What Do Legislators Want to Know About IT? Senator Richard T. Moore, Co-Chair NCSL HITch Project www.hitchchampions.org May 31, 2007 Chicago, IL
Healthcare Landscape 1999 IOM to Er is Human noted there $1.3 milion injuries a year and nearly 100,000 deaths from medical errors alone Healthcare now represents 16% of GDP 70% of healthcare transactions are in paper today Paper administrative costs can be 20 cents on the dollar Healthcare only invests 2-3% of revenue on IT vs. 10-15% in other industries (retail, grocery)
The Value of Interoperability and Electronic Health Records January 2005 CITL Study: Standardized, encoded, electronic healthcare information exchange would: Save the US healthcare system $337B over a 10-year implementation period and $78B in each year thereafter September 2005 RAND Study: Widespread adoption and effective use of electronic medical records system (EMRs) and other health information technology improvements would: Save the US healthcare system $162B annually Potential health and safety benefits could double savings Improve quality and efficiency of the healthcare system
What is Health IT? The use of electronic technology (computers and computer programs) to store, protect, retrieve, and transfer clinical, administrative, and financial information electronically within health care settings Used in various care settings: In-patient (hospital, medical/surgical, long-term care, etc.) Out-patient (ambulatory, specialty (e.g., pediatric, cardiac, mental health)) Examples: Electronic Health/Medical Records, Personal Health Records, (PHRs), Computerized Physician Order Entry Systems (CPOE), Computerized Decision Support Systems (CDSS), Computerized Electronic Alert Systems (e.g., drug interactions), Medical Devices, Handheld Computers, Imaging, etc., Financial/Billing/Administrative Systems, Electronic Communications with Patients, On-line data sources for Patients
What is Driving Action? Quality Patient Safety Medication Errors Efficiency Administrative Costs Accountability facilitating improved reporting of outcomes Bio-preparedness Disaster Management
HIT Landscape: Everybody Getting Involved Bush Administration FY 2006 Budget Request $125M proposed for utilizing technology to improve healthcare $75M for ONCHIT; $50M for year 3 of AHRQ grants Fully funded by the House; Senate funding at $95.2M (76%) Executive Branch Changes Secretary Leavitt takes reins of AHIC ONCHIT office transitions Congressional Action Non-partisan issue, therefore champions reaching across party lines 15 bills offered House 2st Century Healthcare Caucus and Senate HIT Caucus States Activity in most states Not waiting for federal government guidance State Alliance for e-health
State Initiatives States have demonstrated a range of preferences and approaches when integrating health IT (HIT) activities in their policy agendas In 2007, 41 states have over 150 HIT bills pending (as of 4/12/07) During 2006, at least 29 state legislatures introduced or passed legislation related to the use of HIT. The next few years promise to be particularly important in the development of state-level elements in HIT States are looking to HIT to improve quality and safety in the health system and the efficiency and effectiveness of their own health-related operations. They also are an important part of nationwide HIT strategies
HIT Start-Up and Planning State legislatures have directed agencies to conduct studies and funded new projects to explore how the state can lead in this area. In addition to HIT planning, legislators in some states have considered measures that set and enforce HIT standards, use HIT to enable markets, and include HIT as a central feature of comprehensive health reform Start-up Funding at least 17 state governments are funding programs to examine how HIT may be used or implemented. Examples include: AZ, DE, FL, HI, IA, KS, KY, LA, ME, MI, MN, NH, NM, NY, OH (Medicaid only), and WV Building infrastructure At least 10 states are facilitating a statewide regional health information organization (RHIO) through a committee or agency. Examples include: AK, CA, DE, FL, IA, KY, ME, MI, RI and WV
HIT Start-Up and Planning Studies Some states have initiated planning projects such as an examination of the cost / benefit of electronic medical records (EMRs) or a Health IT and infrastructure advisory committee, but have not taken legislative action. Examples include AZ, MD, MN, VA, WI, and WY In 2004, groups in 38 states received grants from the Agency for Healthcare Research and Quality (AHRQ) for planning and implementing projects that demonstrate the value of HIT in terms of patient safety and quality of care.
Accelerating Policy Interest Two Examples: Electronic Health Records / Electronic Medical Records www.ncsl.org/programs/health/forum/07ehrchart.htm Health Information Exchange / Health Information Organizations www.ncsl.org/programs/health/forum/hitch/hitch_planning.htm Issues of Privacy and Security Waiting for Washington?
High Interest Varied Contexts 27 states with HER/EMR bills pending as of 2/26/2007 MA RI CT NJ DE MD EHR/EMR Specifically 9 HIT Bill 10 Comprehensive Reform Bill PLUS 5 Other 3 NA
Elements of HIE Legislation in FL, IL, IN, TX, and VT Definition of entity Establish, authorize or incorporate Lead state agency Stakeholder roles Regulatory responsibility Standards Privacy/security Integration with public programs Public health State health agencies Medicaid Providers to uninsured Funding Authority or charge to collect fees and generate revenue
Pending State Legislation on HIE State vision and planning for HIT Initial planning group (NV) Scope varies Pilot projects (MN) Create state-level exchanges (TN, TX) Support regional activity (NM) Pursue interstate exchange (CO) Funding Dedicated revenue (MD) Authorize fees and charges (IL, TX, VT) Bonding (ME) Revolving loan/funds (CT) Special Models Health record bank (WA) Federated model (IL) Portal for public data use
Privacy and Security Concerns for HIT Concerns over appropriate use Secondary uses National security, research and public health Quality information for consumers and purchasers Data quality issues Concerns over inappropriate use Commercial misuses of data Deny insurance coverage, employment Disclosure in specific area MH, HIV/AIDS, reproductive Security breaches Specific stakeholder concerns Individuals: Privacy, stigmatization Providers: Medical malpractice and HIPAA liability, competition Insurers: Right to access information, HIPAA liability Emerging debate over data ownership
HIPAA HIPAA Privacy Rule Health plans, health care clearinghouses, health care providers who conduct certain health care transactions electronically Not individuals seeking health insurance in the individual market Entities must implement standards to protect and guard against the misuse of personal health information Penalties for noncompliance Differing interpretations of HIPAA HIPAA not specifically written for HIT environment State laws may not address proposed electronic exchange of health information Misunderstanding or misinterpreting HIPAA has become barrier to HIE HIPAA floor: States may adopt more protective policies or practices Other laws govern health information exchange and privacy (e.g. CLIA, SSA, FOIA, ADA; state laws on parental notification, diseasespecific privacy and non-disclosure, etc.)
State Privacy and Security Solutions HISPC and other national efforts moving states toward uniformity addressing the following areas: Securing sensitive information within an electronic medical record Added protections for certain info (Mental health, Genetic) Security issues and standards for electronic transmission of data Encryption and other technologies to protect information privacy Informed consent Implicit or explicit; Multiple consent types and documents; Time limited NY: (Opt-in) Professional Medical Conduct ( NY CRR29.1). Need (oral/written/ express/implied) consent unless authorized/required by law to disclose FL: (Opt-out) 395.3025(4), F.S., Patient consent is not required for the exchange of health information for treatment purposes.
State Privacy and Security Solutions Areas for state action regarding HISPC, March 2007 Facilitate electronic patient consent Address electronic signatures Address emergency care when no one is available to consent Create penalties for medical identity theft Distribution of liability among HIPAA covered entities Analyze and adopt effective standards
HIT Financing Many states are considering changes in the payment system because providers now bear most of the cost for HIT, whereas the benefit is shared with many other groups. At least three states are addressing this misalignment of incentives by investigating the feasibility of tax incentives to encourage providers to invest in HIT. Examples include KY, CA, and ME. 17 states are providing funds for HIT and HIE through a state grant or contract program (EHI, 2006)
HIT in State Medicaid Programs States often have large legacy systems that manage administrative data in their Medicaid programs. While these systems may have the potential to be platforms for data exchange, their sunk costs and structures are just as likely to be obstacles. Some states are updating their Medicaid HIT systems so as to integrate financial and program management with patient care. OH is an example. In many states, the organization, committee, or agency facilitating HIE includes a representative from the state Medicaid agency among other stakeholders. Examples of states that have proposed or enacted this includes AK, CA, FL, IA, KY and SC.
HIT and Transparency Health data centers collect, compile, analyze, disseminate, and otherwise use health-related data. Such centers make the results of special health surveys, health care research, and health care evaluations available for the public. In FL and MA, for example, a state agency is given the responsibility of setting up this center. States are providing consumers with the means to compare health care services, such as pharmaceuticals, physicians, health care facilities, and health plans, by making health care quality measures and financial data publicly available online. Examples include CA, FL and MA. A growing number of states are publishing data on hospital acquired infection (HAI) rates and adverse events on the websites of state agencies, in order to make this information available to providers, purchasers and the public.
Project HITch NCSL focus for HIT Top NCSL and State Leaders HITch Public-Private Partners 12 partners 25 legislators and legislative staff Exploring state legislative interest/action in HIT Activities: Technical assistance to states Network to share information Informational sessions for legislative leaders Platform for states in national activities (State Alliance for e-health) Special projects: e.g., state-level RHIOs with AHIMA www.hitchampions.org