electronic health records and health information exchange: implications for rural hospitals rick...
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Electronic Health Records and Health Information Exchange:
Implications for Rural Hospitals
Rick SnyderVice President, Finance & Information ServicesOklahoma Hospital Association
Brian Yeaman, MDDirector, Physician InformaticsNorman Regional Health SystemGreater Oklahoma City Hospital Council
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American Recovery and Reinvestment Act of 2009 (ARRA)
• Incentive payments for meaningful use of certified Electronic Health Records
• Hospitals and Eligible Professionals
• Medicare incentives
• Medicaid incentives
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Hospital Incentive Payments
• Qualify as early as Oct 1, 2010– Range for OK PPS: ~$2 million - $8 million– Median: $3.7 million– State potential: $311 million
• Qualifying after FFY 2013 reduces amount
• CAH: Medicare share of capital + 20%
• FFY 2015: Incentives end; penalties begin
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Hospital Incentive Payments Medicaid
• Requires: 10% Medicaid inpatient volume
• CAHs can qualify – not based on costs– $500,000 to $1,200,000
• $108 million potential for OK hospitals
• State has some discretion in design
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Eligible Professionals
• Medicare incentives capped at $44,000 (plus 10% in HPSAs) OR
• Medicaid incentives capped at $63,750 (if 30% of practice is Medicaid (Peds: 20%))
• Paid over 5 years beginning Jan. 2011
• Penalties for non-adoption begin Jan. 2015
• Hospital-based professionals ineligible
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EHR Adoption Rates
• 2008 RWJF study of 2,952 hospitals
• Comprehensive EHR:1.5% of US hospitals
• Basic EHR (physician, nursing notes): 7.6%
• Rural hospitals: – 0.6% comprehensive EHR– 4.0% basic EHR
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OHA members tell us:
0 10 20 30 40 50 60 70
Begun to install?
Selected EHR?
Plan to qualify?
Yes
No
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OHA members tell us:Potential obstacles to your hospital adopting
EHR:
1. Insufficient IT staff
2. Incentive payments will likely not cover EHR costs
3. Medical Staff is not supportive
4. Cannot find a suitable EHR
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OHA members tell us: OHA can help most by…
1. Providing education on incentives
2. Providing education on EHRs
3. Offering a “group deal”
4. Helping arrange financing
5. Helping select EHR
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EHR Certification
• Certification Commission for Health Information Technology (CCHIT)
– CCHIT Certified
– Preliminary ARRA certification
– Site certification
• HHS Health IT Policy Committee recommendation
– Allow multiple Certification organizations
– Accreditation process for certifying organizations
• HHS will propose rules
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“Meaningful Use”
• HIT Policy Committee
• HIT Standards Committee
• Public input
• Policy Committee’s August 19 matrix
• Proposed rule due by December 31– 60 day comment period– Final rule: middle or end of spring 2010
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• NE Oklahoma origins
• Oklahoma City exchange
• Projects around the state
• Attractive pricing for hospitals and their physicians
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Regional Extension Centers – ARRA Section 3012
• National: HIT Research Center– Develop or recognize best practices to support and
accelerate efforts to:• Adopt, implement, and effectively utilize HIT for
– Electronic exchange and – Use of information
• Regional Extension Centers– Provide technical Assistance– Disseminate best practices and other information– Support and accelerate efforts to adopt, implement, and
utilize HIT
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Regional Extension Centers
• ARRA law:– Hospitals (public, NFP, CAH)
– Federally Qualified Health Centers
– Entities serving uninsured, medically underserved
– Individual and small group practices in primary care
• Funding opportunity:– Primary care providers in small group practices, public
hospitals & CAHs, CHCs and RHCs, other settings for the uninsured/medically underserved
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Regional Extension Centers
• OFMQ selected by stakeholders• Three waves of funding• $6.5 million potential for Oklahoma• Substantial matching required in years 3 and 4
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State Loan Program
• 5:1 federal match for loans to providers
• Administered through Medicaid agencies
• OHCA will apply; has requested state match in SFY 2011 budget
• Projected availability: October 2010
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SHIECAP
• State Health Information Exchange Cooperative Agreement Program
• Planning and Implementation grants
• State funding required– 2011 1/10– 2012 1/7– 2013 1/3
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SHIECAP
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SHIECAP: Oklahoma Health Information Exchange
• “Network of networks”
• Planning phase beginning Jan. 2010
• TBD: Governance, financing, …
• ONC approval of State plan required before implementation is funded
• OHA participating in planning; volunteers?
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OHA Trade Show – HIT vendors
• Spectron Corp – McKesson products & more – booth 320
• CPSI – booth 800
• Phoenix Health Systems – booth 111– Meditech, CPSI, others, including MedSphere
OpenVista
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Resources
• http://healthit.ahrq.gov/RuralHITtoolbox
• http://www.cchit.org/
• http://www.okoha.com/ARRA