February 17, 2011 Senate Committee on Health & Human Services 1

ARRA HITECH Act and Nevada

Senate Committee on Health & Human ServicesNevada Legislature February 17, 2011

Lynn O’Mara, MBAState HIT Coordinator

Department of Health and Human Services775.684.7593

lgomara@dhhs.nv.govhttp://dhhs.nv.gov/HIT.htm

February 17, 2011 Senate Committee on Health & Human Services 2

ARRA HITECH Act

� Health Information Technology for Economic and Clinical Health (HITECH) Act� Enacted as part of the 2009 American Recovery and Reinvestment Act

(ARRA) and authorizes approximately $36 billion in outlays over 6 years for Health Information Technology (HIT) and Health Information Exchange (HIE)

� Expands the role of states in fostering a technical architecture to facilitate HIE and adoption of electronic health record systems (EHRs) by 2014

� Purpose of HIT & HIE - Total electronic management of health information and its secure exchange among and between health care consumers, providers and payers, with the potential to:� Improve health care quality and population health� Prevent medical errors and improve patient safety� Increase the efficiency of care provision and administrative efficiencies� Reduce unnecessary health care costs

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4 Key HITECH HIT Programs

� State grants to support the planning and implementation of a statewide infrastructure that enables intra-state, interstate and nationwide HIE

� Medicaid and Medicare incentive payments to providers that use certified EHR systems in meaningful ways and participate in HIE

� Regional Extension Center (REC) grants to qualifying entities to provide technical assistance, guidance and information on best practices to support providers’ efforts to become meaningful users of EHRs

� Health IT Workforce Development Program grants for higher education programs to train EHR users to meet HITECH requirements for meaningful use

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February 17, 2011 Senate Committee on Health & Human Services 4

Health Information Technology

Statewide HIT success will be measured by how well it is implemented, and the impact it has on improving the quality, safety and efficiency of health care to Nevadans

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ARRA HITECH State HIE Cooperative Agreement Program� Administered by federal HHS Office of the National

Coordinator for HIT (ONC)� $564 million allocated for 4-year awards to states and territories for

the development and advancement of infrastructure for HIE across health care systems, providers and payers

� DHHS received IFC Contingency Fund allocation of $234,574 to pursue HIE funding; IFC-approved carry forward of approx. $165,000 as cooperative agreement funding match

� Nevada DHHS-Director’s Office awarded $6,133,426 HIE Cooperative Agreement funding: February 8, 2010 through February 7, 2014 � Fully funds Office of HIT operations, 4 staff (including mandatory State

HIT Coordinator position) and HIT Task Force� Funding Match Requirements: Non-federal Cash and/or In-Kind

� None during Planning Phase� Beginning October 2010 - $1 for each $10 federal dollars� Beginning October 2011 - $1 for each $7 federal dollars� Beginning October 2012 - $1 for each $3 federal dollars

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ARRA HITECH State HIE Cooperative Agreement Program

� Targeted funding that must support efforts to establish sustainable HIE capacity that enables intra-state, interstate and nationwide HIE through the meaningful use of federally-certified EHRs, with the goal of improving quality and efficiency of care

� Mandates coordination with state Medicaid HIT efforts� Requires coordination with other relevant ARRA and HITECH

programs� Encouraged to coordinate with health care reform programs, such

as Health Insurance/Benefits Exchange � Requires submission and approval, by both ONC and CMS, of a

State HIT Strategic and Operational Plan that meets HITECH and Cooperative Agreement requirements� Nevada’s State HIT Plan submitted to ONC on January 31, 2011, with

approval expected by late March or early April� Senate Bill 43 contains enabling language to establish the

framework necessary for HIE implementation, and seeks to align relevant state and federal laws

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Medicaid EHR Incentive Payments

� Beginning 2011and through 2015, qualifying Medicaid providers are eligible for EHR adoption and meaningful use incentive paymentshttp://www.cms.gov.EHRIncentivePrograms/� Qualifying Providers – reimbursement of up to 85% HIT

implementation, training and maintenance costs

� Qualifying Hospitals - stipulated reimbursements based on Medicaid patient load

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Medicaid EHR Incentive Payments

� Qualifying Providers� Physicians� Dentists� Certified Nurse Mid-wives� Physician Assistants in FQHCs and Rural Health Clinics� Additional requirements

� Not hospital-based, with a minimum patient volume that is 30% Medicaid recipients, or

� Not hospital-based pediatricians, with a minimum patient volume that is 20% Medicaid recipients, or

� Practice predominantly at a FQHC or Rural Health Clinic

� Qualifying Hospitals� Children’s hospitals� Acute Care Hospitals with a minimum patient volume that is 10%

Medicaid recipients

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February 17, 2011 Senate Committee on Health & Human Services 9

ARRA HITECH State HIE Cooperative Agreement Program

� 20-member HIT Blue Ribbon Task Force established September 2009, by Governor’s Executive Order� Provides feedback from a diverse group of HIE stakeholders during HIE

planning� Members appointed by the Governor� Meets under Nevada Open Meeting Law� Sunsets June 30, 2011

� Two critical human resources components for successful EHR adoption and HIE sustainability� Readiness of health care providers and their staffs to fully use EHR

systems and engage in HIE � A labor pool of trained IT and Health IT professionals to service and

maintain the necessary network systems, hardware, and software

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February 17, 2011 Senate Committee on Health & Human Services 10

State HIT Coordination with Other Key ARRA Programs� Broadband necessary for HIE connectivity and operation

� 12-member Nevada Broadband Task Force � ARRA broadband grantees – not HIT specific

� Department of Commerce� USDA

� College of Southern Nevada (CSN)� HIT Associate in Applied Science (AAS) already in place

� Fully accredited by the Commission on Accreditation for Health Informatics and Information Management Education (CAHIIM)

� Upon successful completion, graduates eligible to become certified as a Registered Health Information Technician (RHIT)

� 2 yr sub-grants under regional HITECH Community College Consortia grant for training EHR users (part of the Health IT Workforce Development Program)

� Los Rios HITECH Consortium - 14 Community Colleges in AZ, CA (lead), HI and NV� Provide ONC-defined training that supports HITECH implementation � Must recruit and enroll 150 students each year� Training began September 30, 2010, with first cohort expected to graduate Spring 2011

� Nevada’s Regional Extension Center (REC) - HealthInsight� Coordination and collaboration that includes Nevada Medicaid and CSN� HIE implementation and utilization depends on successful EHR adoption

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February 17, 2011 Senate Committee on Health & Human Services 11

Health IT Workforce

� ONC has allocated $120 million in HITECH funding for higher education programs to train and equip meaningful users of EHRs� Training and development to meet short-term HITECH programmatic

needs� Community college programs to educate the existing health care

workforce on utilization of EHRs � Research-based curricula that higher education institutions can use to

develop core instructional programs� Competency testing to evaluate trainee knowledge and skills� Additional university programs to support certificate and advanced

training programs

� Federal estimates indicate that 50,000 additional IT and Health IT professionals/workers will be needed over the next 3-5 years to implement and maintain EHR and HIE systems� 50% increase in the size of the current HIT workforce� Staff levels and HIT capabilities are one of top three concerns for EHR

adoption

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February 17, 2011 Senate Committee on Health & Human Services 12

Health IT Workforce� Challenges to Rapid Increase of Health IT Professionals

� Lack of funding� Limited faculty expertise� Limited HIT educational curriculum and resources� Declining higher education enrollments in computer science and IT

programs� Time required to build and maintain a labor pool of sufficient size and

with the necessary skills� Lack of interest by high school students to pursue the necessary post-

secondary education to qualify for Health IT positions� Labor force reductions due to Baby Boomer retirements� U.S. Department Labor Projections

� Rapid growth expected through 2016 for health care practitioners and technicians (drivers of Health IT utilization)

� Increased jobs for medical records, health information technicians and computer support specialists are expected to grow faster than the average for all occupations through 2014, as HIT investments accelerate to meet HITECH and meaningful use requirements (20% growth expected by 2018)

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February 17, 2011 Senate Committee on Health & Human Services 13

WICHE Reports on Healthcare Workforce Needs in the West

“New health IT tools such as EHRs will begin to diminish the need for medical coders, billers, and transcriptionists. Since these professionals make up the largest percentage of the total U.S. health IT graduatepopulation each year, colleges and universities will have to modify their existing degrees and begin to add new degrees to meet the future needs of the IT-enabled healthcare industry.”

• Females make up approximately 90% of students enrolled in health IT programs nationwide

• 718 health IT programs are available in the U.S., with 125 (17%) available in WICHE states

• Approximately 16% of U.S. health IT degrees are granted in WICHE states

“A Closer Look at Healthcare Workforce Needs in the West: Health Information Technology.” WICHE (www.wiche.edu). Copyright 2007. All rights reserved.

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Challenges

� Nevada’s economic situation� Lack of sufficient Broadband connectivity, particularly in

frontier and rural counties � Need to rapidly grow Health IT service businesses and

workforce� Multiple variables and unknowns� Lack of successful HIE business and financial models� Unknown impact of forthcoming federal regulations for

meaningful use and ACA programs � Federal deadlines that may be unrealistic� Unknown impact of related decisions by other federal agencies

(e.g., FCC, FTC, NIST, CDC, etc.)� Ever-evolving Technology changes, innovations and

enhancements

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HIT Glossary

� Electronic Health Record / Electronic Medical Record (EHR / EMR) – A real-time patient health record with access to evidence-based decision support tools that can 1) be used to aid clinicians in decision making; 2) automate and streamline a clinician's workflow, ensuring that all clinical information is communicated; 3) prevent delays in response that result in gaps in care; and 4) support the collection of data for billing, quality management, outcome reporting, and public health disease surveillance.

� Health Information Technology (HIT) – Information systems specific to the health care domain, i.e., the computer hardware, software and procedures and personnel designed, operated and maintained to collect, record, process, retrieve and display information.

� Health Information Exchange (HIE) – Electronic movement of health-related information between and among organizations according to nationally-recognized standards.

� Meaningful Use – Better health care does not come from the adoption of technology itself. It is accomplished through the exchange and use of health information for effective clinical decisions at the point of care.

� Personal Health Record (PHR) – An electronic application through which individuals can maintain and manage their health information (and that of others for whom they are authorized) in a private, secure, and confidential environment. Not required to be HIPAA-compliant and under the jurisdiction of the Federal Trade Commission.

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