The document discusses a survey conducted by eHealth Initiative on regional extension centers and meaningful use of electronic health records. Key findings from the survey include: - Regional extension centers should be flexible and not constrained by state or regional boundaries in order to best meet local needs. There should be 10-100 centers. - Quality improvement organizations are best suited to run the extension centers based on their experience. - Extension centers should focus on disseminating best practices, providing technical assistance to clinicians, and assisting primary care practices and those in rural/underserved areas.

1. Welcome! Thursday, October 22, 2009

2. The Global Opportunities and Legal Challenges Posed by Health Information Technology: Presented by Robert D. Marotta October 1, 2009 A Domestic Perspective

17. October 22, 2009 The Impact of Federal HIT Policy and the State of Ohio Jennifer Covich Bordenick Chief Operating Officer and Interim Chief Executive Officer

22. Overview of National Landscape October 22, 2009

25. Basic Federal HIT Structure in 2009 October 22, 2009 HITSP CCHIT + ? Office of the National Coordinator HIT Policy Committee HIT Standards Committee Chief Privacy Officer National Institute of Standards and Technology

30. Developing and Rewarding Meaningful Use October 22, 2009

33. Paying for Meaningful Use – Example - Medicare for Professionals October 22, 2009 Year Maximum Benefit per Provider using EHR Total Payment Reduction for Not Using EHR First Year $15,000 (If 2011 or 2012, $18,000) 0% Second Year $12,000 0% Third Year $8,000 0% Fourth Year $4,000 0% Fifth Year $2,000 2015: 1% (in some cases, 2%) Sixth Year 0 2016: 2% 2017 0 2017: 3% Beyond 0 Beyond: 3% (or more)

35. Meaningful Use 2011 - Example October 22, 2009

37. The State of Health Information Exchange (HIE) in the Nation October 22, 2009

38. October 22, 2009

41. October 22, 2009

42. October 22, 2009

43. Who Is Exchanging Health Information? October 22, 2009

44. October 22, 2009 Stakeholder Organizations Exchanging Data 2008 2009 Change (+/-) Hospitals 31 48 +17 Primary care physicians 24 42 +18 Community and/or public health clinics 20 32 +12 Specialty care physicians 21 30 +9 Independent laboratories 14 26 +12 Outpatient/Ambulatory surgery centers 11 22 +11 Pharmacies 8 20 +12 Behavioral or mental health providers 12 19 +7 Health plans 14 19 +5 Local Public Health Department 13 19 +6 Independent radiology centers 10 18 +8 Pharmacy benefit management companies 7 18 +11 Healthcare IT suppliers 9 15 +6 State Public Health Department 5 15 +10 Medicaid 5 13 +8 Consumers 3 10 +7 Employers or health care purchasers 5 9 +4

45. What and How is Health Information is Exchanged? October 22, 2009

46. October 22, 2009 Data Currently Exchanged 2008 2009 Change (+/-) Laboratory 26 49 +23 Medication data (including outpatient prescriptions) n/a 48 n/a Outpatient laboratory results 25 45 +20 Outpatient episodes 23 43 +20 Radiology results 23 39 +16 Emergency Department episodes 27 36 +9 Inpatient diagnoses & procedures 27 35 +8 Care summaries n/a 34 n/a Inpatient discharge summaries n/a 32 n/a Pathology 18 32 +14 Dictation / transcription 20 31 +11 Cardiology 15 27 +12 Claims: pharmacy, medical, and/or hospital n/a 27 n/a Enrollment / eligibility 17 25 +8 Pulmonary 13 23 +10

47. October 22, 2009 Current Functionalities for Data Exchange 2008 2009 Change (+/-) Results delivery (e.g. laboratory or diagnostic study results) 31 44 +13 Connectivity to electronic health records n/a 38 n/a Clinical documentation 38 34 -4 Alerts to providers 26 31 +5 Electronic prescribing n/a 26 n/a Enrollment or eligibility checking 29 25 -4 Electronic referral processing 17 21 +4 Consultation/referral 23 20 -3 Clinical decision support n/a 19 n/a Disease or chronic care management 19 19 0 Quality improvement reporting for clinicians 14 19 +5 Ambulatory order entry n/a 16 n/a Disease registries 11 16 +5 Reminders 14 16 +2 CCR/CCD summary record exchange n/a 15 n/a Public health: case management 7 13 +6 Public health: surveillance 9 13 +4 Quality performance reporting for purchasers or payers 9 12 +3 Connectivity to personal health records n/a 10 n/a

48. What is the Impact? October 22, 2009

50. What hurdles exist? October 22, 2009

52. October 22, 2009

53. The Role of States and Regions October 22, 2009

58. presented by Élise Spriggs Scanning the Legislative Landscape

59. Overview of HIT Provisions Included in the American Recovery and Reinvestment Act (ARRA)

68. American Recovery and Reinvestment Act Tries to Address the Barriers

89. Rex Plouck, Enterprise Health IT Officer, State of Ohio Ohio Health IT Agenda

92. Draft OHIP Structure

96. presented by Jeff Porter Establishing Meaningful Use: From the HITECH Act to Improved Quality of Care

108. Medicare and Medicaid HIT Incentives Meaningful Use Standards and Privacy/Security Medicare Incentive payments no sooner than Jan. 1, 2011 Medicaid Incentive payments no sooner than Jan. 1, 2011 OR Penalties Begin Calendar Year 2015

111. Medicare and Medicaid HIT Incentives Meaningful Use Standards and Privacy/Security Medicare Incentive payments no sooner than January, 2011. Medicaid Incentive payments no sooner than October, 2010. AND Penalties Begin Full Fiscal Year 2015

117. “ ARRA 8” Requirements Used to Develop Privacy and Security Standards ARRA Priority Areas of Focus Derived Privacy & Security Services HITSP Standards? 1) Technologies that protect the privacy of health information and promote security in a qualified electronic health record, including for the segmentation and protection from disclosure of specific and sensitive individually identifiable health information Identity management Yes User/entity authentication Yes Identity- / role-based access control Yes Label-based access control No Consent management Partial Transmission integrity protection Yes Transmission confidentiality protection Yes 2) Nationwide HIT infrastructure for electronic use and exchange of EHR Secure communications channel Yes Secure email Yes

118. “ ARRA 8” Requirements Used to Develop Privacy and Security Standards ARRA Priority Areas of Focus Derived Privacy & Security Services HITSP Standards? 3) EHR certification (all) -- 4) Technologies that, as a part of a qualified electronic health record, allow for an accounting of disclosures made by a covered entity Auditing Yes Consistent time Yes Inter-enterprise traceability No Non-repudiation Yes 5) The use of certified electronic health records to improve the quality of health care Document integrity protection Yes Transmission integrity protection Yes Non-repudiation Yes Service availability No

119. “ ARRA 8” Requirements Used to Develop Privacy and Security Standards ARRA Priority Areas of Focus Derived Privacy & Security Services HITSP Standards? 6) Technologies that allow individually identifiable health information to be rendered unusable, unreadable or indecipherable to unauthorized individuals Transmission confidentiality protection Yes Deidentification Yes Anonymization Yes Pseudonymization Partial Limited data set No 7) Demographic data N/A -- 8) Special populations N/A --

121. Meaningful Use Matrix

122. Meaningful Use Matrix

123. Meaningful Use Matrix

124. Meaningful Use Matrix

125. Meaningful Use Matrix

126. Meaningful Use Matrix

127. Meaningful Use Matrix

128. Meaningful Use Matrix

129. Meaningful Use Matrix

130. Meaningful Use Matrix

132. presented by Ralph Breitfeller E-prescribing

133. presented by Geoffrey Stern The Ethics of E-Health

134. Thank You for Coming!