Statewide HIE in Texas. Tony Gilman, CEO Texas Health Services Authority October 21, 2010 Rural Hospital IT Conference

Transcription

1 Statewide HIE in Texas Tony Gilman, CEO Texas Health Services Authority October 21, 2010 Rural Hospital IT Conference

2 Presentation Overview Texas Health Services Authority Health Information Technology Background Statewide HIE Cooperative Agreement Program Purpose/Federal Funding Short-term and Long-term Goals Approach to Statewide HIE Timeline Budget Collaboration with Other Federal HIT Programs 2

3 THSA Organizational Background The Texas Legislature created the Texas Health Services Authority (THSA) in 2007 through House Bill The THSA is a public-private partnership, legally structured as a nonprofit corporation, to promote and coordinate the development of electronic health information exchange (HIE) in Texas. A 13-member Board of Directors appointed by the Governor with the advice and consent of the Texas Senate governs the THSA. 3

4 THSA Mission and Vision Mission The Texas Health Services Authority will promote and coordinate the development of a seamless electronic health information infrastructure to improve the quality, safety, and efficiency of the Texas health care sector while protecting individual privacy. Vision To enhance health care quality and effectiveness for all patients, the health care sector should be supported by an infrastructure made up of interoperable, electronic health records composed of standardized, structured data elements that are exchanged among authorized health care organizations and providers across secure regional and statewide networks. 4

5 Health Information Technology Background HIT is the use of information and communication technology in health care. HIT can include: electronic health records personal health records communication clinical alerts and reminders computerized decision support systems hand held devices other technologies that store, protect, retrieve and transfer clinical, administrative, and financial information electronically within a health care setting 5

6 Health Information Technology Background Electronic Health Record (EHR) An electronic record of health-related information on an individual that can be created, gathered, managed, and consulted by authorized clinicians and staff. Health Information Exchange (HIE) The electronic movement of health-related information among organizations according to nationally recognized standards. Regional Health Information Organization (RHIO) A health information organization that brings together health care stakeholders within a defined geographic area and governs HIE among them for the purpose of improving health and care in that community. 6

7 State HIE Cooperative Agreement Program Funding authority from the American Recovery and Reinvestment Act for planning and implementation grants to states to facilitate and expand HIE In March 2010, the Office of the National Coordinator (ONC) for HIT awarded the Health and Human Services Commission (HHSC) $28.8 million over four years for the Texas Statewide HIE Cooperative Agreement Program. Implementation is being coordinated between HHSC and the THSA. 7

8 Short-term Goal Develop State HIE Plan Of the $28.8 million awarded to Texas, the state used $1 million to develop strategic and operational plans with Texas health care stakeholders to enable statewide HIE. The strategic and operational plans were submitted to ONC on September 10. Access to the remaining funding - $27.8 million - is contingent upon ONC s approval of these plans. 8

9 Short-term Goal Federal EHR Incentive Program Incentives through Medicare and Medicaid for eligible providers and hospitals to encourage the adoption and use of EHRs privately and securely to achieve improvements in care delivery. Providers must make meaningful use of EHRs by exchanging clinical health data across secure networks to qualify for incentives. Texas providers and hospitals are eligible to receive billions in meaningful use incentive payments over the next decade. 9

10 Long-Term Goal Quality, Safety, and Efficiency Ensure providers have the right information at the right time Better care Reduce duplicative tests Avoid adverse drug events Improve quality by increasing provider access to up-to-date clinical research and new clinical guidelines to use when making medical decisions. Increase patient access to health information and empower patients to better manage their personal care. 10

11 Future HIE Vision Medicaid HIE System Development (MEHIS) State-Level HIT and HIE Planning and Development in Texas State-level HIE State HIE System Planning (THSA) s itie c tiv A t n re u C Medicaid HIE Local HIE No Local HIE Local HIE Other State- Level Data Sources EHR EHR EHR EHR EHR Medicaid EHR Incentive Program Provider Provider Provider Provider Provider Provider Provider Provider Provider Provider HIT Regional Extension Centers Medicaid HIE System Operations (MEHIS) State-level HIE State HIE System Operations (THSA) n io is V re tu u F Medicaid HIE Local HIE Local HIE Other State- Level Data Sources EHR EHR EHR EHR EHR EHR EHR EHR EHR EHR Medicaid EHR Incentive Program Provider Provider Provider Provider Provider Provider Provider Provider Provider Provider HIT Regional Extension Centers Abbreviations: EHR Electronic Health Record; HIE Health Information Exchange; MEHIS Medicaid Eligibility and Health Information System; THSA Texas Health Services Authority [rev ] 11

12 Approach to Statewide HIE Goal Enable improvements in the quality and efficiency of the Texas health care sector by establishing HIE infrastructure for the state. Objective Deliver private, secure, and reliable HIE services to all Texas patients and providers through local HIE networks where the capacity exists and through contracts administered from the state level where it does not. Strategies 1.General state-level operations 2.Local HIE grant program 3.White-space coverage 12

13 Strategy 1: General State-Level Operations 1. Administer governance structure 2. Identify core HIE services 3. Establish and maintain required policies and standards for local/regional HIEs 1. Develop state-level shared services 1. Develop and administer statewide evaluation plan to inform sustainability planning. 13

14 Strategy 2: Local HIE Grant Program 1. Identify minimum criteria for applying/candidate local HIEs 2. Develop RFA for local HIE grant program 3. Accept and evaluation applications from local HIEs 4. Award grants to qualifying local HIEs 14

15 Texas HIEs 25 HIEs identified in HIE survey. HIEs are present in more than half of the state s counties and all but four of the state s healthcare referral region s urban centers. Stages of Development and color key: 1 at stage 7 4 at stage 6 3 at stage 4 9 at stage 3 6 at stage 1 15

16 HIEs in the State of Texas Texas White Space can be defined using the Healthcare Referral Regions (HRR) identified by the Dartmouth Atlas. Regions lacking HIE coverage are Lubbock, Odessa, Wichita Falls, and San Angelo. Other HRRs are covered by HIEs in the earliest stage (1) of development including Longview, Tyler, and Waco. 16

17 HIEs by Stage of Development As part of the 2010 HIE Environmental Scan, HIEs were asked to define their stage of development based on the ehealth Initiative's stages of development. Stage 7- Demonstration of expansion of organization to encompass a broader coalition of stakeholders than present in the initial operational model. One in Texas Stage 6- Fully operational health information organization; transmitting. data that is being used by healthcare stakeholders and have a sustainable business model. Four in Texas Stage 4- Well under way with implementation technical, financial and legal. Three in Texas. Stage 3- Transferring vision, goals and objectives to tactics and business plan; defining your needs and requirements; securing funding. Nine in Texas. Stage 1- Recognition of the need for health information exchange among multiple stakeholders in your state, region or community. Six in Texas. 17

18 Strategy 3: White-Space Coverage 1. Develop RFP to provide HIE services for areas not served by a local HIE. 2. Accept and evaluate proposals 3. Execute contract(s) with respondents to establish full HIE coverage of white-space 4. Monitor contracts to ensure delivery of core HIE services and adherence to required policies and standards for local HIEs 5. Monitor and evaluate impact to inform sustainability planning 18

19 Timeline: Update THSA Governance Bylaws Develop and Distribute RFA for Local HIE Grant Program and RFP for the White Space Develop Required Policies and Standards for Local HIEs Establish Interoperability and Other Technical Standards 2011 Award Local HIE Grants for Planning and Development Evaluate Proposals and Execute White-Space Contract(s) 2012 Develop, Implement, and Operate Shared State-Level Services Local HIEs Fully Operational White-Space HIE Fully Operational 2013 Evaluation of HIE Operations Sustainability Dialogue and Development of Sustainability Model Transition to Sustainability 19

20 Budget General State-Level Operations Local HIE Grant Program Proportional Base White-Space Strategy* Total $6.3 million $18 million $1.5 million $2 million $27.8 million *It is anticipated that some of the proportional funding under the Local HIE Grant Program will be dedicated to the White-Space Strategy if the local HIEs do not claim all providers and hospitals. 20

21 Texas Integration Strategy TEXAS HEALTH SERVICES AUTHORITY (THSA) Data elements HIE Standards Security/Privacy Policies State-Level HIE Services Record locator services White space coverage HEALTH & HUMAN SERVICES (HHSC) REGIONAL EXTENSION CENTERS (RECs) Medicaid data (Covers all of Texas) Regulatory issues Patients Technical Consulting Population health Providers Vendor selection e-health Meaningful Use Provider interface HEALTH INFORMATION EXCHANGE (HIE) Coalitions Vendors Community Records Medicaid HIE Provider support Workforce Development/Research Programs 21

22 Contact Information Tony Gilman Chief Executive Officer Texas Health Services Authority