State of Tennessee

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State of Tennessee The Governors eHealth
Council ahdi Association for Healthcare
Documentation Integrity
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• Executive Order 35
• Governor Phil Bredesen Signed Executive Order
  35 on April 6, 2006 to establish the Governors
  eHealth Council.

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• The Council shall advise and support the State of
  Tennessee as it develops and implements an
  overall strategy for the adoption and use of the
  electronic medical records and create a plan to
  promote its use by all healthcare stakeholders.
• The Council shall identify obstacles to the
  implementation of an effective health information
  infrastructure and provide recommendations to
  remove or minimize those obstacles.
• The Council shall advise appropriate parties
  within State government on issues related to the
  development and implementation of the health
  information infrastructure.
• The Council shall use best practices in
  minimizing and eliminating redundant efforts and
  duplicative initiatives.

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eHealthCouncil Members

• CIGNA HealthCare
• Caremark Rx, Inc.
• Eastman Chemical Company
• FedEx Corporation
• SharedHealth
• CenterStone
• Dell
• Nissan North America
• HCA Healthcare
• BlueCross BlueShield of Tennessee
• Vanderbilt University Medical Center
• State of Tennessee, Bureau of TennCare
• The State RHIO organizations

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Our Focus

• To convene, facilitate and incubate regional
  stakeholders to use health information technology
  to improve the quality of care delivered by
  providing necessary information at the point of
  care.
• Patient data will be used for treatment and other
  uses as permitted by HIPAA
• Focus on Tennessees 95 counties - Urban and
  Rural
• Secondary focus on contiguous states, especially
  contiguous counties

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State of Tennessee Population
Population Aprox. 6.1 Million
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eHealth Council Framework

• Coordinating organization facilitates rules of
  engagement
• Data-sharing Agreement
• Legal Framework
• Standards
• Interoperability
• Transparency
• Value
• Quality/Cost

Common Portal
H.I.E.
EMR / EHR/PHR Implementation
Structured Notes Paper Records
Administrative Transactions (claims)
Secure Clinical Messaging (labs, imaging,
TeleHealth)
ePrescribing Roll Out
Broadband of Access, Stakeholders, Automation
Framework for Trust and Collaboration
County-by-County Implementation that Progresses
in Stages
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Goal Broadband Connectivity in 95 Counties
Source Federal Communications Commission,
http//www.universalservice.org/rhc/tools/rhcdb/Ru
ral/2005/result.asp
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Goal Broadband Connectivity in 95 Counties

• URBAN
• Practices 1,335
• Licensed M.D.s 7,302
• Primary Care/Pediatrics 3,019

• Hospitals 160
• Physician Practices 3,779
• Licensed M.D.s 15,387
• Primary Care/Pediatrics 6,992

• SEMI-RURAL
• Practices 1,362
• Licensed M.D.s 6,695
• Primary Care/Pediatrics 3,085

• RURAL
• Practices 887
• Licensed M.D.s 1,390
• Primary Care/Pediatrics 888

Sources Federal Communications Commission,
http//www.universalservice.org/rhc/tools/rhcdb/Ru
ral/2005/result.asp 2007 Tennessee Healthcare
Technology Readiness Assessment, TNHIMSS,
www.TennesseeAnytime.org/eHealth Tennessee Dept.
of Health 2007.
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FCC Designations
Rural BEDFORD
BENTON
BLEDSOE
CAMPBELL
CANNON
CARROLL
CHEATHAM
CHESTER
CLAIBORNE
CLAY
COCKE
COFFEE
CROCKETT
CUMBERLAND
DECATUR
DEKALB
DICKSON
DYER
FAYETTE
FENTRESS
Semi-rural ANDERSON
CARTER
HAWKINS
JEFFERSON
LOUDON
MADISON
MARION
MAURY
MONTGOMERY
PUTNAM
ROANE
ROBERTSON
RUTHERFORD
SEQUATCHIE
SEVIER
SHELBY
SUMNER
UNICOI
WASHINGTON
WILLIAMSON
WILSON
Urban BLOUNT
BRADLEY
DAVIDSON
HAMBLEN
HAMILTON
KNOX
SULLIVAN
FRANKLIN
GIBSON
GILES
GRAINGER
GREENE
GRUNDY
HANCOCK
HARDEMAN
HARDIN
HAYWOOD
HENDERSON
HENRY
HICKMAN
HOUSTON
HUMPHREYS
JACKSON
JOHNSON
LAKE
LAUDERDALE
LAWRENCE
LEWIS
LINCOLN
MACON
MARSHALL
MCMINN
MCNAIRY
MEIGS
MONROE
MOORE
MORGAN
OBION
OVERTON
PERRY
PICKETT
POLK
RHEA
SCOTT
SMITH
STEWART
TIPTON
TROUSDALE
UNION
VAN BUREN
WARREN
WAYNE
WEAKLEY
WHITE
Source Federal Communications Commission,
http//www.universalservice.org/rhc/tools/rhcdb/Ru
ral/2005/result.asp
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eHealth Council Framework

• Coordinating organization facilitates rules of
  engagement
• Data-sharing Agreement
• Legal Framework
• Standards
• Interoperability
• Transparency
• Value
• Quality/Cost

Common Portal
H.I.E.
EMR / EHR/PHR Implementation
Structured Notes Paper Records
Administrative Transactions (claims)
Secure Clinical Messaging (labs, imaging,
TeleHealth)
ePrescribing Roll Out
Broadband of Access, Stakeholders, Automation
Framework for Trust and Collaboration
County-by-County Implementation that Progresses
in Stages
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We have a good start

• 29 physician practices already have T-1
  connectivity

• 67 hospitals already have T-1 connectivity

Source 2007 Tennessee Healthcare Technology
Readiness Assessment, TNHIMSS, www.TennesseeAnytim
e.org/eHealth
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Connectivity Disparities from Urban to Rural
URBAN
SEMI-RURAL
RURAL
Source 2007 Tennessee Healthcare Technology
Readiness Assessment, TNHIMSS, www.TennesseeAnytim
e.org/eHealth
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Current EMR Usage
Source 2007 Tennessee Healthcare Technology
Readiness Assessment, TNHIMSS, www.TennesseeAnytim
e.org/eHealth
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EMR Disparities from Urban to Rural
URBAN
SEMI-RURAL
RURAL
Source 2007 Tennessee Healthcare Technology
Readiness Assessment, TNHIMSS, www.TennesseeAnytim
e.org/eHealth
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eHealth Council Framework

• Coordinating organization facilitates rules of
  engagement
• Data-sharing Agreement
• Legal Framework
• Standards
• Interoperability
• Transparency
• Value
• Quality/Cost

Common Portal
H.I.E.
EMR / EHR/PHR Implementation
Structured Notes Paper Records
Administrative Transactions (claims)
Secure Clinical Messaging (labs, imaging,
TeleHealth)
ePrescribing Roll Out
Broadband of Access, Stakeholders, Automation
Framework for Trust and Collaboration
County-by-County Implementation that Progresses
in Stages
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Scripts Per Capita
Tennesseans rank 3rd in the nation in
prescriptions per person in 2006
Source The Kaiser Family Foundation, 2007.
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High Prescription Drug Use Has Consequences

• Consequences of high prescription drug use
  include medication errors, adverse effects,
  accidental poisoning, antibiotic resistance, and
  prescription abuse
• Tennessees accidental poisoning rate is 26
  above the national average and cost about 593
  million in 2003
• Tennessee has some of the highest rates of
  antibiotic resistance in the nation
• Tennessee is among the top 5 states for use of
  prescription
• Hydrocodone is the number one prescribed drug in
  Tennessee, making up almost 3 of all
  prescriptions

Source The Tennessee Prescription Safety Program
of the Tennessee Medical Association 2007.
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TN Drug Snapshot BCBST Commercial
Courtesy of Dr. Bruce Taffel, Shared Health
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Current ePrescribing
Source 2007 Tennessee Healthcare Technology
Readiness Assessment, TNHIMSS, www.TennesseeAnytim
e.org/eHealth
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Why Is eHealth Important?

• 1.5 million Americans suffer from medication
  mistakes each year.
• Each year 800,000 preventable ADEs occur in
  long-term care facilities.
• 530,000 preventable ADEs occur among the general
  population.

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eHealth Council Framework

• Coordinating organization facilitates rules of
  engagement
• Data-sharing Agreement
• Legal Framework
• Standards
• Interoperability
• Transparency
• Value
• Quality/Cost

Common Portal
H.I.E.
EMR / EHR/PHR Implementation
Structured Notes Paper Records
Administrative Transactions (claims)
Secure Clinical Messaging (labs, imaging,
TeleHealth)
ePrescribing Roll Out
Broadband of Access, Stakeholders, Automation
Framework for Trust and Collaboration
County-by-County Implementation that Progresses
in Stages
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Steps

• Standards
• Formats
• Segments

Discharge Summary
Dictation
Transmission
Transcription
Data Access
Quality Assurance
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Health Reform Needed

• 1999 Institute of Medicine Report To Err is
  Human reported that 44,000-98,000 people die
  each year from medical errors
• Medical errors are the 8th leading cause of
  death. Higher than
• Motor vehicle accidents (43,000)
• Breast cancer (42,297)
• AIDS (16,516)

Source Institute of Medicine (1999). To Err is
Human Building a Safer Health System. Retrieved
May 20, 2006 from http//www.iom.edu/CMS/8089/5575
.aspx.
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But TennesseeIs No Healthier!
Tennessee Ranks 47th in Overall Health Status
Source United Health Foundation and Public
Health Association
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Existing HIEs

• Shared Health
• Statewide
• Claims based data
• Exchanging information since June 2006
• Already includes more than 2.2 million people
  (1/3 of Tennessees population)
• MidSouth eHealth Alliance
• Shelby, Tipton and Fayette counties (Memphis
  area)
• Clinical data
• Exchanging information since June 2006
• Already includes almost 1 million records
• CareSpark
• 7 counties in Upper East Tennessee and 7 counties
  in Virginia
• Expected to go live by the end of 2007
• Administrative and clinical data

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Emerging Initiatives

• TeleHealth
• 1.6 million grant to Community Health Network to
  organize, equip and maintain a TeleHealth network
  
• Up to 45 community health centers including
  federally qualified health centers
• Making specialty care available to rural and
  underserved areas
• Serving 100,000 patients
• Middle Tennessee Rural Health Information Network
• 1.6 million HRSA grant to connect 3 critical
  access hospitals and the regional tertiary
  hospital and implement EMR with information
  exchange
• Public health services
• Goal Expose medical care and medication
  dispensed in public health facilities where there
  are no payers billed
• Department of Health
• 89 County Health Departments 6 subcontracted
  counties
• 1,000,000 patient encounters per year
• Department of Mental Health
• 5 Regional Mental Health Hospitals

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Next StepsOn The Road Map

• Connectivity
• Utilize existing TNII network to extend broadband
  connectivity to physicians across the state
• Already private, secure network
• Infrastructure already exists in every county
• Makes broadband available to physicians at state
  negotiated rates
• ePrescribing
• Currently designing pilot projects for each grand
  division

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How Can I Learn More?

• www.TennesseeAnytime.org/eHealth