Kentucky Health Information Exchange

(KHIE)

Kentucky e-HealthHistorical Overview

• March 8, 2005– Legislation (Senate Bill 2) to create a

secure interoperable statewide electronic health network• Kentucky eHealth Network Board (KeHN)• Health care Infrastructure Authority

– University of Kentucky– University of Louisville– Supported by the Cabinet for Health & Family

Services

• Appointment of several committees– Health Information Exchange

Kentucky Health Information ExchangeThe Beginning

2007 Medicaid Transformation Grant ($4.9M)

Allowed development of core functionality ofThe Kentucky Health Information Exchange

(KHIE)

6 Pilot Hospitals and 1 Clinic signed the KHIE Participation Agreement

KHIE pilot went live online April 1, 2010

KHIE and ARRA

2009 - American Recovery & Reinvestment Act (ARRA)

to provide State Grants to Promote Health Information Technology

to improve the quality and efficiency of health care

and expand the secure, electronic movement and use of health information among organizations

according to nationally recognized standards

Governor’s Office of Electronic Health Information

GOEHI Overview

In August 2009, Governor Steve Beshear named the Cabinet for Health and Family Services

as the state entity responsible for the administration of Kentucky’s Health Information Exchange (KHIE)

and issued an Executive Order to create GOEHI

Charged with providing leadershipfor statewide health information technology

ARRA Funding

State HIE Cooperative Agreement

•Strategic & Operational Plan submitted August 27, 2010

•ONC must approve plan before operational funds will be made available

•Kentucky expected to receive $9.75M

KHIE GOAL

Provide HIE Connectivity

to as many providers as possible

over the next year or so

with little or no startup cost to the providers

KHIE – The Stakeholders

• KHIE Coordinating Council– 23 Members on the Council

• 6 Committees reporting to the Council(Six to ten members serve on each committee)

– Accountability & Transparency– Business Development & Finance– Interoperability & Standards Development– Provider Adoption & Meaningful Use– Privacy & Security– Population Health

CHFS Administrative Order in February 2010

Kentucky Environmental Scan

• Laboratory - 60% Labs operating can deliver reports electronically

43% Providers receiving reports electronically

• Pharmacy – 85% Pharmacies capable of receiving e-Prescribing

16% Providers actually e-Prescribing

• Nationally < 4% Providers fully utilizing EMR Systems

Key Findings

Identifying ‘challenges’ (and resolutions)!!

• Many vendors/EMR systems not ready to process CCD(Continuity of Care Document – Standard of patient data transfer)

• Cost of EMR upgrades to hospitals & physician practices

• Disruption of practice for EMR implementation

• Getting Participant Agreements signed with KHIE

Current Work & Progress(!)

ACS and Axolotl in Partnership for KHIE Connectivity

Four Additional Hospitals and Two FQHC Clinics being added

Outreach and Informational Sessions:

• Four Regional KHA meetings in September & October• KPCA Annual Meeting October 18• Regional AHIMA Meetings October 22nd & November 5th • Five CME Meetings with KY REC• KHA/KMA e-Health conference November 17• One-on-One meetings at Provider Locations

KHIE & RHIO’s

• KHIE is working closely with all RHIO’s in Kentucky including HealthBridge, the Northeast KY RHIO and LouHIE

• KHIE and HealthBridge have a signed MOU to connect Health Bridge to the KHIE

KHIE and REC Coordination

2 Regional Extension CentersFor Provider EMR Adoption, Implementation,

And Connectivity

University of Kentuckyand

HealthBridge

Kentucky Regional Extension Centers

Source: Kentucky Hospital Association, 2010

Bath

Boone

Boyd

Bracken

Campbell

Carter

Elliott

Fleming

Gallatin

Grant

Greenup

Kenton

Lawrence

Lewis

Magoffin

Mason

Menifee

Montgomery

Morgan

Nicholas

Pendleton

Powell

Robertson

Rowan

Wolfe

Bourbon

Boyle

Clark

Fayette

Franklin

Garrard

Harrison

Jessamine

Madison

Mercer

Owen

Scott

Woo

dfo

rd

Breckinridge

Bullitt

Carroll

Grayson

Hardin

Henry

Jefferson

LarueMarion

Meade

Nelson

Oldham

Shelby

Spencer

Trimble

Washington

Adair

Allen

Anderson

Ballard

Barren

Bell

Breathitt

Butler

Caldwell

Calloway

Carlisle

Casey

Christian

Clay

Clinton

Crittenden

Cumber

land

Daviess

Edmonson

Estill

Floyd

Fulton

Graves

Green

Hancock

Harlan

Hart

Henderson

Hickman

Hopkins

Jackson

Johnson

Knott

Knox

Laurel

Lee

Leslie

Letcher

Lincoln

Livingston

Logan

Lyon

Marshall

Martin

Mccracken

Mccreary

Mclean

Metcalfe

Monroe

Muhlenberg

Ohio

Owsley

Perry

Pike

Pulaski

Rockcastle

Russell

Simpson

Taylor

Todd

Trigg

Union

Warren

Wayne

Webster

Whitley

Healthbridge Tri-State REC

UK & Healthbridge

UK, UL & Kentucky REC

University of Kentucky REC

KHIE and CHFS Cabinet Resources

• KHIE is the resource for Cabinet data– 2 years of Medicaid Claims Data currently available in

production with nightly data load updates

• State Laboratory Results– Newborn Screenings– All other legally available state lab tests available– Currently in testing mode with the two lab vendors

• Immunization Registry – In production in pilot stage– Currently in design phase to connect the Immunization Registry

to the KHIE

• Future interfaces with Public Health planned

KHIE Rollout

• Continue to add hospitals in groups of 4-5• Two methods to submit

– Using CCD (Continuity of Care Document)– Using Edge Server allowing access to the

Virtual Health Record• Provide server to providers that choose

the Edge Server method• Working with EHR Vendors statewide to

get interfaces built

Medicaid Incentive Program Physicians

• Medicaid - Physicians whose caseloads include at least 30% Medicaid patients are eligible to receive up to $63,750 over the course of 6 years.

MedicareEligible if not hospital-based:• Doctor of Medicine or Osteopathy• Doctor of Dental Surgery or Dental

Medicine• Doctor of Podiatric Medicine• Doctor of Optometry• Chiropractor

Ineligible - Hospital-based EPs defined as:• Furnishing 90% or more of their

services in either the inpatient or emergency department of a hospital

• Place of service (POS) code:• 21 (Inpatient Hospital), or• 23 (Emergency Room, Hospital)

MedicaidEligible if not hospital-based and minimum 30% Medicaid volume (exception, 20% for pediatricians):• Physicians• Nurse Practitioners (NPs)• Certified Nurse-Midwives (CNMs)• Dentists

Eligible without hospital-based exclusion: • Physician Assistants (PAs) working

in a Federally Qualified Health Center (FQHC) or Rural Health Centers (RHC) led by a PA with minimum 30% patient volume attributable to needy patients.

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Eligible Professionals (EPs) that qualify can receive only Medicare or Medicaid incentive payments, not both

Verify Eligibility: Professionals

Patient Volume

• One member, one provider, same day – one encounter

• A “proxy” at the clinic level is acceptable, but all EPs need to be included

• Count only Medicaid not KCHIP• Passport members can be included• Methodology to include “panels”

Attestation: Medicaid First Year Requirements

• If states design their Medicaid EHR incentive program for first year payment before MU status is achieved, EHs and EPs must:• Attest to have “adopted, implemented, or upgraded to

Certified EHR technology.”

• Adopt, implement, or upgrade means:• Acquire, purchase, or secure access to Certified EHR

technology;

• Install or commence utilization of Certified EHR technology capable of meeting meaningful use requirements; or

• Expand the available functionality of Certified EHR technology or upgrade from existing EHR technology to Certified EHR technology.

States may elect to establish first year Medicaid payments before EHs and EPs achieve MU status

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Attesting to Meaningful Use

• An EP who works at multiple locations, but does not have certified EHR technology available at all of them would:

• Have to have 50% of their total patient encounters at locations where certified EHR technology is available.

• Would base all MU measures only on encounters that occurred at locations where certified EHR technology is available.

Attestation for EPs who work at multiple locations

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EP - AIU costs

• Medicaid pays 85% of the Net Average Allowable cost.

• Can include costs from the past.• Hardware, software, connectivity,

training, initial data entry, practice workflow redesign

• Maintain auditable records

Medicaid EHR Incentive for PPS Hospitals and CAHs

• Similar to Medicare EHR incentive formula design.• Built on a base amount of $2 million per hospital, per year.• Adjusted:• Upward by hospital’s all-payer discharges ( includes the

hospital’s projected average annual rate of growth for years 2 through 4); then

• Downward by hospital’s Medicaid percent of total patient days with an adjustment to account for charity care (KY medicaid has proposed using the DISH payment K-MAP4 form).

Medicaid EHR incentive payment formula for PPS hospitals and CAHs

• Payments will be made in 3 years• First year payment will be 50% of the total incentive payment

for the Hospital. KY DMS has proposed 40% for year two and 10% for year 3 with a caveat that this can be adjusted based on overall effectiveness of the program.

Allocation of Medicaid EHR incentives

Register for EHR Incentive Program

• CMS will establish on-line provider registration as early as January 2011• http://www.cms.gov/EHRIncentivePrograms/

• Eligible hospitals and physicians and other professionals should register even before they are meaningful users.

Electronic registration

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“We frequently talk about health IT with an emphasis on the technology.

But at the heart of the transformation of our health system, it’s really all

about people.

Above all, it’s about improving care for all Americans.”

Dr. Charles Friedman

More information on the KHIE can be found on the Governor’s Office of Electronic Health Information

website at

http://chfs.ky.gov/os/goehi/