Minnesota e-Health InitiativeWhat’s New?
Minnesota Critical Access Hospital and
Rural Health Conference
June 16, 2009
Liz Carpenter
Deputy Director, Center for Health Informatics
Anne Schloegel
Technology Projects Planner, Office of Rural Health & Primary Care
Minnesota e-Health Initiative Vision
“… accelerate the
adoption and effective use
of Health Information
Technology to improve
healthcare quality,
increase patient safety,
reduce healthcare costs,
and enable individuals and
communities to make the
best possible health
decisions.”
Source: e-Health Initiative Report to the MN Legislature, January 2004
State Mandates that Advance e-Health
2011 e-Prescribing Mandate
All providers, group purchasers, prescribers, and dispensers establish
and maintain an electronic prescription drug program by January
2011
2015 Interoperable EHR Mandate:
All healthcare providers and hospitals have interoperable EHRs by
2015
MDH to develop a statewide plan to meet the mandate
Establish uniform health data standards by January 2009
All EHRs must be certified by CCHIT or it successor assuming a
certified EHR product for the provider’s particular setting is available
Minnesota Model for Adopting
Interoperable Electronic Health Records
Breaks achieving the 2015 Mandate into
manageable steps
Applies across organizational settings
Continuum
of EHR
Adoption
Achievement of
2015 Mandate
Adopt
Assess
Plan
Utilize
Select
Implement
Effective Use
Exchange
Readiness
Interoperate
Minnesota’s Statewide
Implementation Plan
Components of the Plan
Part 1:
Part 2:
Part 3:
Part 4:
Background
Minnesota Model for
EHR Adoption
Emerging Issues
Recommendations
Appendices
Guide 1: Addressing Common
Barriers
Guide 2: Minnesota e-Health
Standards
Special Interest Area:
# 1 Long Term Care
# 2 Public Health
Available at: http://www.health.state.mn.us/ehealth/ehrplan.html
Minnesota EHR Adoption Rural-Urban
Implementation Stage
All
Rural
Urban
2005 2007 2005 2007 2005 2007
Fully implemented
17% 42%
13% 20%
Implementation in process
29% 20%
23% 28%
20%
58%
34% 13%
Implementation in next 12 months
11% 11%
13% 15%
10%
9%
Implementation in next 13-24 months
16% 13%
22% 21%
11%
8%
Implementation beyond 25 months
**%
9%
**% 11%
**%
7%
No plans for implementation
**%
5*%
**%
**%
4%
In 2007 next two years, 86.7% of Minnesota’s primary care clinics with be fully implemented.
* 47.6% of those who have no plans for implementation have done some exploration in the possibility of using EHR.
50.0% are clinics with 1 physician, compared to 16.7% of all respondents having 1 physician.
76.2% are free standing, independent clinics, compared to 26.7% of all respondents being free standing, independent clinics.
**In 2005, “No plans for implementation in next 24 months was 27% for All, 29% for Rural, and 25% for Urban.
5%
Supporting Rapid Adoption: MN Funding
$14.6 million in grants and loans to support
adoption of interoperable EHRs and targeted
funds to rural and safety net providers.
e-Health Grant Program: $ 8.3 million
2006 - $1.3 million
2007 - $3.5 million
2008 - $3.5 million
EHR Loan Program: $ 6.3 million
e-Health Grants 2006-2008: $8.3 million
Requests
Planning
Implementation
29
64
93
Requested
Amount
1,276,411
25,946,031
$27,222,442
Awards
25
24
49
Awarded
Amount
821,000
7,479,000
$8,300,000
• Five implementation grants were awarded to organizations who had
received prior planning grants.
• Grants were awarded to 49 organizations but included over 120
community and/or collaborative partners throughout the state.
Minnesota e-Health Grantees & Community Partners
2006-2008
Award Year
2006
2007
2008
Roseau
Community
Partners
Cook
Ely
Bemidji
Bigfork
Grand
Marais
Deer River
Mahnomen
Ogema
Moorhead
Longville
Walker
New York
Perham Mills
Wadena
Alexandria
Wheaton
Ortonville
Staples
Bertha
Kennsington
Morris
Graceville
Appleton
Osakis
Moose Lake
Long Prairie
Brooten Albany
Mora
Milaca
Braham
North Branch
Cambridge
St. Cloud
Isanti
Willmar
Chisago City
Minneapolis
Glencoe
Redwood
Falls
Sleepy Eye
Tracy
Walnut Grove
Balaton
Sandstone
Little Falls
Sauk Centre
Glenwood
Holdingford
Starbuck
Avon
Madison
Dawson
Granite Falls
Cottonwood
Duluth
Crosby
Ottertail
Henning
Fergus
Falls
Browns
Valley
Cloquet
Pine River
Menahga
Pelican Rapids
Westbrook
Stewart
Lester
Prairie
Arlington
Gaylord
Winthrop Henderson
Bloomington
Red Wing
Wabasha
New Ulm
Rochester
Madelia
Owatonna
Plainview
St. Paul
Electronic Health Record Loans: $6.3 million
Total Requests (27)
$ 14,156,018
Represents pre-application requests.
Some requests were not approved or the applicant
declined to continue loan process
Approved EHR Loans (8)
$ 6,300,000
−Critical Access Hospital (5)
−Rural Physician Clinic/Other Provider (2)
−Community Clinic (1)
Estimated unmet need
4,605,045
1,541,000
153,955
$ 4,056,356
EHR Loans: $6.3 million
Total Requests (27)
$ 14,156,018
Less requests that were not approved or
where the applicant declined to continue loan process
Approved EHR loans (8)
$
−Critical Access Hospitals(5)
−Rural Physician Clinic/Other Provider(2)
−Community Clinics(1)
Unmet need
(3,463,117)
6,300,000
4,605,045
1,541,000
153,955
$
4,056,356
Greater MN Telehealth Broadband Initiative
• Consortium of five health care networks
representing 120 hospitals and mental health
clinics
• FCC Rural Health Care Pilot Program
• Awarded ~$5.4M over 3 years in potential
reimbursements for installation and support of
rural broadband networks for health care
Greater MN Telehealth Broadband Initiative
• SISU Medical Systems, Duluth (16 hospitals
primarily in NE), Lead Organization
• Medi-sota, Inc. (31 hospitals in SW)
• Minnesota Telehealth Network and North
Region Health Alliance (38 hospitals in NW
MN and NE ND)
• MN Assn of Community Mental Health
Programs (78 clinics)
ARRA Key Provisions
Health Information Technology (HITECH Act) ($2 B)
Medicaid and Medicare HIT Incentives for hospitals and
providers ($29 B)
Community Health Center Grants ($2.5 B) ($500M for
operations and $1.5B for capital projects, including HIT)
Health Workforce Shortages – scholarships, loan repayment,
grants to training programs, and NHSC ($500 M)
Broadband
USDA: Distance Learning, Telemedicine and Broadband
Program ($2.5 B)
NTIA: Broadband Technology Opportunities Program
($4.7 B)
USDA Rural Community Facilities Program grants and loans
(additional $130M)
Health Information Technology for Economic and
Clinical Health Act (HITECH)
• Office of National Coordinator for HIT (ONCHIT)
• Grants to states to promote HIT
• Competitive grants to states and tribes to establish
EHR loan programs for providers
• Regional HIT extension and research centers
• Grants to health professions programs to
incorporate HIT into curriculum
• Grants to higher education to expand programs in
health informatics and IT
Overview of Recovery Act
HIT Provisions
• $2 billion in direct funding for health IT efforts through the
Office of the National Coordinator (ONC)
• $300 million reserved for supporting regional exchange efforts
• $20 million reserved for National Institute on Standards and Technology
(NIST)
• $24 million for privacy and security – Estimated in ONC Plan
• $29 billion in Medicare and Medicaid incentives to providers
and hospitals that adopt and use health IT systems
• Starting in 2011 and increases the deficit by $29 billion through 2019.
• Includes Medicare penalties that kick in 2015
• Health IT expected to reduce federal spending by approximately $12 billion
American Recovery and Reinvestment Act of 2009
HIT Provisions: Title IV of HR 629
Subtitle A: Codifies Office of the National Coordinator &
Defines Duties
Subtitle B: Testing of HIT by National Institute of Standards
Subtitle C: Reimbursement Incentives for Use of HIT
Funding for Grants & Loans
Medicare Incentives
Medicaid Funding
Subtitle D: Makes Improvements in Privacy & Security
Provisions
Office of the National Coordinator for HIT: Coordinate
funds to HRSA, AHRQ, CMS, CDC, IHS ($300M)
• HIT architecture to support exchange
• Training and best practices
• Telemedicine infrastructure and tools
• Promote interoperability of clinical data
• Improve/expand public health HIT
American Recovery and Reinvestment Act of 2009
HIT Provisions: Title IV of HR 629
Subtitle C: Reimbursement Incentives for Use of HIT
State Grants to Promote HIT
– Coordinated through ONC
– Planning & Implementation Grants
– State Match Required
• For FY 2011, not less than $1 for each $10 of Federal funds
• For FY 2012, not less than $1 for each $7 of Federal funds
• For FY 2013 and thereafter, not less than $1 for each $3 of
Federal Funds
• Authorized to set State match for funds awarded prior to 2011
Grants to states to promote HIT:
Minnesota e-Health Initiative
•
•
•
•
•
•
•
•
•
Enhance HIT adoption and effective use
Identify state and local resources
Provide technical assistance
Promote HIT for underserved areas
Assist patients to use HIT
Support use of regional extension centers
Support public health HIT
Promote quality measurement
Match: $1 to $10 (2011), $1 to $7 (2012),
$1 to $3 (2013)
American Recovery and Reinvestment Act of 2009
HIT Provisions: Title IV of HR 629
Subtitle C: Reimbursement Incentives for Use of HIT
Competitive Grants to States & Tribes for Loan Programs
– Purpose: facilitate purchase, enhance utilization, train personnel on
the use of EHRs, or improve the secure electronic exchange of health
information
– 4% of Funds may be used for administration of the program
– Awards beginning January 1, 2010
– Matching requirements:
• Not less than $1 for each $5 of Federal Funds provided
• State match may come from either state funds or donations from public or
private entities.
Competitive grants to states and tribes for
loan programs
• To assist providers with:
– Purchase of EHR technology
– Enhanced use of EHR
– Train personnel
– Improve secure health information exchange
• Up to market rate
• Repayment begins after 1 year
• 10 year amortization
• $1/$5 match
Medicare HIT Incentives: 2011-2015
• Available for hospitals and individual
providers
• Must be “meaningful user” of HIT
– Using certified EHR technology
– Demonstrates information exchange
– Reports clinical quality measures
• Incentives become penalties in 2015
Medicare Hospital HIT Incentives: 2011-2015
• PPS Hospitals = Base of $2M plus a pro-
rated amount of the total based on # of
discharges x Medicare share
– Could receive up to $8 million over 4 years.
• Critical Access Hospitals = Depreciation
value of HIT costs x Medicare share plus 20%
points
More about Critical Access Hospital Incentives
• Depreciation value of HIT costs x Medicare share
•
•
•
•
plus 20% points
“Certified EHR” definition will ultimately determine
value incentive. What will be included?
Can only depreciate EHR capital costs, not time
costs
Incentives don’t begin until after the investments
made; issue of need for capital financing left
unaddressed
Maximizing incentive bonus: strategy to leave as
much “Certified EHR” investments undepreciated at
time of reaching meaningful user designation
Medicare Incentive Payments: Professionals
• Qualified EHR user in 2011/2012 can receive up to
$44,000 (or up to $48,400 if practicing in HPSA)
• Applies to all physicians who can prove use of a
qualified EHR, regardless of purchase date
• Must be meaningful EHR User. Includes:
– Using certified EHR technology
– Demonstrates information exchange
– Reports clinical quality measures
Medicaid HIT Incentive Payments
• For providers with high Medicaid volumes to cover the
providers costs for acquiring, using and maintaining certified
EHR technology.
– Up to 85% of the providers’ costs
– Minnesota’s costs to administer matched at 90%
• Eligible providers:
– Children’s hospitals (regardless of Medicaid patient volume)
– Acute care hospitals with at least 10% Medicaid patient volume
– Professionals in FQHCs or RHCs with at least 30% needy individuals
– Other non-hospital based professionals with 30% Medicaid volume
– Pediatricians with at least 20% Medicaid volume
MDH priorities under ARRA
• Position providers to pull down maximum
incentive $$$s under Medicare and/or
Medicaid
• Address two largest barriers to implementing
electronic health records:
– Help finance the capital costs of purchasing and
adopting EHRs
– Assist health care providers in using EHRs
effectively
MDH Activities to Prepare Minnesota
• Secure state matching funds and make policy
changes to position MN for funding
• Apply for state grant to continue promoting HIT
• Apply for competitive grants to states for HIT loan
programs to help Minnesota providers purchase
EHR systems
• Inform Minnesota providers and stakeholders
• Collaborate with DHS on Medicaid HIT incentives
• Support statewide partner applications for
exchange, education and technical assistance,
telehealth, and broadband funding
Preparing Minnesota for ARRA:
2009 Policy Legislation Passed
• Assign new duties to coordinate with national
activities
• Allow collection of data for assessment & incentive
eligibility determination
• Identifies the Commissioner of Health as the lead
applicant or designating authority for HIT funding
• Aligns current Minnesota EHR loan program with
competitive state grant requirements
Securing matching funds
to seize ARRA opportunities
• Governor’s Budget:
– $350,000 Base Funding for e-Health (1:5 Match)
– $4 Million Funds for EHR Loans (1:5 Match)
– $128,000+ State Loan Repayment for Health
Professionals (1:1Match)
What Health Care Providers Can Do Now
•
If you are looking at buying an EHR be sure to plan thoroughly
before you buy
•
If you have an EHR, implement techniques that support effective use
•
Talk with your vendor to understand their plans for getting & staying
certified/qualified
•
Ensure your plan meets criteria for “meaningful use” as it evolves
•
Make sure you are adopting and using e-prescribing
•
Reach out to community partners and HIE’s to begin exchange of
information
•
Keep current by checking the e-Health website frequently
Resources for Adoption & Effective Use:
Companion Guides to Minnesota Statewide Implementation Plan
Companion Guides to the MN Statewide Implementation Plan
•
Guide 1: Addressing Common Barriers to the Adoption of EHRs
Released 2008
•
Guide 2: Standards Recommended to Achieve Interoperability in MN
Released 2008, Updated June 2009
•
Guide 3: A Practical Guide to e-Prescribing
Released June 2009
•
Guide 4: A Practical Guide to Effective Use of EHR Systems
Released June 2009
Additional Minnesota Resources
for Adoption & Effective Use of HIT
• ORHPC Grant Programs
– Rural Hospital Flexibility (Flex) Program
– Rural Hospital Capital Improvement Grant Program
– Rural Hospital Planning and Transition Grant Program
• Stratis Health
– Health Information Technology Toolkit for Small and Rural
Communities
– Support and Consulting
Minnesota e-Health Initiative
Resources & Learning Opportunities
• Minnesota e-Health “Gov Delivery” List – Weekly Updates
• Monthly Conference Call Updates
• HITECH Web Page: www.health.state.mn.us/e-health
• Minnesota e-Health Summit
– “Strategies for Success in Challenging Economic Times”
– June 25, 2009 – Northland Inn
• Minnesota e-Health Pre-Summit
– June 24, 2009 – Northland Inn
– Effective Use
• Minnesota Rural Health Summit
– June 15-16, 2009 – Duluth, MN
For More Information
www.health.state.mn.us/e-health/hitech.html
Liz Carpenter
MDH
Center for Health Informatics
[email protected]
651-201-5979
Anne Schloegel
MDH
Office of Rural Health and Primary Care
[email protected]
651-201-3850