Transcript Slide 1

Kentucky Health
Information Exchange
(KHIE)
Kentucky e-Health
Historical Overview
• March 8, 2005
– Legislation (Senate Bill 2) to create a
secure interoperable statewide
electronic health network
• Kentucky eHealth Network Board (KeHN)
• Health care Infrastructure Authority
– University of Kentucky
– University of Louisville
– Supported by the Cabinet for Health & Family
Services
• Appointment of several committees
– Health Information Exchange
Kentucky Health Information Exchange
The Beginning
2007 Medicaid Transformation Grant ($4.9M)
Allowed development of core functionality of
The Kentucky Health Information Exchange
(KHIE)
6 Pilot Hospitals and 1 Clinic signed
the KHIE Participation Agreement
KHIE pilot went live online April 1, 2010
KHIE and ARRA
2009 - American Recovery & Reinvestment Act
(ARRA)
to provide State Grants to Promote
Health Information Technology
to improve the quality and efficiency of health care
and expand the secure, electronic movement and use
of health information among organizations
according to nationally recognized standards
GOEHI Overview
Governor’s Office of Electronic Health Information
In August 2009, Governor Steve Beshear
named the Cabinet for Health and Family Services
as the state entity responsible for the administration of
Kentucky’s Health Information Exchange (KHIE)
and issued an Executive Order to create GOEHI
Charged with providing leadership
for statewide health information technology
ARRA Funding
State HIE Cooperative Agreement
• Strategic & Operational Plan submitted
August 27, 2010
• ONC must approve plan before
operational funds will be made available
• Kentucky expected to receive $9.75M
KHIE GOAL
Provide HIE Connectivity
to as many providers as possible
over the next year or so
with little or no startup cost to the
providers
KHIE – The Stakeholders
CHFS Administrative Order in February 2010
• KHIE Coordinating Council
– 23 Members on the Council
• 6 Committees reporting to the Council
(Six to ten members serve on each committee)
– Accountability & Transparency
– Business Development & Finance
– Interoperability & Standards Development
– Provider Adoption & Meaningful Use
– Privacy & Security
– Population Health
Kentucky Environmental Scan
• Laboratory - 60% Labs operating can deliver reports
electronically
43% Providers receiving reports electronically
• Pharmacy – 85% Pharmacies capable of receiving ePrescribing
16% Providers actually e-Prescribing
• Nationally < 4% Providers fully utilizing EMR Systems
Key Findings
Identifying ‘challenges’ (and resolutions)!!
• Many vendors/EMR systems not ready to process CCD
(Continuity of Care Document – Standard of patient data transfer)
• Cost of EMR upgrades to hospitals & physician practices
• Disruption of practice for EMR implementation
• Getting Participant Agreements signed with KHIE
Current Work & Progress(!)
 ACS and Axolotl in Partnership for KHIE Connectivity
 Four Additional Hospitals and Two FQHC Clinics being
added
 Outreach and Informational Sessions:
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Four Regional KHA meetings in September & October
KPCA Annual Meeting October 18
Regional AHIMA Meetings October 22nd & November 5th
Five CME Meetings with KY REC
KHA/KMA e-Health conference November 17
One-on-One meetings at Provider Locations
KHIE & RHIO’s
• KHIE is working closely with all
RHIO’s in Kentucky including
HealthBridge, the Northeast KY
RHIO and LouHIE
• KHIE and HealthBridge have a
signed MOU to connect Health
Bridge to the KHIE
KHIE and REC Coordination
2 Regional Extension Centers
For Provider EMR Adoption, Implementation,
And Connectivity
University of Kentucky
and
HealthBridge
Kentucky Regional Extension Centers
Healthbridge Tri-State REC
UK & Healthbridge
UK, UL & Kentucky REC
University of Kentucky REC
Boone
Gallatin
Bracken
Grant
Carroll
Mason
Trimble
Henry
Harrison
Oldham
Nicholas
Scott
Jefferson
Franklin
Shelby
Meade
Hancock
Henderson
Breckinridge
Daviess
Union
Crittenden
Mclean
Ohio
Green
Taylor
Christian
Trigg
Todd
Pulaski
Calloway
Fulton
Source: Kentucky Hospital Association, 2010
Barren
Laurel
Owsley
Perry
Clay
Floyd
Pike
Knott
Knox
Allen
Monroe
Letcher
Leslie
Russell
Logan
Simpson
Hickman Graves
Metcalfe
Warren
Marshall
Jackson
Rockcastle
Casey
Adair
Lyon
Lee
Breathitt
Mccracken
Carlisle
Garrard
Boyle
Clinton
Wayne
Mccreary
Martin
Magoffin
Edmonson
Butler
Caldwell
Ballard
Johnson
Wolfe
Estill
Lincoln
Hart
Muhlenberg
Morgan
Powell
Madison
Grayson
Hopkins
Menifee
Mercer
Marion
Elliott
Lawrence
Clark
Washington
Larue
Webster
Rowan
Fayette
Anderson
Boyd
Carter
Bath
Nelson
Hardin
Fleming
Bourbon
Spencer
Bullitt
Greenup
Lewis
Robertson
Owen
Harlan
Whitley
Bell
KHIE and CHFS Cabinet Resources
• KHIE is the resource for Cabinet data
– 2 years of Medicaid Claims Data currently available in
production with nightly data load updates
• State Laboratory Results
– Newborn Screenings
– All other legally available state lab tests available
– Currently in testing mode with the two lab vendors
• Immunization Registry
– In production in pilot stage
– Currently in design phase to connect the Immunization Registry
to the KHIE
• Future interfaces with Public Health planned
KHIE Rollout
• Continue to add hospitals in groups of 4-5
• Two methods to submit
– Using CCD (Continuity of Care Document)
– Using Edge Server allowing access to the
Virtual Health Record
• Provide server to providers that choose
the Edge Server method
• Working with EHR Vendors statewide to
get interfaces built
Medicaid Incentive Program Physicians
• Medicaid - Physicians whose caseloads
include at least 30% Medicaid patients are
eligible to receive up to $63,750 over the
course of 6 years.
Verify Eligibility: Professionals
Eligible Professionals (EPs) that qualify can receive only
Medicare or Medicaid incentive payments, not both
Medicare
Eligible if not hospital-based:
• Doctor of Medicine or Osteopathy
• Doctor of Dental Surgery or Dental
Medicine
• Doctor of Podiatric Medicine
• Doctor of Optometry
• Chiropractor
Ineligible - Hospital-based EPs
defined as:
• Furnishing 90% or more of their
services in either the inpatient or
emergency department of a hospital
• Place of service (POS) code:
• 21 (Inpatient Hospital), or
• 23 (Emergency Room, Hospital)
Medicaid
Eligible if not hospital-based and
minimum 30% Medicaid volume
(exception, 20% for pediatricians):
• Physicians
• Nurse Practitioners (NPs)
• Certified Nurse-Midwives (CNMs)
• Dentists
Eligible without hospital-based
exclusion:
• Physician Assistants (PAs) working
in a Federally Qualified Health
Center (FQHC) or Rural Health
Centers (RHC) led by a PA with
minimum 30% patient volume
attributable to needy patients.
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Patient Volume
• One member, one provider, same
day – one encounter
• A “proxy” at the clinic level is
acceptable, but all EPs need to be
included
• Count only Medicaid not KCHIP
• Passport members can be included
• Methodology to include “panels”
Attestation: Medicaid First Year Requirements
States may elect to establish first year
Medicaid payments before EHs and
EPs achieve MU status
• If states design their Medicaid EHR incentive program
for first year payment before MU status is achieved, EHs
and EPs must:
• Attest to have “adopted, implemented, or upgraded to
Certified EHR technology.”
• Adopt, implement, or upgrade means:
• Acquire, purchase, or secure access to Certified EHR
technology;
• Install or commence utilization of Certified EHR technology
capable of meeting meaningful use requirements; or
• Expand the available functionality of Certified EHR
technology or upgrade from existing EHR technology to
Certified EHR technology.
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Attesting to Meaningful Use
Attestation for EPs who work at multiple
locations
• An EP who works at multiple locations, but does not
have certified EHR technology available at all of them
would:
• Have to have 50% of their total patient encounters at
locations where certified EHR technology is available.
• Would base all MU measures only on encounters that
occurred at locations where certified EHR technology is
available.
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EP - AIU costs
• Medicaid pays 85% of the Net
Average Allowable cost.
• Can include costs from the past.
• Hardware, software, connectivity,
training, initial data entry, practice
workflow redesign
• Maintain auditable records
Medicaid EHR Incentive for PPS Hospitals and CAHs
Medicaid EHR incentive payment formula
for PPS hospitals and CAHs
• Similar to Medicare EHR incentive formula design.
• Built on a base amount of $2 million per hospital, per year.
• Adjusted:
• Upward by hospital’s all-payer discharges ( includes the
hospital’s projected average annual rate of growth for years
2 through 4); then
• Downward by hospital’s Medicaid percent of total patient
days with an adjustment to account for charity care (KY
medicaid has proposed using the DISH payment K-MAP4
form).
Allocation of Medicaid EHR incentives
• Payments will be made in 3 years
• First year payment will be 50% of the total incentive payment
for the Hospital. KY DMS has proposed 40% for year two
and 10% for year 3 with a caveat that this can be adjusted
based on overall effectiveness of the program.
Register for EHR Incentive Program
Electronic registration
• CMS will establish on-line provider registration as early as
January 2011
• http://www.cms.gov/EHRIncentivePrograms/
• Eligible hospitals and physicians and other professionals should
register even before they are meaningful users.
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“We frequently talk about health IT
with an emphasis on the technology.
But at the heart of the transformation of our
health system, it’s really all
about people.
Above all, it’s about improving care
for all Americans.”
Dr. Charles Friedman
More information on the KHIE can
be found on the Governor’s Office
of Electronic Health Information
website at
http://chfs.ky.gov/os/goehi/