Office of Health Information Technology
Welcome to the Commonwealth of Virginia Health Information Technology Grant Applicant Conference
Office of Health Information Technology
August 31, 2006
Office of Health Information Technology
Our Purpose Today
• Overview the Commonwealth’s strategy for information technology improving health care for all Virginians • Continue and expand the marketplace dialogue around electronic health records • Describe near term action steps
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Office of Health Information Technology
Agenda
• • • • • • • Opening Remarks Electronic Health Records Context and Vision Project Organization Request For Information (RFI) Desired Outcomes Our Process Lunch Discussion
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Office of Health Information Technology
Opening Remarks
The Honorable Aneesh P. Chopra Secretary of Technology The Honorable Marilyn B. Tavenner Secretary of Health and Human Resources August 31, 2006
Office of Health Information Technology
Healthcare IT Investment Atop the National, State Agenda
A Lofty (National) Goal • President Bush calls for most Americans to have an electronic health record by 2014 Goal to develop a nationwide interoperable health information technology infrastructure House passed ―Health Information Technology Promotion Act‖ on July 27th, 2006 following similar passage in the Senate in 2005 • Virginia’s Approach The Legislature has elevated the importance of this issue by calling for the creation of an Advisory Committee on Electronic Health Records Allocates $1.5 Million over the biennium for encouraging Electronic Medical Records Adoption through grants issued to providers The Governor has signed Executive Order 29 which creates the ―Health Information Technology Council‖
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Warner Report in Brief
Establish an ongoing statewide Virginia Health Care Innovations Group, Establish incentives for EHR adoption in the state’s r ole as a purchaser Appropriate state monies to facilitate increased eHealth initiatives, Identify and support the implementation of a master patient index, Address the health information management workforce shortage
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Office of Health Information Technology
Myriad Opportunities to Spur the Adoption of Healthcare IT
Public-Private Partnerships to Drive Physician Adoption Rate Communities develop innovative solutions with the private sector to lower the cost, maximize marketing communication to area physicians, and boost adoption
Virginia Health Information Network Commonwealth establishes standard to ensure data interoperability with sufficient protections for patient privacy, including the consideration of a master patient index
Pilot Projects to Lower Health Care Costs Commonwealth invests in pilot projects to demonstrate cost savings in its capacity as a large employer, with particular emphasis on rewarding quality healthcare
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Office of Health Information Technology
Framing Virginia’s 2007 Health IT Investment Agenda
I
Improving Virginia’s Health IT Infrastructure
#Virginia Department of Health EMR: Electronic Medical Record to serve
Health Department clinics approved by IT Investment Board
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Extending the Enterprise
#Medicaid Transformation Grants: Proposing to fund webbased PHR populated by claims
data and electronic billing for smaller providers
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Seeding Global Reform
#Office of Health
Information Technology:
Virtual Office combining staff from both the Health and Technology Secretariats; serves as support staff for the Health IT Council in its mission to review proposals for funding from $1.5 Million appropriation
#Department of Mental Health, Mental Retardation, and Substance Abuse Services EMR: Medication
Management and EMR Systems – Also approved
#Electronic Master Patient Index: Seed capital available for developing a statewide Electronic
Master Patient Index in current biennial Budget
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Office of Health Information Technology
Governor’s Health IT Council Membership
• Corporate
– – – Gil Minor, Owens and Minor Bob Johnson, Sprint Nextel Balan Nair, AOL Ron DeCesare, Professional Healthcare Resources Barbara Baldwin, UVA Golden Bethune, Riverside Joe Roach, Martinsville Memorial Hospital
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Home Healthcare
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Hospital Members
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Insurance
– – – – Megan Philpotts Padden, Sentara Health Plans Hon. Janet Howell, VA Senate Hon. Sam Nixon, VA House of Delegates Hon. John O’Bannon, VA House of Delegates
Elizabeth Brown, Sentara Healthcare
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Legislative
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Long-Term Care
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Office of Health Information Technology
Governor’s Health IT Council Membership
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Patient Advocate
– – Nancy Davenport-Ennis, Patient Advocate Foundation Michele Vilaret, National Association of Chain Drug Stores
Pharmacy
Physician Members
– – – Dr. Gopinath Jadhav, Southside Gastroenterology, Richmond Dr. Keith Newby, Cardiology and Arrhythmia Consultants, Norfolk Dr. Larry T. Wilson, Holston Medical Group, Gate City
Anna Slomovic, Revolution Health Group David Merritt, Center for Health Transformation Chas Roades, Advisory Board Co. Don Detmer, American Medical Informatics Association / UVA
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Privacy Expert
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Thought Leaders
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Office of Health Information Technology
Our Process
Greg Walton Executive Advisor
Office of Health Information Technology
Office of Health Information Technology - A Virtual Team
• Betty Jolly – Department of Health Professions
• Heidi Dix – Asst. Sec. of Health and Human Resources • Thomas Gates – Assistant Secretary of Technology
• Tristen Pegram – Special Assistant for Technology
• Kim Barnes – Virginia Department of Health • Greg Walton – Executive Advisor to the Council
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Office of Health Information Technology
Health & Human Resources Priorities
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Medicaid Reform Healthy Virginians Health Workforce Issues Uninsured in Virginia Quality Health Initiatives
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Office of Health Information Technology
Our Process
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Subcommittees of the Technology Council Regional Approach Project Sweet Spots Guidelines to the Statement of Interest Applicant Dialogue
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Office of Health Information Technology
Technology Council Sub Committees
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Business Case and Partnerships Privacy and Security Physician Communications Order of Merit Confirmation
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Office of Health Information Technology
Economic Development Regions
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Office of Health Information Technology
VIRGINIA’S EHR ADOPTION IN PHYSICIAN OFFICES
“Given that physicians in small practices account for 88 percent of all outpatient visits and four-fifths of physicians work in small practices, this group represents a sizable adoption gap.”
From “Information Technologies. When Will They Make It into Physicians’ Black Bags?” Medscape General Medicine 6, no. 4 (2005)
Office of Health Information Technology
Health Regions in Virginia
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Office of Health Information Technology
Number of MD’s by Health Region
Total licensed MD’s • 3346 = Central Region • 4167 = Eastern Region • 7966 = Northern Region • 2464 = Southwest Region
Source: Department of Health Professions BOM, 2006 data
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Office of Health Information Technology
Physician Adoption • 33% of respondents in a recent Virginia survey of physician offices said they have an EHR in use today.
• Of those who said they had an EHR, 36.6% utilized 3 components or fewer. 12% reported 3 components or fewer; 17% reported 4 to 6 components; 4% reported 7 or more components
• Those in a hospital setting (60%) were more likely than those in large group practice (3 or more doctors; 33%) and small group practice (2 or less doctors; 17%) to have and EHR.
Source: VDH Survey, 2005
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Office of Health Information Technology
Most Adopted Feature of an EHR
• • • • • • • • • • • Receipt of lab results = 62% Entry of progress notes = 57% Decision support such as online material = 56% Images = 55% Lab ordering = 50% Alerts to drug interactions = 40% Image ordering = 38% Records transmitted/received from other offices = 38% Electronic Prescriptions = 24% Alerts to deviations from patient care protocol = 14% Patients can access part or all of the record = 5%
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Source: VDH Survey, 2005
Office of Health Information Technology
On average, how many patient records are currently in your system?
Source: VDH Survey, 2005
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Office of Health Information Technology
How many years have you had your current electronic health record system?
Source: VDH Survey Early Adopters, 2005
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Office of Health Information Technology
Virginia’s Hospitals
Office of Health Information Technology
Virginia Hospital Statistics Compared Nationally
Number of hospitals
Staffed beds
Total discharges
738,588 32,748,037
Patient days
Gross patient revenues (hundred thousands)
$26,119,057 $1,265,638,838
Virginia U.S.
81 3,886
14,759 650,143
3,592,628 155,432,732
Note: Data based on most recent hospital Medicare cost reports; access from http://www.ahd.com/state_statistics.html on August 30, 2006.
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Office of Health Information Technology
Acute Care Hospitals
FP* 18% Rural 45% Urban 55% NFP* 82%
76 Acute Care Hospitals (2003)
Source: Department of Health Professions BOM, 2006 data
Source: Virginia State Planning Grant Phase One, Final Report to the Secretary of Health and Human Services, September 2005
* FP-Proprietary Hospitals; NFP—Not-for-Profit Hospitals
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Office of Health Information Technology
Trauma Centers Serving Virginians
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Office of Health Information Technology
Additional Providers
• Other Hospitals: – 4 State or Locally Owned Hospitals – 6 Psychiatric Hospitals – 4 Rehabilitation Hospitals – 36 Ambulatory Surgery Centers • Other Providers: – 245 Licensed Nursing Facilities – 4 Health Regions (Northern, SW, Central, and Eastern) – 35 Local Health Districts
Source: Virginia State Planning Grant Phase One, Final Report to the Secretary of Health and Human Services, September 2005 and Virginia Department of Health: www.vdh.virginia.gov/LHD Full list of Virginia Hospitals available at: http://www.ahd.com/states/hospital_VA.html
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Office of Health Information Technology
Virginia Local Health Districts
Source: Virginia Department of Health, http://www.vdh.virginia.gov/LHD/LocalHealthDistricts.asp
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Office of Health Information Technology
Project Sweet Spots
Key Attributes
Demonstrate
Innovate
Automate
Validate
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Office of Health Information Technology
Guidelines to the Statement of Interest
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Contact Information Project Overview Partnership History Timeline and Work plan Description of Technical Approach Special Commonwealth Considerations Business Model
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Office of Health Information Technology
Guidelines to the Statement of Interest - Contact Information
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Recommended Length: 1 Paragraph Required Information
1. Organization(s) 2. Contact Person’s Name, Address, Phone Numbers & E-mail
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Suggested
1. Company Web Site
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Office of Health Information Technology
Guidelines to the Statement of Interest - Project Overview
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Recommended Length: 3 Pages Suggested
1. What Will Be Done 2. Roles of the Partners 3. Regional Orientation and Impact
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Office of Health Information Technology
Guidelines to the Statement of Interest Partnership History
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Recommended Length: 2 Pages Suggested
1. Virginia Partnership Activity 2. Institutional & Physician 3. Challenges Overcome
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Office of Health Information Technology
Guidelines to the Statement of Interest - Timeline and Work Plan
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Recommended Length: 2 Pages Required
1. Start Date from Award 2. Project Phases
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Suggested
1. Project Sub-phases 2. Work Load by Partner
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Office of Health Information Technology
Guidelines to the Statement of Interest Description of Technical Approach
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Recommended Length: 1 Page Required
1. Multiple Choice/Fill in the Blank Questions
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Office of Health Information Technology
Guidelines to the Statement of Interest Description of Technical Approach
• Network, Systems Architecture, Hardware, Operating Environment, Database, etc. • What deployment models are available for your product? (check all that apply
o Application Service Provider (Vendor Hosted) o Software Product (User Hosted) o Third Party Site
• What operating system(s) does your product use? (check all that apply)
o o o o o Windows Linux Unix Mac OS Other
• What minimum client application does your product require?
o Thick client o Browser-based o Rich Browser-based (e.g., Applets)
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Office of Health Information Technology
Guidelines to the Statement of Interest Description of Technical Approach
• What other client applications does your product provide? (check all that apply)
o Thick client o Browser-based o Applet-based
• What underlying database management software is supported? (check all that apply)
o Oracle o Microsoft SQL Server o Open Source (MySQL, Firebird, Ingres) o DB2 o OODBMS o Other List other required 3rd party software____________
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Office of Health Information Technology
Guidelines to the Statement of Interest Description of Technical Approach
• Scalability features (check all that apply)
o o o o o Database/Server Replication Server Clustering SMP computing Grid Computing Other [please fill in] _______________________
• What types of access points does your product support for physicians, nurses, other caregivers and non-clinical reviewers (check all that apply)
o o o o o o o o Desktop computers Laptop computers Wireless tablet computers Text message Cell phone IM Remote Access Other
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Office of Health Information Technology
Guidelines to the Statement of Interest Description of Technical Approach
• What additional data entry mechanisms are supported (check all that apply)
o o o o o o o o o o o o o Bar code readers OCR Scanning (?) Web forms Patient monitoring equipment Laboratory analysis equipment Voice Handwriting recognition RFID Biometrics Smart Cards Proximity Badges Other [fill in]
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Office of Health Information Technology
Guidelines to the Statement of Interest Description of Technical Approach
• Data and System Security Requirements • What provisions are made for compliance with Privacy standards and regulatory requirements (fill in URL or less than 50 words) _______________________________________ • What provisions are made for compliance with requirements for legally sound medical records (fill in URL or less than 50 words)) ______________________________________ • What features exist for data protection and disaster recovery (fill in URL or less than 50 words) ___________________________ • What data security measures does your system support (check all that apply)? • SSL • 3rd party SSL accelerators • Event logging to support auditing and strict user accountability • Rollback
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Office of Health Information Technology
Guidelines to the Statement of Interest Description of Technical Approach
• • • • • • • Data and System Security Requirements All information is time-stamped (Y/N) All data entry is associated with a particular user (Y/N) Users have unique login (Y/N) Users can be assigned particular roles (Y/N) Provides unique patient identifier (Y/N) Supports electronic signature where permitted by Virginia law (Y/N)
• Routine Maintenance Procedures • What is the expected downtime per week for maintenance under normal utilization? • <1 hr o 1-4 hrs o 4-8 hrs o > 8 hrs
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Office of Health Information Technology
Guidelines to the Statement of Interest Description of Technical Approach
• Tools for Computer Operators and Support Staff
• • • • • • • • • • • What tools does your product support (check all that apply)? Data migration from legacy medical records systems Workflow management? Customizable (Y/N) Statistical Data Analysis OLAP Custom Reports Data Mining Tools Flat file import (CSV, etc.) XML input XML export
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Office of Health Information Technology
Guidelines to the Statement of Interest Description of Technical Approach
• Required or Suggested Staffing
• Requires dedicated administrator (Y/N) • Use of standards • What standards are supported for information exchange (check all that apply)? • HL7 2.3.1 HL7 2.4 CVX MVX • NCDCP ICD-9 CDISC CABIG • IEEE 1073 IHE PIX X12N ELINCS • DICOM HUGN NDF-RT HIPAA • LOINC SNOMED RXNORM • Other (list): _______________________________
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Office of Health Information Technology
Guidelines to the Statement of Interest Description of Technical Approach
• What underlying database management software is supported? (check all that apply)
o o o o o o Oracle Microsoft SQL Server Open Source (MySQL, Firebird, Ingres) DB2 OODBMS Other
• List other required 3rd party software requirements: ________________ • Scalability features (check all that apply)
o o o o o Database/Server Replication Server Clustering SMP computing Grid Computing Other [please fill in] _______________________
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Office of Health Information Technology
Guidelines to the Statement of Interest - Special State Considerations • • Recommended Length: 1 Page Required
1. Highlight commitments to any of the following, Small(SBE), Women (WBE), and Minority owned (MBE) businesses ((SWAM)).
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Office of Health Information Technology
Guidelines to the Statement of Interest - Business Model • • Recommended Length: 1 Page Required 1. State your dollar request for the Grant 2. State any assumptions/plans about other funding sources you expect to pursue
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Office of Health Information Technology
Guidelines to the Statement of Interest Diagrams and Pictures
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Suggested
1. High-level Architecture 2. High-Level Systems/Applications 3. Project Organization Chart
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Office of Health Information Technology
Applicant Dialogue
• Web Postings from OHIT www.healthitcouncil.vi.virginia.gov • Frequently Asked Questions FAQs • Staff Dialogue and Coaching • Weekly Project Updates • Supporting Material • SOI applicant survey and Proposal Repository on-line as of Sept 11th
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Office of Health Information Technology
Time Table • • • • RFI issued - August 21st Applicant Conference - August 31st Statements of Interest Due - September 15th Technology Council Meetings - September 15th, 29th and October 12th • Order of Merit List Ranking Released October 15th -30th • Stage #2 Begins
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Office of Health Information Technology
LUNCH
Office of Health Information Technology
Discussion
Office of Health Information Technology
ADJOURN
http://www.healthitcouncil.vi.virginia.gov