Health Information Technology

Maryland's Approach

May 11, 2011

The MARYLANDHEALTH CARE COMMISSION

Health IT - An Essential Care Delivery Framework

State Involvement in Health IT

Leading Initiatives

Privacy and Security - Policy Development

Legislation on the Horizon

Discussion Items

The best evidence suggests:

People receive only about half the preventive care recommended

People with acute or chronic conditions receive about two-thirds of the care they need

About one-fifth to one-third of both acute and chronic care is unnecessary

Whelan, Ellen-Marie; Sekhar, Sonia, “Costly and Dangerous Treatments Weigh Down Health Care,” Center for American Progress, 2009

Why Health IT is Important

Properly implemented and widely adopted, health IT will save money and significantly improve health care quality

Annual savings from efficiency alone could average $77 billion or more per year in both inpatient and outpatient care

Largest savings come from reduced hospital stays as a result from increased safety and better scheduling and coordination, reduced nurses’ administrative time, and more efficient drug utilization

Rand Health, Research Highlights, “Health Information Technology, Can HIT Lower Costs and Improve Quality?” 2005

Health IT System Savings – Efficiency

Improves diagnostic accuracy by providing prompts, alerts, and reminders built around evidence based guidelines and real time clinical knowledge

Reduces adverse drug interactions and dosing complications, permits the primary care physicians to monitor script refills, avoid hospital utilization, and improve treatment plan adherence

“Coordinating Chronic Care Management through HIEs,” Deloitte Center for Health Solutions, 2007

Health IT Enabled Chronic Care Management

Facilitates the interaction between the provider and the patient by providing real-time knowledge about a patient between visits and reduces avoidable complications and costs from unmanaged chronic conditions

Allows a team of providers to work with the physician and patient to determine the best course of self-care management and to share information to better coordinate care, monitor outcomes, and avoid complications

“Coordinating Chronic Care Management through HIEs,” Deloitte Center for Health Solutions, 2007

Health IT Enabled Chronic Care Management (Continued)

Advance the health and wellness of Marylanders by implementing the best in the nation clinical data sharing utility that ensures consumers have access to the highest quality, most efficient, and safest care by giving providers access to the right information at the right time

The Maryland Goal

MHCC Involvement

The MHCC has a broad mandate to promote health information technology (health IT) statewide that will improve patient safety, quality of care, and administrative efficiencies

The MHCC‘s health IT initiatives supports the national strategy to implement information technology in the health care sector

By working together with consumers, payers, providers, and purchasers, the MHCC expects to achieve its mandate

Ensure that providers have greater access to secure and accurate health information when and where it is needed

Enhance public health initiatives such as biosurveillance, disease management, and emergency preparedness efforts

Balances the need for information sharing with the need for strong privacy and security policies

Information Sharing - Guiding Principles

The MHCC convened a series of multi-stakeholder groups to discuss a range of policy issues and published a number of major policy reports

The Task Force to Study Electronic Health Records

Review of the Task Force to Study Electronic Health Records 2007 Final Report Recommendations

Assessment of Privacy and Security Policies and Business Practices

Privacy and Security Solutions and Implementation Report

Service Area Health Information Exchange: A Hospital Data Sharing Community Resource Guide

Health Information Technology: An Assessment of Maryland Hospitals

Management Services Organizations: A Vision of State Designated Organizations for Physician Practices

Policy Reports Framing The Challenge

A decentralized standards-based hybrid model that supports both distributed data, personal health records, and health record banks

This approach ensures that data is held where it is created and not in a large centralized HIE repository

Allow statewide availability for the secure transfer of a defined set of clinical information between appropriate participating entities

Enable the consumer to control the flow of electronic health information

Include opt-out as the baseline consumer consent process

Principles Guiding the Future of HIE

Two multi-stakeholder groups were chosen by a panel of well-known experts on health IT to examine different models for a statewide citizen-centric exchange

Chesapeake Regional Information System for our Patients (CRISP)

Montgomery County Health Information Exchange Collaborative (MCHIE)

Key Planning Activities

State DesignationFollowing the nine-month planning project, the MHCC released a Request for Application to implement a statewide HIE

July 2009, the MHCC designated CRISP as the statewide HIE; the following month, the HSCRC agreed to fund $10M in development cost

Policy Development

The Policy Board has the authority to evaluate and recommend to the MHCC the policies that will govern the statewide HIE

Members were selected based upon their expertise, with a strong emphasis on achieving both broad stakeholder representation and a strong consumer orientation

The existence of a Policy Board that is separate from the statewide HIE assures participation by the public in both policy development

Overview

Roughly 20 policies related to privacy and security have already been identified

Policies for Development

The Sensitive Health Information policy aims to keep select PHI confidential, by definition sensitive health information is subjective and varies depending on the specifics of an individual consumer’s situation and context

In general, sensitive health information is considered to be information that carries with it unusually high risks in the event of disclosure

The state designated HIE currently does not have the capability to selectively identify or prevent the exchange of specific PHI

Sensitive Health Information Policy Development - Items of Consideration

The Policy Board recommended the MHCC adopt a policy on sensitive health information that calls for the HIE to implement key requirements on participating organizations:

Adhere to federal and state law when exchanging PHI through the statewide HIE

Participating organizations with the technical capability should allow consumers to request that sensitive information be withheld from the statewide HIE

Notify consumers and the state designated HIE of an inadvertent release of sensitive health information to the state designated HIE after a consumer requested that it be withheld

Participating organizations that are not able to withhold publishing health information deemed sensitive as part of the organization’s PHI will not upload information to the state designated HIE except in cases of point-to-point messaging

Sensitive Health Information Policy

On the HorizonHouse Bill 784

Medical Records - Health Information Exchanges

Requires MHCC to adopt regulations for the privacy and security of protected health information obtained or released through a health information exchange

Requires that an insurer that releases personal health information to providers make the information available to the state-designated exchange

Establishes liability protections under certain circumstances for an HIE and a health care provider

Key Elements of the Legislation

Questions?

The MARYLANDHEALTH CARE COMMISSION