Chris Guerrero

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                                  Health Information Technology
                                           and Exchange

                                   Presented at Texas Immunization Summit, Fort Worth

                                                     Executive Briefing Document October 1, 2010
                                  On Tuesday, September 2nd, 2009 the Office of the National Coordinator for

                                     Health Information Technology announced posting of the Health
                                     Information Technology for Economic and Clinical Health Act
                                     (HITECH) grant.

                                  HITECH Grant funding was made available for the purpose of Planning and
                                    Implementation of Health Information Technology and Health
                                    Information Exchange.

                                  September 2009 Health and Human Services Commission submitted a letter
                                     of intent to the ONC on behalf of the State of Texas

                                  September 2010, Texas submits Statewide Strategic and Operational Plan for
                                     Health Information Exchange for ONC approval

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                                  What is Health IT?

                                   Health IT or HIT describes the comprehensive management of

                                    health information and its secure exchange between consumers,
                                    providers, government and quality entities, and insurers.
                                   Shared and consistent utilization of HIT will:
                                      Improve health care quality;
                                      Prevent medical errors;
                                      Reduce health care costs;
                                      Increase administrative efficiencies;
                                      Decrease paperwork; and
                                      Expand access to affordable care.
                                      Interoperable health IT will improve individual patient care.

                                  GTC Thursday, February 18, 2010   3
                                  HIT Goal 1- Patient-Focused Healthcare

                                   Enable the transformation to higher quality, more cost-efficient,

                                     patient-focused health care through electronic health information
                                     access and use by care providers, and by patients and their designees.
                                       Objective 1.1 – Privacy and Security: Facilitate electronic
                                         exchange, access, and use of electronic health information while
                                         protecting the privacy and security of patients’ health information
                                       Objective 1.2 – Interoperability: Enable the movement of
                                         electronic health information to where and when it is needed to
                                         support individual health and care needs
                                       Objective 1.3 – Adoption: Promote nationwide deployment of
                                         electronic health records and personal health records that put
                                         information to use in support of health and care
                                       Objective 1.4 – Collaborative Governance: Establish mechanisms
                                         for multi-stakeholder priority-setting and decision-making to guide
                                         development of the nation’s health IT infrastructure
                                  Goal 2 - Population Health

                                   Enable the appropriate, authorized, and timely access and use of

                                     electronic health information to benefit public health, biomedical
                                     research, quality improvement, and emergency preparedness.
                                       Objective 2.1 – Privacy and Security: Advance privacy and
                                         security policies, principles, procedures, and protections for
                                         information access and use in population health
                                       Objective 2.2 – Interoperability: Enable the mobility of health
                                         information to support population-oriented uses
                                       Objective 2.3 – Adoption: Promote nationwide adoption of
                                         technologies and technical functions that will improve population
                                         and individual health
                                       Objective 2.4 – Collaborative Governance: Establish coordinated
                                         organizational processes supporting information use for population
                                  HHSC Office of eHealth Coordination (OEHC)

                                  “The goal is to allow comprehensive management of medical information and its secure exchange

                                      between health care consumer, providers, and payers. HI initiatives include, but not limited to,
                                      electronic health records, electronic prescribing, and health information exchange systems.”

                                  “The HHS Enterprise agencies are working on multiple fronts to use HI to better coordinate care for
                                      Texans enrolled in Medicaid and other state programs. Examples of such projects include the
                                      Health Passport for Medicaid children in foster care, the Clinical Management for Behavioral
                                      Health Services (CMBHS) system at the Department of State Health Services (DSHS), and the
                                      planned use of the Medicaid Electronic Health Information Project (MEHIP) for a Medicaid
                                      electronic health record. H.B. 1218, 81st Legislature, Regular Session, 2009, directed Health and
                                      Human Services Commission (HHSC) to develop an electronic HI exchange system to improve the
                                      quality, safety, and efficiency of health care services provided under Medicaid and the Children’s
                                      Health Insurance Program (CHIP).”

                                  *HHS Circular C-000, Health and Human Services Enterprise Office of eHealth Coordination, September 16, 2009

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                                  Texas Health Services Authority (THSA)

                                   Structure –

                                        public-private partnership, 501c3 non-profit corporation governed
                                         by a board appointed by Governor
                                        to serve as a catalyst for the development of a seamless electronic
                                         health information infrastructure
                                   Status –
                                        Gubernatorial appointments made in July 2008 and 2010.
                                        Executive Director 2010
                                        Contracted with CTG for Planning and Assessment
                                        Workgroups convened including stakeholders and agencies
                                        Implementation begins with approval of state plan
                                  DSHS Collaboration with OEHC

                                   On September 16, 2009 the DSHS Information Resources Steering Committee

                                        approved “A Coordinated Approach to ARRA Planning and Implementation”
                                        which emphasizes:
                                              Alignment of DSHS business systems as a foundation for advancing HIT/HIE goals in Texas

                                              Strategic coordination of information technology efforts within DSHS creates an opportunity
                                               for success with HHSC on behalf of Texas

                                              Complimenting OEHC goals by establishing a DSHS State Health Information Partnerships
                                               (SHIP) Office as a central point of contact for HIT/HIE initiatives

                                              Leveraging IT Projects already in progress to realize HIT outcomes as early success

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                                       DSHS HIT/HIE Data Sets
                                  HHSC determined that Department of State Health Services (DSHS) supports and maintains


                                     49% of all HHS Service Delivery Applications.
                                  DSHS supports systems utilizing Electronic Health Records (EHRs) that benefit the following
                                     providers and/or consumer groups:
                                                   Substance Abuse Providers

                                                   State hospitals

                                                   Community MHMR centers

                                                   Consumers of Health Information data:

                                                           Birth, death, and divorce records

                                                           Immunizations, cancer, birth defects, trauma, and adult/child lead

                                                           Infectious disease (STDs, HIV, tuberculosis, etc.) identification and management

                                                           Hospital discharge

                                                           Newborn screening

                                  1   Functional Review of Health and Human Services Technology, July 1 ,2009, pg. 4

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                                   The HIT/HIE Opportunity

                                  “The goal is to allow comprehensive management of medical information
                                   and its secure exchange between health care consumer, providers, and
                                   payers. HI initiatives include, but not limited to, electronic health
                                   records, electronic prescribing, and health information exchange

                                  * HHS Circular C-000, Health and Human Services Enterprise Office of eHealth Coordination, September 16, 2009

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                                  Federal Partners

                                  Funding was made available through a number of agencies within the

                                    U.S. Department of Health and Human Services (HHS).

                                  These include the Office of the National Coordinator for Health
                                     Information Technology (ONC), Health Resources and Services
                                     Administration (HRSA), Agency for Healthcare Research and Quality
                                     (AHRQ), the Centers for Medicare and Medicaid Services (CMS), the
                                     Centers for Disease Control and Prevention (CDC), and the Indian
                                     Health Service.
                                  Federal Funding

                                  Targeted Federal Funding was authorized in 2009 for:

                                       HIT architecture that supports nationwide electronic exchange and
                                         use of health information in a secure, private, and accurate manner
                                       Development and adoption of certified EHRs for providers not
                                         eligible for other support
                                       Training on and dissemination of best practices to integrate HIT,
                                         including EHR, into a provider’s delivery of care
                                       Infrastructure and tools for telemedicine
                                       Promotion of interoperability of clinical data repositories or
                                       Promotion of technologies that enhance protection of
                                         health information
                                       Improvement and expansion of uses of HIT by public health
                                  HIT/HIE Impacts On Public Health –When?
                                       Medicaid Funded Programs - Now

                                       Registries – Cancer, ImmTrac, VSU, HAI, PAE - Now
                                       Electronic Health Information Electronic Laboratory Exchange - Now
                                       Unstructured Data – 12-18 Months
                                       Integrated Biosurveillance Data 12-18 Months
                                       National Disease Detection and Collaboration - Now
                                       Workforce – 12-18 Months

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                                  Impact of HIT/HIE on Biosurveillance

                                  The National Biosurveillance Strategy for Human Health 2008-2013

                                  Centers for Disease Control and Prevention December 2008

                                  Health information technology (HIT) and electronic health information exchange have the potential to
                                      accelerate timely and accurate sharing of health data between clinical care settings and public
                                      health practice settings. Healthcare information provides the most specific and direct representation
                                      of the health of the nation’s communities. At present the healthcare system has four critical roles in
                                                  1)        report notifiable diseases and clusters of suspicious illness to state and local health
                                                  2)        provide automated data streams that can be used to recognize and monitor outbreaks;
                                                  3)        assist health investigators though clinical information, such as from patient medical records,
                                                       screening services and diagnostic results; and
                                                  4)        monitor patient and worker health and safety within its own facilities (especially hospitals and
                                                       long-term care facilities).

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                                  Current DSHS Technology

                                                                Existing DSHS business
                                                             systems support Public Health

                                                            DSHS supports 165 unique
                                                               business systems

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                                  DSHS Systems Evolution

                                   As new partnerships
                                      were needed,
                                    systems and data
                                       were shared

                                                                    Not elegant, but
                                                                 services are delivered

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                                  DSHS Planning Strategy for Improving Partnerships

                                  Sunday, August 19, 2012   17
                                  DSHS Architecture Strategy

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                                    DSHS Target Data Sets

                                   Blueprint for DSHS Registries

                                      Immunization Registry
                                      Trauma Registry
                                      Birth Defects Registry
                                      Texas Cancer Registry
                                      Child and Adult Blood Lead Registry

                                   Health/Medical Electronic Records
                                      Clinical Management for Behavioral Health Services (CMBHS)
                                      Regulatory Automation System
                                      Texas Health Steps
                                      Laboratory

                                   Health Statistics Systems
                                      Hospital Data Discharge
                                      Vital Statistics

                                   Disease Prevention and Wellness Systems
                                      Laboratory Newborn Screening (NBS) Enhancements
                                      Healthcare Associated Infections (HAI)

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                                   ImmTrac and Health Information Exchange

                                   State Medicaid Health Information Technology Plan (SMHP)

                                      Provider Incentives for eHR adoption
                                      Criteria for achieving “Meaningful Use”

                                   Medicaid Electronic Health Information System
                                           Primary Care Provider
                                           Single client view

                                   Health Information Exchanges (HIEs)
                                      Non- Profit
                                      Private
                                      For-Profit

                                   eHR and eMR Software Developers

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                                  Challenge & Opportunity for Public Health

                                  “The nature of public health also defines a special

                                    set of informatics challenges. For example, to
                                    assess a population’s health and risk status, data
                                    must be obtained from multiple disparate sources
                                    such as hospitals, social service agencies, police,
                                    departments of labor and industry, population
                                    surveys, on-site inspections, etc.
                                  Challenges and Opportunities Continued..

                                  Data about particular individuals from these various sources

                                    must be accurately combined; then individual-level data
                                    must be compiled into usable, aggregate forms at the
                                    population level. This information must be presented in
                                    clear and compelling ways to legislators and other
                                    policymakers, scientists, advocacy groups, and the general
                                    public, while ensuring that the confidentiality of the
                                    health information of specific individuals is not

                                     “J PublicHealth Management Practice, 2000, 6(6), 67–75, William A. Yasnoff, Patrick W. O’Carroll, Denise Koo,
                                      Robert W. Linkins,and Edwin M. Kilbourne”

                                  For information regarding this presentation please contact:

                                  Chris Guerrero
                                  HIT Coordinator, Director Information Technology, Department of State Health Services


                                  Chris Legnon
                                  HIT Project Manager, Department of State Health Services
                         512-458-7111 ext 6143

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