Health Information Technologyand Puerto Rico

Juan Eugenio Rodríguez de HostosChief Information Officer, Government of Puerto Rico

Dr. José PiovanettiChief Medical Information Officer / CIO, Health Umbrella

FactsQuality of Health Care in America Committee

of the Institute of Medicine (IOM)- September 1999 -

Boeing 767± 200 Passengers

• “44,000 to 98,000 people die in hospitals each year dueto preventable medical errors…”– Equivalent to 120 to 260 persons / day

• One jet airliner crash, daily, for one year…

Health IT and the Government

• The Government of Puerto Rico has awakened to the fact that our healthcare system is broken and that IT can play a pivotal role in enhancing the health of our citizens.

• The CIO’s strategic plan is based on connectivity, service, integration, interoperability and data security across the entire Government and Island.

• Healthcare is a main focus. Why? The benefits to citizens are IMMENSE

Action Plan

• Reevaluate how PR-DoH does business• Look for ways to serve our customers better:

– Integrate ASES and PAM from technological point of view

• MMIS

– Improve Reforma’s offerings through operational and technological integration with other welfare agencies

• TGP and data-exchanges

– Digitize and integrate medicine in Puerto Rico• HIE and EMR

– Provide better connectivity for the Health Ecosystem• PREPA.net and Broadband

How can Broadband facilitate better health?

• Connected patients– Telemedicine requires bandwidth to transmit images in real time

– Personal Health Records (PHR): Patients control information and participate in their health

• Connected health care providers, laboratories, pharmacies– Supports a system that provides the right information to define

the right care at the right time for any patient.

– Allows access to information from anywhere on the island.

• Connect PR to the National Health Information Network

Funding Sources

• ARRA Broadband– Mapping and Planning*: $1.4 million approved– Infrastructure, Public Computer Centers, Adoption

• $12.6 million to INTECO for Infrastructure• Second round will be closing in a couple of weeks

• ARRA HITECH – HIE Planning and Implementation*: $7.8 million approved– Regional Extension Centers– EMR and Health Informatics educational curricula– EMR incentives

• Other Health IT non-ARRA– MMIS* – planning grant approved– HIT* – working on grant approval

* States Only

Health Information Exchange

State and Federal Healthcare-related Agencies

Hospitals / IDNs

CDCFDA

SSADoH

Medicare / Medicaid

Labs.

Pharmacies

Hosted orOn-Site EHRs

PHR’s

Payers / Health Plans

State, Nationwide and International HIE Networks

State, Nationwide and International HIE Networks

Clinical Encounter

Index of Where Patients Have Records Temporary Aggregation

of Patient History

Patient Authorized

Inquiry

Patient Authorized

Inquiry

Hospital Record Laboratory Results Specialist Record

Patient Data Delivered to

Physician

Patient Data Delivered to

Physician

PR-HIOPR-HIO

RecordsReturnedRecords

Returned

Requests for Records

Requests for Records

CommunityCommunity

Index of Where Patients Have Records Temporary Aggregation

of Patient History

Authorized Inquiry

from HIO

Authorized Inquiry

from HIO

Hospital Record Laboratory Results Specialist Record

Patient Data Delivered to Other HIO

Patient Data Delivered to Other HIO

PR-HIOPR-HIO

RecordsReturnedRecords

Returned

Requests for Records

Requests for Records

NationwideNationwide

AnotherHIO

Approach

• “Health Umbrella” CIO, José Piovanetti, MD• Health Information Exchange

– Environmental assessment, strategic and operational plans to be completed by September 2010

– Steering body to be created with local stakeholders– Clinical/Public Health, Technical, Operational,

Legislation, Financial, and Governance working groups– HIE Implementation, 2-3 years

• Accelerate Government’s HIT/EMR project(s)• Government ensures money used correctly,

Meaningful Use criteria are met and plan followed

Our involvement with you!

• We will be…– Providing periodic updates and info about ARRA programs

and deadlines– Asking stakeholders to participate in various concurrent

initiatives, committees and workgroups– Holding Town Hall meetings to communicate progress with

HIE planning and hear ideas and concerns– Educating citizens on Electronic Medical Records and their

benefits and address concerns regarding privacy– Interested in meeting consultants, product and service

providers as we finalize HIE planning– Recruiting your help communicating with Association

members and enlisting their responses– Asking you to call Washington so PR gets its fair share of

funds

HIT/HIE Timeline

ICD-10 CM/PCS AdoptionICD-10 CM/PCS Adoption

Oct 1, 2013Oct 1, 2013

NHII / NHINNHII / NHIN

NPRMDec 30, 2009

NPRMDec 30, 2009 “Meaningful Use”“Meaningful Use”

MU Stage 1MU Stage 1 MU Stage 2MU Stage 2 MU Stage 3MU Stage 3

Medicare IncentivesMedicare Incentives

Medicaid IncentivesMedicaid Incentives

MMIS / MITAMMIS / MITA

HIPAA v5010 TransactionsHIPAA v5010 Transactions

PenaltiesPenalties

State Health Information Exchange Cooperative Agreement ProgramState Health Information Exchange Cooperative Agreement Program