Health IT Remarks to RHIOhio Conference

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Health IT Remarks to RHIOhio Conference
The Honorable Aneesh P. Chopra Secretary of
Technology October 2008 www.healthitcouncil.vi.v
irginia.gov
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A Strong Performance Culture Launches Ideas
Community
All Hands on Deck
Commonwealth Ideas Portal Launched September
2008

• Best State for Business (2006-8)
• Tied for Top Performing State (2005, 2008)
• 1st in Best of the Web (2008)

Source ideas.virginia.gov
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A Portfolio Management Approach to Meet Budget
Challenge
The Task at Hand
Our Purpose Elevate Performance
Program Prioritization
Program Re-Engineering
Program Financial Alternatives
Have we Explored NGF Sources? (yes/no)
Is it Run Efficiently? (cost / customer)
Does it Address a High Priority Outcome? (
eligible served)
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Virginia Driving National Health IT Strategy
Despite Fiscal Pressure
Health IT Strategy
CMS EHR Award to leverage national certification
to assist physicians
Governor Kaine signed legislation requiring
interoperability standards for state purchases
Virginia serving on a leadership team to develop
policies and guidelines
Virginia honored to host two NHIN implementation
pilot sites
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Road Map
Comprehensive Reform Agenda to Deliver on the
Promise of Health IT
I Simplifying EHR Purchases
II Establishing a Policy Framework
III Seeding Innovation
DHRM Public-Private Partnership Fulfill EO42
through innovative partnership to provide health
IT-powered services for state employees Innovati
on Grants Seed capital to demonstrate Health IT
value across Virginias communities
E-Store for EHRs Establish a public-private
partnership to simplify EHR selection for
participants in CMS Pilot for small practice
adoption goal to leverage CMS investment to
simplify purchasing decision and increase market
value of EHRs through competitive effort
Administrative Simplification A public-private
consortium to lower administrative costs,
starting with a universal eligibility
portal Standards Fulfill HB2198 requirement
that any EHRs purchased by a state agency or
grant must adhere to accepted standards for
interoperability, privacy and data exchange, and
be certified by a recognized certification body
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Simplifying EHR Purchases
CMS EHR Demonstration Turbo-Charges Small
Practice Purchases
HHS Initiatives Addressing the Small Clinic
Adoption Problem

• Purpose Drive adoption of EHRs in primary care
• Virginia one of only 12 sites awarded
• Target Small-medium PCP practices (
• Goal Attract 200 practices (100 control, 100
  study)
• Incentives Through additional Medicare
  reimbursement, participating providers will earn
  for
• Year 1 Adoption of CCHIT-certified EHR
• Year 2 Reporting of quality measures
• Year 3-5 Clinical improvements (P4P)
• Value 58,000 per physician or 290,000 per
  practice in total over five years

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Develop EHR Applications Center of Excellence in
Rural Virginia
Vision of the Future
E-Store for EHRs
Goal Establish a public-private partnership to
support multiple EHR applications in a shared
services center Problem Deliver EHR services
at low-cost in an environment that encourages
rapid best practice adoption Strategy Simplify
EHR acquisition, drive public sector adoption,
and promote rural economic development
In October, 2006, Virginia invested 150K in the
OnePartner Advanced Technology and Applications
Center, expected to employ 40 health IT jobs
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Broadband Applications
High-Speed Broadband Key Ingredient for Physician
Connectivity
Case Study
Physician Broadband Access 2007 TN Survey
Description Following merger with Centra Health,
SCH saves 48K in telco bill and secures 45
rural health funding by leveraging
MBC Virginias Tobacco Commission approves 750k
towards broadband access for rural clinics to
match 2.7M FCC grant Virginia launches
Virginia Telehealth Network to increase
services that elevate care quality through
broadband access
Only 18 of one rural Virginia hospitals medical
staff have access to high-speed broadband service
40
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Urban TN
Rural TN
Publicly-Influenced Applications
HIMSS members are encouraged to build
relationships with local governments to support
applications for Rural Health or e-Rate funds to
support provider connectivity
Represents T-1 Level Service or Above
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Administrative Simplification
Payer-Provider Collaborative to Lower Transaction
Costs
Universal Eligibility Portal
Goal Lower transaction costs associated with
verifying a patients insurance eligibility by
jointly procuring a common portal for Virginia
providers to use when interacting with Virginia
Payers Scope Allow a provider to retrieve
up-to-date eligibility information on a patient
from any participating Virginia health plan from
a single point of entry. Timeline RFI responses
due August 15th, 2008 vendor selection expected
October 29th, 2008 implementation in 2009
The VHEN Charter
Following an initial summit in Richmond with
Virginia payers and providers discussing scope
and focus for a Virginia Administrative Exchange
modeled on NEHEN, the VHEN workgroup formalized a
charter in October 2007 charter members include
9 health plans and 7 health systems including
MCV, UVA, Riverside, Anthem-Wellpoint, Aetna, and
DMAS
Source CORE Patient Identification Survey, 2006
funded, in part, by California HealthCare
Foundation
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Kaine Leads in Adopting Federal Policy on
Standards, Transparency
Standards
Accountability and Transparency Public, Private
Action
Data Interoperability Standards Public Policy
HB 2198 requires that all health records systems
purchased by the Commonwealth adhere to accepted
standards of interoperability
Governor signs Executive Order 42 calling for
standards compliance for all public health IT
procurements and improved transparency on pricing
and quality
Mental Health community established a Performance
Contract Partnership Agreement including HIE
standards with implementation by 2012
Virginias hospitals through the VHHA support
Transparency through open access to charge
information through PricePoint
A Federal Priority
President Bush signed an Executive Order
directing Federal Agencies that administer or
sponsor health insurance programs to increase
transparency in pricing and quality while
encouraging the adoption of Health IT
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How Should the Commonwealth Apply National
Standards?
Health-related Priorities Established
American Health Information Community (AHIC)
Certification Commission for Healthcare IT
(CCHIT)
Describe Health-related Scenarios

• Used in Health IT Product Certification
• Required in
• Federal Systems and Healthcare
  Contracts (Executive Order
  13410)
• Stark exceptionsand Anti- Kickback safe
  harbor

Identify Health IT Standards
Healthcare IT Standards Panel(HITSP)
Acceptance by Secretary of HHS
Recognition by Secretary of HHS
Testing and Implementation (1 year gap)
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Seeding Innovation
Evidence-Based Medicine a Key Pillar of
Innovative Programs
Finalists Award Expected Winter 2008
Health Plan IT-Related Services Virginia
Department of Human Resources

• DHRM has accepted an unsolicited proposal under
  the PPEA act to provide wrap-around services for
  the Employee Health Plan
• Many firms have proposed to lower costs for the
  Commonwealth by creating a data warehouse with
  business intelligence and a customer service
  center to help advise state employees on the
  intervention that will most likely resolve their
  problem at the lowest cost
• Goal to prevent duplicative care and minimize
  challenges felt by employees navigating the
  complex healthcare system

DHRMs comprehensive care management vision is
truly ground breaking. Once operational, it will
mark COVA as a leader among state employee
medical plans and private industry Joe
Marlowe Aon Consulting, May 2008
Proposals Available at http//www.dhrm.virginia.g
ov/rfps/ppea/ppeatoc.html
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Innovation Grants
6 of 8 Regions Home to Health IT Innovator
Selected by Experts
NOVARHIO Access to patient medical histories in
ERs comprehensive outreach campaign for a
voluntary web-based File for Life that could be
accessed by emergency responders
UVA Telemedicine initiative to identify
high-risk poor pregnant woman to minimize
pre-term labor in the Valley
Centra Nations first outpatient EHR link with
ACCs outpatient cardiac registry to benchmark
adherence to practice guidelines and measures
MedVirginia EMR adoption by free clinics with
HIE interfaces for secure messaging, Rx history,
vitals, aligned with NHIN assessment of e-Rx for
mental health providers
CareSpark Comprehensive approach to regional HIE
aligned to NHIN goals specific attention to
rural health disparities in region
CCNV Fully funded EHR implementation at all
clinic sites (15 live today) with pilot
connectivity to public health services in
Southside
Health IT Council Members
-CIO, AOL Board Member, Harvest
Foundation -SVP, Sprint Nextel Board
Chairman, Owens Minor -Chief Privacy Officer,
Revolution Health EVP,
Riverside Regional MC
Awarded August, 2008 as part of Governor Kaines
Productivity Investment Fund
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Embedding Best Practice into Daily (Outpatient)
Encounters
Evidence-Based Medicine
Case Study Delivering Better Cardiac Care
Situation Patient John Smith has a heart attack
and is cared for by Dr. Cardiologist X whose
practice is enrolled in IC3 Value Following
discharge, during a follow-up visit, Dr. X is
prompted to ask
1) Have you truly stopped smoking? 2) Are you
enrolled in a cardiac rehab program? 3) If yes,
are you taking the beta blockers, aspirin, and
clopidigrel as recommended? If not, why
not? Transition Data uploaded directly to Heart
House and clinical guidelines available
real-time Outcomes Dr. X can document Patient
Smiths performance over time and allow the Heart
House to continuously improve guidelines based on
aggregated data
Heart House
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Coda Instill a Spirit of Commonwealth
Hampton Roads Uniquely Positioned as National
Leader on HIE
Pilot Project to Lower Costs, Increase Quality,
Promote Safety for Military, VA Endorse Hampton
Roads pilot linking civilian and military/VA
health systems potential initiatives leverage
CCD reporting through PHR systems for pediatric
consultants between Portsmouth Naval and civilian
providers additional value cases to be
developed as opportunities arise
HITSP-Approved Continuity of Care Document
Demographics
Problems/Results
Procedures/Summary
Inpatient, ED, Outpatient procedures All
discharge summaries from Inpatient stays All
Operative notes All ED visit summaries Letters Pho
ne calls Encounter summaries
All inpatient, ED, outpatient visit diagnosis in
the date range requested All Lab results (chem,
hem, urinalysis, blood gases etc.) All reports
from CT Scan, Pathology/Biopsy, X-ray, MRI,
Cardiac Catheterization, EEG, ECG/EKG, PET Scan,
Pulmonary Function, Cardiac Reports and Tests
Social Security Number Name Gender Birth
time Address Phone number Next of Kin information
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