4/ 17/ 2017 1 2 Let’s S et the Tone – WHY is there the for HIE? Healt h Informat ion Exchange (HIE): � Over the last several years there have been presentations about being a data driven Impact on t he Behavioral Health and organizat ion and the need to integrate physical and behavioral health which include: � population health analytics, IDD Syst em � moving to outcome driven decisions � Pay for performance contracting � Conducting readiness reviews on your agency to be a data driven organization NC Tide Conference April 23, 2017 � The physical health side of the Medicaid space accessed federal meaningful use Tara Larson, Cansler Collaborative Resources funding. Funding that was not available to “ straight” behavioral health or IDD providers. NCHealthConnex slides are used with permission from HIEA and were � S presented at the NC Council of Community Programs December, 2016 ome behavioral health agencies began to move toward purchasing EHRs and also Conference looking at the use of analytics. IDD agencies are lagging further behind than MH/ S U agencies 3 4 Obj ect ives Let ’ s Set t he Tone � will outline the current status of HIE � Some agencies leveraging purchasing arrangement s t o implementation in NC; j oint ly purchase or buy t he analyt ics capacit y � identify business and clinical work flows � So t he t ime is here… no more of t he maybe or let ’ s wait to incorporate results of obtaining and see. information through the HIE; and � Some of you are probably overwhelmed –more CHANGE in a syst em of change. � identify agency planning and change � This is not j ust a NC challenge – t his is t he movement of management steps for successful HIE healt h care implement at ion 5 6 MU and Behavioral Healt h Meaningful Use (MU) and Behavioral Healt h � Prior t o Meaningful Use t here was t he Cert ificat ion Commission for Healt h � What happened t o Behavioral Healt h and why were t hey excluded? Informat ion Technology or CCHIT. � Self inflict ed wounds by t he Behavioral Healt h indust ry � Founded in 2004 and first Cert ificat ions in 2006 � Provider community took position that BH was different than medical � BH Vendor community (not all) followed suit and lead maj or efforts to stay � Healt hcare Informat ion Management and Syst ems Societ y (HIMSS) st art ed outside the MU discussions HIE St eering Commit t ee 2006 � Finally t he decision was made t o leave t he BH communit y out of t he MU � CCHIT event ually became Meaningful Use in 2009 when ARRA-HITECH was program creat ed � Huge mist ake t hat now comes back t o haunt t he ent ire indust ry � Focus of HITECH was t o fund EHR development around t he concept of MU t o mat ure provider syst ems so t hat HIE could become a realit y 1
4/ 17/ 2017 7 What is NC Healt hConnex? What is Health Information Exchange (HIE)? • The North Carolina General Assembly created the North Carolina Health Information � “Communication is the beginning of understanding.” Exchange Authority (NC HIEA) in 2015 to facilitate the creation of a modernized HIE to better serve North Carolina’ s health care providers and their patients. (NCGS 90-414.7). � When it comes t o healt h care not hing could be t ruer, whet her it 's provider t o provider, doct or-t o-pat ient or syst em-t o-syst em. The more a healt h care provider • Housed within the Department of Information Technology’s Government Data Analytics knows about his pat ient s, t he bet t er he underst ands t heir problems, t he bet t er he Center (GDAC). can help. Providers • A Health Information Exchange LMC/ MCO Technology partners are S AS Institute and Orion Health. (HIE) is a secure, electronic network that gives authorized • Advisory Board made up of various health care representatives will provide input . Labs & HIE health care providers the ability to Diagnost ics access and share health-related information across a statewide Hospit als information highway. Public Healt h 8 9 Goals of NC HealthConnex Pending Legislation To link all providers across the � HB 618 – Improve Healt hcare IT Syst em Efficiency state via a modernized HIE � All existing and new DHHS software systems that contain health data and requires input from providers must be fully interoperable to exchange data and interpret To put patient care at the in accordance with national standards center of all decisions to help � IRIS improve health care quality � NC-TOPPS and outcomes � A+Kids � CS RS (also is referenced in the S TOPs bill) To support Medicaid Reform in the transition from fee for � Appropriat ions Bill and Ot her possible legislat ive act ivit y service to whole patient care 10 12 Goal 1: Pending Legislation To link all providers across the state via a modernized HIE What Does the Law Mandate? � HB 618 Improve Healt hcare IT Syst ems Efficiency � All software used by providers meet national accepted standards of interopearablity of HER Law mandat es t hat by February 1, 2018, all Medicaid providers � NC IRIS t o be connect ed and submit t ing dat a t o t he HIE in order t o � NC-TOPPS cont inue t o receive payment s f or Medicaid services provided. � A+Kids � CSRS By June 1, 2018, all ot her ent it ies t hat receive st at e funds for t he provision of healt h services (i.e. St at e Healt h Plan), including LME/ MCOs, also must be connect ed. 1 1 2
4/ 17/ 2017 Goal 1: Types of HIEs in North Carolina To link all providers across the state via a modernized HIE State-wide HIEs – run by state governments or may be the state’s What Does Connected Mean? designated entity (i.e. the North Carolina Health Information Exchange Authority/ NC HealthConnex is the state -designated HIE) To meet the state’s mandate, a Medicaid provider is “connected” when Private/Proprietary HIEs – often concentrate on a single community or its clinical and demographic information pertaining to services paid for network (i.e. Mission Health Connect, CareConnect – HIEs developed by Medicaid and other State-funded health care funds are being sent to by Mission Health and Carolinas HealthCare respectively) the NC HealthConnex at least twice daily – either through a direct Regional/Community HIEs – often not for profit (i.e. Coastal Connect connection to NC HealthConnex or via a hub (i.e. a larger system with in eastern North Carolina is a good example of this type of HIE) which it participates, another regional HIE with which it participates, or an EHR vendor). Participation agreements signed with the designated entity would need to list all affiliate connections. 13 14 16 How Does the Technology Work? Barriers t o HIE Implement at ion Query – “Do you know my patient?” HIE responds with a list � Most obvious barrier is t he absolut e lack of funding for BH providers (and ot hers of patients. Hospitals Chronic Care EHR by t he way including LTC and Home Healt h) t o invest in EHRs f rom t he f ederal Registry Stored Query - level Requesting HL7 Clinical Standalone “What do you know DSM Direct Secure EHR Portal Messaging about my patient?” Pharmacy � Siloed funding for Medical and BH services – Medicaid reform changes t hat Clinical Integration Data CCDA EHR EMPI Repository � Note: This is changing rapidly so pay attention Platform HIE responds with a list Public HL7 of documents. This list CCD/A � Don’ t assume this is 4 years out, many initiatives are looking at coordination NOW Health includes a Patient EHR Orion Document Summary CCD and any � 42 CFR Part 2 – t he privacy elephant in t he room Repository documents that the HIE LME/MCOs CPs and PLEs � S ome movement by S AMHS A and CMS , but not enough yet is aware of. Providers and � Lack of desire by many providers t o share dat a – t his is t he real elephant in t he Retrieve Document Set Practices “May I have it?” room 15 17 18 Barriers t o HIE Implement at ion Barriers t o HIE Implement at ion � Lack of clear and concise dat a st andards which cause t echnical problems wit h � Market driven healt h care is not conducive t o sharing of pat ient clinical dat a t he exchange of dat a � Fundament al HIPAA concept = Pat ient owns t heir own dat a � The road map is clear and t here is NO good reason for non-compliance at t his � Not the providers point � Not t he payers � The pat ient … � Providers need t o t ake t he st eps now t o become compliant … … … ..owns their data!!! � Good news there are alternatives out there � HIEs were designed so t hat t he dat a follows t he pat ient � Vendors are going to have to step up and produce � Healt h syst ems have been sued over t his issue because t hey refuse t o share � Clear and concise standards are critical pat ient dat a bet ween delivery syst ems � HIEs must have a financially sust ainable business model � Federal funding is j ust not going to be enough 3
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