Electronic Health Records and Health Information Exchange:

Implications for Rural Hospitals

Rick SnyderVice President, Finance & Information ServicesOklahoma Hospital Association

Brian Yeaman, MDDirector, Physician InformaticsNorman Regional Health SystemGreater Oklahoma City Hospital Council

American Recovery and Reinvestment Act of 2009 (ARRA)

• Incentive payments for meaningful use of certified Electronic Health Records

• Hospitals and Eligible Professionals

• Medicare incentives

• Medicaid incentives

Hospital Incentive Payments

• Qualify as early as Oct 1, 2010– Range for OK PPS: ~$2 million - $8 million– Median: $3.7 million– State potential: $311 million

• Qualifying after FFY 2013 reduces amount

• CAH: Medicare share of capital + 20%

• FFY 2015: Incentives end; penalties begin

Hospital Incentive Payments Medicaid

• Requires: 10% Medicaid inpatient volume

• CAHs can qualify – not based on costs– $500,000 to $1,200,000

• $108 million potential for OK hospitals

• State has some discretion in design

Eligible Professionals

• Medicare incentives capped at $44,000 (plus 10% in HPSAs) OR

• Medicaid incentives capped at $63,750 (if 30% of practice is Medicaid (Peds: 20%))

• Paid over 5 years beginning Jan. 2011

• Penalties for non-adoption begin Jan. 2015

• Hospital-based professionals ineligible

EHR Adoption Rates

• 2008 RWJF study of 2,952 hospitals

• Comprehensive EHR:1.5% of US hospitals

• Basic EHR (physician, nursing notes): 7.6%

• Rural hospitals: – 0.6% comprehensive EHR– 4.0% basic EHR

OHA members tell us:

0 10 20 30 40 50 60 70

Begun to install?

Selected EHR?

Plan to qualify?

Yes

No

OHA members tell us:Potential obstacles to your hospital adopting

EHR:

1. Insufficient IT staff

2. Incentive payments will likely not cover EHR costs

3. Medical Staff is not supportive

4. Cannot find a suitable EHR

OHA members tell us: OHA can help most by…

1. Providing education on incentives

2. Providing education on EHRs

3. Offering a “group deal”

4. Helping arrange financing

5. Helping select EHR

EHR Certification

• Certification Commission for Health Information Technology (CCHIT)

– CCHIT Certified

– Preliminary ARRA certification

– Site certification

• HHS Health IT Policy Committee recommendation

– Allow multiple Certification organizations

– Accreditation process for certifying organizations

• HHS will propose rules

“Meaningful Use”

• HIT Policy Committee

• HIT Standards Committee

• Public input

• Policy Committee’s August 19 matrix

• Proposed rule due by December 31– 60 day comment period– Final rule: middle or end of spring 2010

• NE Oklahoma origins

• Oklahoma City exchange

• Projects around the state

• Attractive pricing for hospitals and their physicians

Regional Extension Centers – ARRA Section 3012

• National: HIT Research Center– Develop or recognize best practices to support and

accelerate efforts to:• Adopt, implement, and effectively utilize HIT for

– Electronic exchange and – Use of information

• Regional Extension Centers– Provide technical Assistance– Disseminate best practices and other information– Support and accelerate efforts to adopt, implement, and

utilize HIT

Regional Extension Centers

• ARRA law:– Hospitals (public, NFP, CAH)

– Federally Qualified Health Centers

– Entities serving uninsured, medically underserved

– Individual and small group practices in primary care

• Funding opportunity:– Primary care providers in small group practices, public

hospitals & CAHs, CHCs and RHCs, other settings for the uninsured/medically underserved

Regional Extension Centers

• OFMQ selected by stakeholders• Three waves of funding• $6.5 million potential for Oklahoma• Substantial matching required in years 3 and 4

State Loan Program

• 5:1 federal match for loans to providers

• Administered through Medicaid agencies

• OHCA will apply; has requested state match in SFY 2011 budget

• Projected availability: October 2010

SHIECAP

• State Health Information Exchange Cooperative Agreement Program

• Planning and Implementation grants

• State funding required– 2011 1/10– 2012 1/7– 2013 1/3

SHIECAP

SHIECAP: Oklahoma Health Information Exchange

• “Network of networks”

• Planning phase beginning Jan. 2010

• TBD: Governance, financing, …

• ONC approval of State plan required before implementation is funded

• OHA participating in planning; volunteers?

OHA Trade Show – HIT vendors

• Spectron Corp – McKesson products & more – booth 320

• CPSI – booth 800

• Phoenix Health Systems – booth 111– Meditech, CPSI, others, including MedSphere

OpenVista

Resources

• http://healthit.ahrq.gov/RuralHITtoolbox

• http://www.cchit.org/

• http://www.okoha.com/ARRA