease

duplication.


American Recovery & Reinvestment Act

The Stimulus Bill changed our direction and created a

sense of urgency among the hospitals.

The Stimulus package introduces a Carrot and Stick

approach for health care providers to adopt new Health

information Technology and Electronic Health Records.



19 Billion Dollars are allocated for H.I.T. funding.

– 17 Billion in the form of direct incentive payments from Medicare

and Medicaid.

– Providers must make the investment in H.I.T. and be qualified as a

meaningful user of the technology prior to receiving any incentive

payments.



Critical Access, IPPS Hospitals & Physicians

– CAH have a four year window for incentive payments beginning in

FY 2011 and ending in 2015. No incentives if first eligible year is

after 2015.

– PPS Hospitals will also receive payments over a four year period

but can be certified anytime between FY 2011 to FY 2013

– Physicians – same “meaningful use” rules as hospitals but can only

qualify for Medicaid or Medicare, not both.

– Hospital-based physicians not eligible for incentives



A Study by PricewaterhouseCoopers Health Research Institute:

– Efforts to implement EHR systems will be affected by the money

they stand to lose rather than incentive dollars.

– $33-38 billion in incentives will not be enough to completely

compensate hospitals for all EHR-related costs.

– “The incentives will go away and the stick will only get bigger.”

– How much is spent on technology has no relevance to how much

stimulus money is received. Its directly related to Medicare,

Medicaid and charity care volumes.*Source – Healthcare IT News



HIMSS publishes some “meaningful use” definitions* – 4/28/09:

– HIMSS says requirements must be introduced in incremental stages

for providers to be able to meet them.

Milestones achieved in phases of not less than 2 years, starting 2011.

– Final phase starts in FY15 and will include at least the following:

Functional EHR system certified by CCHIT

Standardized Health Information Exchange (HIE) using Health

Information Technology Standards Panel (HITSP) specifications.

Clinical decision support; support of CPOE

Capability to support process and care measurements that drive patient

safety improvements, quality outcomes and cost reductions.

– HIMSS urges the use of CCHIT as EHR certifying body.

*Source – Healthcare IT News



Health I.T. Money lessons:

– It will be a while before anyone sees money from the stimulus

– There will be some that will get nothing

– You must spend HIT money before you get HIT money

– The distribution formula is biased – the more charity care you

provide & inpatient load you have, the more money you get

– CMS rulemaking process will define the detail devils

– Geography plays no direct role in incentive payments

– Don’t count on appeals to HHS

– As of today, hospitals can qualify for Medicare & Medicaid but don’t

be surprised if in the end you have to choose


The Impact to Small, Rural & Independent Healthcare Providers

The small, rural & independent providers will be the ones

who have the hardest financial burden to meet these

new requirements with the CAH potentially having the

shortest window of opportunity.


The Impact to Small, Rural & Independent Healthcare Providers

An additional challenge for hospitals and physicians will

be to implement system that will enable the exchange of

information among providers.

Supporting the systems after the stimulus monies stop

flowing.

Vendors will not be paying attention to the smaller

clients.


The Challenge

Creating a solution that is built on a sound, self sustaining

business model that is primarily funded by existing dollars,

reductions in costs to those who provide, fund and pay for

healthcare.


A Solution

Ohio Health Information Technology Alliance (OHITA): An

alliance of hospitals, physicians and existing regional efforts in

Ohio working together to share information technology

resources.

– Resources include but not limited to:

Technology, Hardware and Software

Health Information Data Center

IT Staff

Other Technology Purchases


H.I.T. Collaborative

Health Information

Exchange


What are the Possibilities?

This alliance will help hospitals and physicians access health information technology in a more cost effective manner to better provide patient care and employee satisfaction.

Reduce I.T. and redundant healthcare costs while simultaneously increasing I.T. efficiency.


One Integrated Platform

Community-Wide Scheduling Module (CWS)

Admissions Module (ADM)

Authorization & Referral Management (ARM) (now bundled w/CWS)

Billing / Accounts Receivable Module (BAR)

Billing / Remit to 3rd Party Option

LTC: Administrative Suite

LTC: Clinical Suite

Enterprise Medical Record (EMR)

Provider Order Management (now bundled w/ PCM)

Patient Care System (PCS)

Order Entry Module (OE)

Bedside Medication Verification (BMV) (now bundled w/PCS)

Patient Education

Operating Room Management (ORM)

Imaging & Therapeutic Services Module (ITS)


Accounts Payable Module (AP)

Fixed Assets Accounting Module (FA)

Payroll / Personnel Module (PP) (now bundled w/ HRM)

Human Resource Management (HRM)

Staffing & Scheduling Module (SS) (now bundled w/ HRM)

Materials Management Module (MM)

Internet Gateway (MIG) (now bundled w/ HRM; PCM)

Document Imaging & Archiving (SCA)

Physician Care Manager (PCM)

Medical & Practice Management Suite (MPM)

Emergency Department Management (EDM)

Patient Discharge Instructions (PDI)

Laboratory Module (LAB)

Microbiology Module (MIC)



Blood Bank Module (BBK)

Anatomical Pathology Module (PTH)

Medical Records Module (MRI) (Req'd)

Case Mix Management Option (ABS)

Quality Management (QRM)

Pharmacy Module (PHA)

Executive Support Module (ESS)

Budgeting & Forecasting Option (BF)

Cost Accounting Module (CA)

Data Repository (DR)

Behavioral Health



Potential Benefits

Alleviates the headaches of maintaining equipment and performing software updates and data backups.

All member providers collaborate in the maintenance of the central data center, eliminating the need for each site to invest in an elaborate infrastructure.

Working with existing information technology staff to provide a seamless support process.


Factors to Success

Providers share in the ownership.

The alliance needs to be an extension of each facility and provider office.

The benefit of working together with other facilities and creating a new level of collaboration. Regular local user group meeting and e-mail "list serves" will be very effective for gathering and disseminating information.


Physician Integration

In an effort to ensure physician offices are provided a potential

solution – the search for ambulatory based Practice

Management Systems and E.H.R.’s are integral part of defining

“Success”.

Each potential H.I.T. vendor that OHA is currently working with

has a physician solution available.


Additional Possibilities

Broadband Development Initiative

– Southern Ohio Health Care Network (SOHCN)

Health Information Exchange


Health Information Exchange

Of the 28 million visits to Ohio Hospitals in 2008 – the vast

majority were patients who resided in the same county in

which the hospital was located.

This prompted us to rethink the definition of a “RHIO” and

create new possibilities of what a Health Information

Exchange model could look like.


“Community Health Records”

Provider Centric – where physicians can access the health

information on their patients.

Hospitals could gain access to the same information as needed

from the patient’s physicians or other providers.


A Different Concept

One community based hospital and their area physicians can

now become their own RHIO.

All of the community, regional and other current efforts will then

be able to interact with each other. Thus protecting investments

already made.


Community Health Record

The key becomes a master patient index or pointer that will allow

the provider and the technology to know where to access the

patients information.


OHA Objective: Connected Care

Doctors/

Clinics

Hospitals

Build Communities—

Local HIE

Enable secure

sharing of clinical

information within

and between

communities

Objectives

Youngstown

Cleveland

Akron/

Canton

Wooster

Zanesville

Dayton

Cincinnati

Toledo

HH

H

H

HD/C

D/CH

HD/C

D/C

D/C

D/CH

Columbus

D/C

D/C

H

H

H

Community D/C

D/CH

H

H

D/CD/C

HH

H

D/C

H

H

H

D/C

D/C

D/C

H

Provide

physicians

the tools to

enable

efficient and

effective

quality care

33


Communitythe Basic Building Block

34


Medical HUB

Mercy

Medical

Good

Samaritan

St. Mary’s

Outpatient

Labs

Outpatient

ImagingAll Pharmacies

Memorial

Patient’s Home

Meds

Radiology

Dictation

Labs &

PathPhysician

Office

Physician

Office

Physician

Office

Meds

Radiology

Dictation

Labs &

Path

Transcription

Services

3rd Party

EMR

Meds

Radiology

Dictation

Labs &

PathCommunity

Blue=Orders & Results

Red=VIEWER

Green=Orders, Results

and Messages

35

• Electronic Master Patient Index (EMPI)

• Common Clinical Vocabulary

• Community Health Record

• Integration Engine

• Communication & Messaging

• Security & Authorization


Hospital-to-Hospital HIE Functionality

within a community

36


Mercy Medical

(Federated)

Good

Samaritan

St. Mary’s

Outpatient

Labs

Outpatient

ImagingAll Pharmacies

Memorial

Patient’s Home


Red=VIEWER

Green=Orders, Results

and Messages

Black=Requests/Responses

Meds

Radiology

Dictation

Labs &

PathPhysician

Office

Physician

Office

Physician

Office

Meds

Radiology

Dictation

Labs &

Path

Transcription

Services

3rd Party

EMR

Meds

Radiology

Dictation

Labs &

Path

Community

• Electronic Master Patient Index (EMPI)

• Common Clinical Vocabulary

• Community Health Record

• Integration Engine

• Communication & Messaging

• Security & Authorization

Medical HUBWarehouses data or

provider shares data

on request via

Federated data model

37


Community-to-CommunityHIE Functionality

38


St. Mary’s

Physician

Office

Meds

Radiolog

yDictation

Labs &

Path

Meds

Radiolog

yDictation

Labs &

Path

Alpha

Community

Physician

Office

Mercy

Memorial

Physician

Office

Meds

Radiology

Dictation

Labs &

Path

Meds

Radiology

Dictation

Labs &

Path

Beta

Community

Physician

Office

Good

Samaritan

County

General

Physician

Office

Meds

Radiology

Dictation

Labs &

Path

Meds Radiology

Dictation

Labs &

Path

Charlie

CommunityPhysicia

n Office

St. John’s


Red=VIEWER

Black=Requests/

Responses

Medical HUB

39


Hospital

Amalga Data

Warehouse

Google Patient Portal

H.I.E. and P.H.R.

Blue=Orders and Results

Green= Results and Messages

Black=Requests/Responses

Patients

Medical HUB

40


Factors to Success

Revenue collected from the H.I.T. Collaborative, Physician Practice Management Systems, EHR’s and the Health

Information Exchange implementations will fund the model.

Additionally the broad coalition of support for this statewide project will be used to apply for grants to help jump start the

projects.


OHA’s Strategy

An alliance of hospitals, physicians and existing regional

efforts in Ohio working together to share information

technology ideas and resources.

Health Information Technology (H.I.T.)

Health Information Exchange (H.I.E.)

Broad Band Access

Steering Committees to provide continued H.I.T.

direction and strategy to OHA

42


2009 Timeline

May 11th - HIT vendor presentations at OHA

May 18th – Conference call and webinar to review final vendor proposals

June 1st - Final vendor selection meeting at OHA– Discussion on HIE with larger group

June 15th – at OHA Annual Meeting (Hilton Easton), begin design and implementation strategies along with vendor agreement items

June, July & August – Hospitals interested in participating in HIT model will begin work on contracts, implementation and project planning.

June, July & August – A broader group of providers begin work on final plan for HIE & Broadband projects

September & October – The goal is to be ready for the 1st group of hospitals to begin HIT implementation


Scott Conaway, MBA

Network Administrator & HIT Project Coordinator

Ohio Hospital Association

155 E. Broad St.

Columbus, OH 43215

614-221-7614

[email protected]

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