Connecting California: The Role of State Leadership in Advancing Health Information Technology

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Connecting CaliforniaThe Role of State
Leadership in Advancing Health Information
Technology

• CCST Board and Council Meeting
• Molly Coye, MD, MPH
• Chair, CalRHIO Planning Committee
• CEO, Health Tech
• October 19, 2005

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The Vision

• If I go to see my doctor, she or he will have
  all the information needed right on the spot. I
  won't have to fill in any more forms, lab tests
  won't be repeated, and my doctor will know if
  I've been to see another doctor, or to a
  hospital, and what medicines I'm taking.

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The Vision

• If I'm taken to the hospital in an emergency,
  the nurses and doctors in the emergency
  department will be able to find out all the
  information they need to take care of me - within
  seconds.

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The Vision

• I have my own personal health record, that I
  keep at home on my computer or as a printed
  record. It has all the information I need about
  my medical history, current conditions, medicines
  I'm taking, the doctors that are caring for me,
  and education about my medical conditions.

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The Vision

• If there is a public health emergency.my
  records will be available to treat me or my
  family at any location.

The Vision Health care that is safe, of high
quality, and efficient, in an information-rich
environment that meets the needs of consumers,
patients, providers and others in Californias
communities.
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Lessons from Katrina

• There may not have been an experience that
  demonstrates, for me or the country, more
  powerfully the need for electronic health records
  ... than Katrina." Mike Leavitt, HHS Secretary

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Lessons from Katrina

• Starting yesterday (9/14), doctors in eight
  shelters for evacuees could go to the Internet to
  search prescription drug records on more than
  800,000 people from the storm-racked region.
• Washington Post

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National HIT Picture

• Federal advocacy for healthcare IT
• Secretary Leavitt a strong proponent
• Limited federal funding
• 125M proposed for health care HIT in FY 2006
• Re-structuring the market
• Establishing standards
• Harmonizing privacy and security legislation
• Safe harbor for hospital funding of physician IT
• Accrediting products as standard-compatible
• Stimulating development of models for national
  highway
• Linkage to Pay-for-Performance
• Medicare pilot
• MedPAC proposal for pay-for-use of IT
• Interoperability standards underway
• Strong White House support
• Congressional stampede

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The Baseline Is California Ready?

• Estimates, for all California consumers and
  patients
• 10 online appointment scheduling
• 20 pharmacy refills
• 40 enroll in health plan online
• 5 email with physician
• 5 pay medical bills online
• 10 customized health education
• 5 personal health record online

Source Structured inquiry of California health
care leaders, November 2004
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Is Technology Transforming California Healthcare
?

• Estimates for Infrastructure
• 10 physicians using EMR light
• 30 integrated clinical data within
  integrated delivery networks (IDNs)
• 5 integrated data plan - IDNs
• lt2 community health data shared
• lt5 telemedicine-enabled
• 10 EMR light
• 20 full EMR

Source Structured inquiry of California health
care leaders, November 2004
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The Opportunity Safety, Satisfaction and
Efficiency

• Increase access to information
• Without HIE, 30 of the time, physicians could
  not find information previously recorded in a
  paper chart
• Reduce duplicate testing
• Same drug or radiology exam ordered 11 of the
  time patients agreed to duplicate testing 50 of
  the time
• Ensure complete information
• Physicians unaware of 1 in 4 patient
  prescriptions
• Eliminate uncertainty
• On average, test results come from 5 or more
  locations problems with retrieval accounted for
  1 in 7 admissions and 1 of 5 lab tests and
  radiology exams
• Reduce data collection/transfer costs
• Cost of tracking down and obtaining information
  on the data user/originator sides range from 12
  - 28 per visit

Electronic Medical Records Getting it Right
and Going to Scale. W. Edward Hammond, III,
Ph.D. Commonwealth Fund background paper.
www.cmwf.org publication 695. January 2004.
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The Opportunity Cost and Savings
Potential benefits of EHR adoption (Assume 90
adoption over 15 years)

• Annual Cost
• National - 7.7 billion
• 6.5 billion for hospitals
• 1.2 billion for physicians
• California - 77 million (est.)

• Annual Savings
• National - 81 billion
• 77 billion improved efficiency
• 5 billion reduced medical errors
• California - 8.1 billion (est.)

Sources National estimates Rand California
estimates Extrapolation
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The Opportunity Office-Based Patient Care
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Health Technology Center

• The Vision
• Advancing the use of new technologies to make
  people healthier.

• The Mission
• To create a trusted source of expert information
  about the future of healthcare technologies.

• The Means
• A nonprofit pooled research center for delivery
  systems and health plans. Funding independent of
  technology developers and vendors.

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HealthTech Partners
Stanford Hospital and Clinics University
HealthSystem Consortium (UHC) Froedtert
Hospital Hospital Corporation of America
(HCA) Greenville Medical Center Health Alliance
of Greater Cincinnati Blue Shield of California
Foundation Lucile Packard Medical Center Chinese
Hospital Health Plan Catholic Health
Initiatives CHI) St. Alphonsus Regional Medical
Center Rockingham Memorial Salem Hospital El
Camino Hospital Banner Health System
Baylor Health Care System Bon Secours Health
System Carolinas HealthCare System Catholic
Healthcare West Centers for Medicare and Medicaid
Services (CMS) Federal Liaison CHRISTUS
Health Parkview Health Partners HealthCare System
The Queens Medical Center Veterans Health
Administration Overlake Hospital UC Davis Health
System Methodist Health System Lumetra Ascension
Health CAPH John Muir/Mt. Diablo Health System
Group Health Cooperative Kaiser Permanente
Mills-Peninsula Health Services PeaceHealth Prem
ier, Inc. Providence Health System Sutter
Health VHA Inc. WellPoint Health
Networks Texas Health Resources New 2005 SCAN
Health Plan University of Chicago Hospitals and
Health System Palomar Pomerado Health Memorial
Hermann Sandia National Laboratories
TEKES/SITRA Trillium Health Centre Stormont-Vail
HealthCare
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CalRHIOs Role

• Independent umbrella organization
• Leading a collaborative effort to
• incrementally build a statewide information
  exchange for California
• implement projects that build systems for data
  exchange, and demonstrate their feasibility and
  utility
• ensure participation by safety net providers and
  underserved populations in data exchange and IT
  investment
• build financial and business case models for
  health information exchange
• facilitate creation of common governance,
  process, technology, and other elements needed
  for regional and statewide data exchange
  organizations

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CalRHIOs Role

• encourage business, healthcare, and policy
  leaders to create private and public policy
  agendas and funding for data exchange and IT
  investment
• help organizers of local and regional data
  exchange efforts within California work toward
  common goals and share what they develop and
  learn
• ensure that Californias data exchange projects
  are consistent with national technology platforms
  and networks
• identify legislation and regulation necessary for
  statewide data sharing

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Statewide Highway for Health Information Exchange
National Health Information Network
CalRHIO
A - 3
Payers found 15
Looking for Private Ryan in CA!
B - 1
Little RHIO B Found 1
Community A
Medical Group/ MSO None
C - 2
Multi-Community RHIO C Found 2
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Geographic Coverage
Northern Sierra
CalRHIO and CAPG cover the entire state
Mendocino
Marin
Central Valley
Smart Health
Santa Cruz RHIO Santa Cruz CCN
Loma Linda Riverside
Santa Barbara
Long Beach
San Diego
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2005 Projects

• Linking hospital emergency departments across the
  state
• Defining the infrastructure necessary for
  statewide health data exchange
• Supporting enhanced safety in medication
  management
• Improving the efficiency of administrative
  functions for plans and providers
• Giving consumers more direct access to health
  information in a Personal Health Record

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CalRHIOs Future Role

• Core functions of CalRHIO
• Convene and support communications,
  problem-solving
• Resource center
• State policy analysis and development
• Representation to federal agencies
• Health care IT in 2010
• National highway for data exchange established
• Public utility or commercial models
• State and federal privacy and security
  protections
• Standards support interoperability
• Two key tasks for CalRHIO
• Statewide exchange of health data
• Statewide adoption of electronic health records
  and supporting applications by all health care
  entities

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Other States Act

• Nationwide 150 bills in state legislatures
  addressing HIT
• 13 states have introduced or passed HIT
  legislation or have Governor support through an
  Executive Order
• 40 states have one or more community-based data
  exchanges or grants for regional health
  information organizations
• 28 states have formal efforts for secure health
  care data exchange underway
• Source Health Information and Management Systems
  Society (HIMSS)

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New York

• Legislature Created Major Funding
• 1 billion over 4 years to
• Finance HIT investment in projects that will
  build a statewide infrastructure to share
  clinical information
• 1.5 billion over 3 years through fed/state
  Medicaid waiver for HIT investment
• Created HIT grant sources and other budget
  initiatives in 2005-6
• 3 million for physician HIT development
• 10 million for pay for performance (P4P)
  initiatives which will connect to HIT development
• Focus
• Regional HIE projects
• E-prescribing
• EHRs

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Tennessee

• Governor leveraging HIT to reform states
  Medicaid Program
• Gov. Phil Bredesen announced pilot to improve
  health care delivery in SW Tennessee managed by
  State in partnership with Vanderbilt University
  Medical Center
• 1 million patients in 3 counties 5 year
  demonstration pilot
• Funded by AHRQ, technology provided by Vanderbilt
  University and Accenture
• Focus
• ED linkage
• Clinical and administrative, eventually financial

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Arizona

• Governor takes lead in Call to Action Summit
• Gov. Janet Napolitano led October Summit to
  create a successful statewide electronic medical
  records system
• More than 300 representatives from the health
  care, technology and government sectors attended
• Gov. acted on recommendations from a steering
  committee she had formed to develop a roadmap for
  providing EMRs to all Arizonans by 2010
• Funding TBD

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Kentucky

• Legislation calls for statewide network
• Nation's first legislated statewide electronic
  health network.  (Took four years to pass law.)
• Universities of Kentucky and Louisville to create
  the Kentucky Health Care Infrastructure
  Authority, which would coordinate efforts such as
  conducting pilot projects and managing the
  network.
• Gov. Ernie Fletcher (R), a physician, to appoint
  members to a Kentucky e-Health Network Board,
  which would oversee the development and
  implementation of the network.
• The board to meet monthly and include health care
  providers, patient representatives and other
  stakeholders.

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Florida

• Governor creates advisory board
• Gov. Jeb Bush, May 4, 2004, created the Health
  Information Infrastructure Advisory Board.
• Established to advise the Agency for Health Care
  Administration (AHCA) which administers Florida's
  14 billion Medicaid program, licenses and
  regulates more than 32,000 health care facilities
  and 30 HMOs, and publishes health care data and
  statistics
• Funding from AHRQ Grant

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Gulf States

• Infrastructure expected to emerge post Katrina
• Example KatrinaHealth.org developed in 10 days
  available from anywhere in US
• an online service for authorized health
  professionals to gain electronic access to
  prescription medication records for evacuees from
  Hurricane Katrina
• medication and dosage information to renew
  prescriptions, prescribe new medications, and
  coordinate care

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Why Now?

• Federal leadership, pressure and pending
  legislation
• Technology makes data exchange possible,
  affordable
• California and other states are mobilizing
• Standards are under development
• State leadership

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Potential State Role in California

• Funding
• Waiver Enable Medi-Cal to pay its share of
  investments in community-wide IT infrastructure
  provide financial incentives to providers who use
  HIT add telemedicine as covered service
• Funding
• Explore use of proceeds from converted
  not-for-profits to create investment
  fund/revolving loan fund to support RHIOs
• Authorize finance authority or other entity to
  establish revolving loan fund
• Create budget line-item to fund CalRHIO
• Mandates
• Mandate that every California nursing home
  resident have an EHR with retrievable medication
  data by July 1, 2006
• Mandate that every Californian have a PHR by 2007

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Potential State Role California

• Legislation
• Researching need removal of legal barriers to
  acquisition and effective use of HIT
• Example privacy and security of personal health
  information
• Researching need legislation to create
  certification process for RHIOs
• trusted intermediaries charged with facilitating
  HIE and promoting public health
• promote consumer trust
• limit liabilities resulting from good-faith
  participation in HIE

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Are we prepared for the Big One?
How can we help?