OHA s Technology Strategic Initiative

OHA s Technology Strategic Initiative CSOHIMSS 2009 Slide 0 May 8 th, 2009

OHA s Technology Strategic Initiative Scott Conaway May 8, 2009 PACCAR Education Medical Center Chillicothe, Ohio CSOHIMSS 2009 Slide 1 May 8 th, 2009

CSOHIMSS 2009 Slide 2 May 8 th, 2009 New England Journal of Medicine March 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 providerorder entry for medications Teaching and Larger hospitals were more likely to have implemented an EHR.

CSOHIMSS 2009 Slide 3 May 8 th, 2009 Health Information Technology One of the Greatest Changes and Challenges in Healthcare Facing Small, Rural and Independent Healthcare Providers

CSOHIMSS 2009 Slide 4 May 8 th, 2009 OHA s Strategic Directions 2009-2012

CSOHIMSS 2009 Slide 5 May 8 th, 2009 Technology Statement of Intent Ohio hospitals promote the use of technology to increase efficiency, improve care and enhance access to information.

CSOHIMSS 2009 Slide 6 May 8 th, 2009 Technology Initiative HOSPITAL LEADERSHIP: OHA is positioned as a leader in data, information and technology in order to maintain hospital control and influence.

CSOHIMSS 2009 Slide 7 May 8 th, 2009 Technology Initiative STANDARDIZATION: Ohio hospitals proactively achieve standardization of health care information and data exchange.

CSOHIMSS 2009 Slide 8 May 8 th, 2009 Technology Initiative DATA EXCHANGE: There is a comprehensive statewide information technology exchange that allows interaction and data sharing among providers.

CSOHIMSS 2009 Slide 9 May 8 th, 2009 Technology Initiative COLLABORATIONS: Ohio hospitals participate in technology-based collaborations designed to increase efficiency, increase affordability and decrease duplication.

CSOHIMSS 2009 Slide 10 May 8 th, 2009 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.

CSOHIMSS 2009 Slide 11 May 8 th, 2009 American Recovery & Reinvestment Act 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.

CSOHIMSS 2009 Slide 12 May 8 th, 2009 American Recovery & Reinvestment Act 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

American Recovery & Reinvestment Act 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 CSOHIMSS 2009 Slide 13 May 8 th, 2009

American Recovery & Reinvestment Act 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 CSOHIMSS 2009 Slide 14 May 8 th, 2009

American Recovery & Reinvestment Act 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 CSOHIMSS 2009 Slide 15 May 8 th, 2009

CSOHIMSS 2009 Slide 16 May 8 th, 2009 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 CSOHIMSS 2009 Slide 17 May 8 th, 2009 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.

CSOHIMSS 2009 Slide 18 May 8 th, 2009 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 CSOHIMSS 2009 Slide 19 May 8 th, 2009

CSOHIMSS 2009 Slide 20 May 8 th, 2009 H.I.T. Collaborative Health Information Exchange

CSOHIMSS 2009 Slide 21 May 8 th, 2009 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.

CSOHIMSS 2009 Slide 22 May 8 th, 2009 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)

CSOHIMSS 2009 Slide 23 May 8 th, 2009 One Integrated Platform 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)

CSOHIMSS 2009 Slide 24 May 8 th, 2009 One Integrated Platform 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

CSOHIMSS 2009 Slide 25 May 8 th, 2009 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.

CSOHIMSS 2009 Slide 26 May 8 th, 2009 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.

CSOHIMSS 2009 Slide 27 May 8 th, 2009 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.

CSOHIMSS 2009 Slide 28 May 8 th, 2009 Additional Possibilities Broadband Development Initiative Southern Ohio Health Care Network (SOHCN) Health Information Exchange

CSOHIMSS 2009 Slide 29 May 8 th, 2009 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.

CSOHIMSS 2009 Slide 30 May 8 th, 2009 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.

CSOHIMSS 2009 Slide 31 May 8 th, 2009 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.

CSOHIMSS 2009 Slide 32 May 8 th, 2009 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.

CSOHIMSS 2009 Slide 33 May 8 th, 2009 OHA Objective: Connected Care D/C H Community Doctors/ Clinics Hospitals Objectives Build Communities Local HIE D/C D/C H Dayton H H H Toledo D/C H D/C H D/C H D/C Columbus H Wooster H D/C H H D/C H Cleveland H D/C H D/C D/C Akron/ Canton H H Zanesville H D/C D/C H H Youngstown Provide physicians the tools to enable efficient and effective quality care Enable secure sharing of clinical information within and between communities D/C Cincinnati H D/C 33

CSOHIMSS 2009 Slide 34 May 8 th, 2009 Community the Basic Building Block 34

CSOHIMSS 2009 Slide 35 May 8 th, 2009 Community Labs & Path Dictation Radiology Good Samaritan St. Mary s Physician Office Meds Patient s Home Mercy Medical Memorial Medical HUB Electronic Master Patient Index (EMPI) Common Clinical Vocabulary Community Health Record Integration Engine Communication & Messaging Security & Authorization Meds Radiology 3 rd Party EMR Meds Physician Office Dictation Labs & Path Outpatient Labs Outpatient Imaging All Pharmacies Transcription Services Physician Office Radiology Dictation Labs & Path 35 Blue=Orders & Results Red=VIEWER Green=Orders, Results and Messages

CSOHIMSS 2009 Slide 36 May 8 th, 2009 Hospital-to-Hospital HIE Functionality within a community 36

CSOHIMSS 2009 Slide 37 May 8 th, 2009 Community Dictation Radiology Good Samaritan St. Mary s Physician Office Meds Patient s Home Mercy Medical (Federated) Memorial Medical HUB Warehouses data or provider shares data on request via Federated data model Electronic Labs Master & Patient Index (EMPI) Common Clinical Path Vocabulary Community Health Record Integration Engine Communication & Messaging Security & Authorization Meds Radiology 3 rd Party EMR Meds Physician Office Dictation Labs & Path Outpatient Labs Outpatient Imaging All Pharmacies Transcription Services Physician Office Radiology Dictation Labs & Path 37 Blue=Orders & Results Red=VIEWER Green=Orders, Results and Messages Black=Requests/Responses

CSOHIMSS 2009 Slide 38 May 8 th, 2009 Community-to-Community HIE Functionality 38

CSOHIMSS 2009 Slide 39 May 8 th, 2009 Meds Radiolog y Dictation Labs & Path St. Mary s Physician Office Alpha Community Medical HUB Mercy Physician Office Meds Radiolog y Dictation Labs & Path Meds Radiology Dictation Labs & Path Memorial Physician Office Beta Community Good Samaritan Physician Office Meds Radiology Dictation Labs & Path Labs & Path Dictation Meds Radiology County General Physicia n Office St. John s Charlie Community Physician Office Labs & Path Dictation Meds Radiology Blue=Orders & Results Red=VIEWER Black=Requests/ Responses 39

CSOHIMSS 2009 Slide 40 May 8 th, 2009 H.I.E. and P.H.R. Amalga Data Warehouse Patients Hospital Google Patient Portal Medical HUB Blue=Orders and Results Green= Results and Messages Black=Requests/Responses 40

CSOHIMSS 2009 Slide 41 May 8 th, 2009 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 CSOHIMSS 2009 Slide 42 May 8 th, 2009 42

CSOHIMSS 2009 Slide 43 May 8 th, 2009 2009 Timeline May 11 th - HIT vendor presentations at OHA May 18 th Conference call and webinar to review final vendor proposals June 1 st - Final vendor selection meeting at OHA Discussion on HIE with larger group June 15 th 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 1 st 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 scottc@ohanet.org CSOHIMSS 2009 Slide 44 May 8 th, 2009