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NC Strategy for Building HIT and HEALTH
Steve Cline, DDS, MPHHIT Coordinator, NC DHHS
June 22, 2012
NC Primary Care Conference
Asheville, NC
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Outline
• Introduction – Why HIT?
• Quick overview of HITECH grants to NC
• NC HIT Landscape
• HIT and Health Care Reform
• Q & A
Questions to Ponder
1) Why do we tolerate “low” IT in health?
2) What would it take to change that?
3) Who has to change? or Who is going to resist?
4) Will the federal plan work in NC?
5) What should we do next?
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HIT Goals
• Improved healthcare quality
• Better health outcomes– Individuals– Populations
• Control costs
• Better engage health care consumers
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The Problem
• Paper is inefficient
• Duplicate tests
• Medical errors
• Lack of information
• Too much information
• Consumer engagement
• Quality-Quality-Quality5
Waste in HealthcareSix areas account for 21% of the cost of healthcareBerwick and Hackbarth, JAMA ,April 2012
1. Failures of Care Deliver ($102-154 B)
2. Failures of Care Coordination ($25-45 B)
3. Overtreatment ($158-226 B)
4. Admin complexity ($107-389 B)
5. Pricing failures ($84-178 B)
6. Fraud and Abuse ($82-272 B)
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Federal HIT Strategy
• Office of the National Coordinator of Health Information Technology (ONC)
• Federal Stimulus Act (ARRA)
• HITECH Component = HIT
• States charged with developing solutions (no single national system)
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1. Admit we have a problem
• The nation cannot afford to keep doing business as usual in healthcare.
• HIT transformation is coming, like it or not.• Simply automating what we currently do will not
fix the problem.• The right technology already exists, it’s the
people that need to change.• We CAN do better!
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2. Must get clinical information into an electronic sharable format (EHRs)
• NC• NC AHEC• 9 Existing Regions• Existing
Relationships• Existing Quality
Initiative• $13.6 million
• FEDS• HITECH – Regional
Extension Centers
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3. Incentivize targeted providers to adopt EHRs and meaningful use (MU)• NC• NC Medicaid• Eligible providers and
hospitals• MU “bar”• $63,000 M’caid• $44,000 M’care• $500 million to
hospitals
• FEDS• HITECH – Incentive
Payments• Medicare• Medicaid
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4. Create a new standard for EHR functionality and interoperability
• NC• Private entities• Temporary
Certification• “Preferred Provider”
list• Cost to providers
• FEDS• HITECH – EHR
Certification Program
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5. Build a mechanism for sharing health information electronically
• NC• NC HWTF• NC HIE Non-profit• CEO level Board• Public-Private
Partnership• $12.9 million
• FEDS• HITECH – State
Level Health Information Exchange (HIE)
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State Strategy for Meaningful UsePriorities for HIE to enable MU
• Structured lab results reporting
• e-Prescribing
• Sharing of clinical record summaries
• Public Health reporting
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Leveraging the power of North Carolina’s health information exchange to improve patient
outcomes
+What is NC HIE? NC HIE operates North Carolina’s statewide health information
exchange, a secure, standardized electronic system where providers can share important patient health information.
NC-based: The Board of Directors are active and prominent in the North Carolina medical community and represent a variety of organizations and interests.
Independent: NC HIE is independent and is not owned by insurance companies, health care organizations, associations, employers or government.
Nonprofit: NC HIE is a private nonprofit organization. It is funded by many sources including North Carolina health care organizations and grants.
Multi-stakeholder: Involves Consumers, Providers, Payers, Business and Government.
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+How does it work?
NC HIE’s network combines information from separate health care sites to create a single virtual patient health record.
Patient health information is automatically uploaded or linked from a provider’s electronic medical record system.
The information is standardized and aggregated across care sites.
Clinicians can seamlessly access their patient’s information in NC HIE from within their EMR.
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+What is in the network?
In the NC HIE Network:
Patient Identifier and Demographics
Encounter History
Laboratory and Microbiology Results
Radiology Reports and Images
Adverse Reactions/Allergies
Medication History
Diagnosis/Conditions/Problems (primary and secondary)
Immunizations
Dictated/Transcribed Documents
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+Consent Policy
Consumers are automatically part of NC HIE if their health care provider is a participant. North Carolina law requires NC HIE follow an opt-out consent policy allowing patients the choice of not participating.
This policy was written with input from stakeholders representing patients, providers, employers, payers, and government.
Consumers may opt-out by mail using the opt-out form or by phone. In the future consumers will be able to opt-out online.
State law requires participating providers give the patient a state-approved form the first time they visit that provider location.
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Hospital Systems
NC Medicaid
Physicians and
Providers
Commercial Payers
Financing Principles
• Core System Cost Allocation
6. Make sure healthcare providers know how to use the new systems
• NC• NC Community
College System-Pitt • 13 State Region• Curriculum
Development-Duke• Distance Learning• $20.1 million
• FEDS• HITECH –
Workforce Development
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7. Make sure the network has the capacity for all these new users
• NC• MCNC • NC Research and
Education Network• “Middle mile strategy”
to connect health• $28.2 million-Phase 1• $75.8 million Phase 2
• FEDS• HITECH – Broadband
Technology Opportunities Program (BTOP)
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8. Make good use of the data(Data Analytics)
• NC• UNC, Duke, Wake,
ECU, RTI, & others• Evidenced-based
medicine• Best practices• “Learning System”• $200+ million
• FEDS• HITECH –
Comparative Effectiveness Research (CER)
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9. Make good use of the technology to improve health
• NC• NC Telehealth
Network• Rural health strategy• Community Health
Centers• $6.1 million
• FEDS• HITECH – Telehealth
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10. Children as a priority
• NC (1 of 10)• NC Medicaid-CCNC• NC Pediatric Society,
NC Academy of Family Physicians, and NC Quality Alliance
• EMR for children• $9.3 million
• FEDS• HITECH – Children’s
Health Insurance Program Reauthorization Act (CHIPRA)
• Establish a national quality system for children’s health care
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11. Learn from the leaders
• NC (1 of 17)• Southern Piedmont
Community Care Plan (CCNC)
• Existing community partnerships
• Cabarrus, Rowan, and Stanly Counties
• $15.9 million
• FEDS• HITECH – Beacon
Community Program
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12. Sustainability
• Value added proposition (ROI)
• Integral to how we do business
• Lower the cost of doing business
• Patient-centered
• Dynamic and responsive
• Improve quality
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HIT Landscape in NC• Existing HIT systems: Hospitals, RHIOs, Public Health,
Individual Provider Practices, Payers • Medicaid MMIS Replacement System: New claims
processing system, reporting and analytics
• Quality in NC: NC AHEC Quality Initiative, NC Healthcare Quality Alliance, Carolinas Center for Medical Excellence
• Community Care of NC: Informatics Center
• NC Laws: Legal framework for HIE, NC is Opt Out
• Economic Crisis: $3.5 billion “hole”
• Healthcare Reform
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Information Technology Reform IS
Health Care Reform
• ARRA/HITECH is to HIT as PPACA is to health care reform
• PPACA assumes new models of HIT are in place – can’t do it without it
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Keys to Success
• EHR Adoption
• Consumer Engagement
• Change Leadership
• Strengthen the “Trust Fabric” of health information exchange
• GOOD USE OF THE DATA!
And the Winner Is . . .
• Whoever can figure out how to take the tsunami of new health data that is heading our way and turn it into actionable health information.
• Whoever can help us move from surveillance and reaction to event prediction and prevention.
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