1 Colleen Woods Health IT Coordinator State of New Jersey June 8, 2012 Connecting Patients to a Greater State of Health.

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Colleen WoodsHealth IT CoordinatorState of New Jersey

June 8, 2012

Connecting Patients to a Greater State of Health

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The Population is Aging (Baby Boomers)Nursing, Physician and Other Clinical ShortagesMore than 51% of the US Population’s healthcare is financed in some way by tax dollars (Medicare, Medicaid, Charity Care, Government Employees, Armed Services, Firefighters, Police, Teachers, Etc…)Healthcare IT adoption is 12 years behind other industriesToday’s healthcare information network for sharing clinical information is connect via phones and faxIn New Jersey 60 – 70% of providers are still using paper-based medical records (NJHA Estimate)

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David BrooksNew York Times Columnist

“The average 56-year-old couple pays about $140,000 into the Medicare system over a lifetime and receives about $430,000 in benefits back. The program is also completely unaffordable. Medicare has unfinanced liabilities of more than $30 trillion. The Medicare trustees say the program is about a decade from insolvency. “

– New York Times, Monday June 6, 2011

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1. Electronic Health Records (EHRs)2. Health Information Organizations (HIOs)3. Health Information Network (HIN)

Payment Transformation Delivery of Care

Transformation

Health Information Technology

Transformation

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Primary Care Practices of Better Health Greater ClevelandPractices that use electronic health recordssaw significantly higher achievement and improvement in meeting standards of care and outcomes in diabetes than practices using paper records. --NEJM, September 1, 2011

Nearly 51% of patients in EHR practices received care that met all of the endorsed standards.Only 7% of patients at paper-based practices received this same level of care– a difference of 44%.After accounting for differences in patient characteristics between EHR and paper-based practices, EHR patients still received 35% more of the care standards.

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* Count of 14 functions includes: electronic medical record; electronic prescribing and ordering of tests; electronic access test results, Rx alerts, clinical notes; computerized system for tracking lab tests, guidelines, alerts to provide patients with test results, preventive/follow-up care reminders; and computerized list of patients by diagnosis, medications, due for tests or preventive care.

Source: 1. 2009 Commonwealth Fund International Health Policy Survey of Primary Care Physicians

Percent reporting at least 9 of 14 clinical IT functions*

Adoption of health information technology (IT) among primary care practices is highly variable across countries, with the United States lagging well behind other nations

7Source: 1. CDC/NCHS, National Ambulatory Medical Care Survey Electronic Medical Record/Electronic Health Record Systems of Office-based Physicians: United States, 2010, and Preliminary 2011 State Estimates

*Also includes office-based physicians who have EHR system capabilities to support eight Stage 1 Core Set meaningful use objectives

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Salem

Camden (Noteworthy)Hospitals:• Cooper University Hospital• Kennedy University Hospital (Turnersville, Cherry Hill,

Stratford)• Lourdes Medical Center of Burlington County• Our Lady of Lourdes Medical Center• Underwood Memorial Hospital• Virtua Hospital (Berlin, Marlton, Memorial,

Voorhees)Federally Qualified Health Centers:• CAMcare Health Corporation• Project Hope, Inc.

Camden (Noteworthy)Hospitals:• Cooper University Hospital• Kennedy University Hospital (Turnersville, Cherry Hill,

Stratford)• Lourdes Medical Center of Burlington County• Our Lady of Lourdes Medical Center• Underwood Memorial Hospital• Virtua Hospital (Berlin, Marlton, Memorial,

Voorhees)Federally Qualified Health Centers:• CAMcare Health Corporation• Project Hope, Inc.

Integrated Delivery NetworksHospitals: • AtlantiCare Regional Medical Center (Atlantic City,

Mainland Campus)• South Jersey Healthcare (Regional Medical Center,

Elmer Hospital)

Integrated Delivery NetworksHospitals: • AtlantiCare Regional Medical Center (Atlantic City,

Mainland Campus)• South Jersey Healthcare (Regional Medical Center,

Elmer Hospital)

MOHIE (ICA)Hospitals:• Bayshore Community Hospital• Community Medical Center• Jersey Shore University Medical Center• Kimball Medical Center• Monmouth Medical Center• Ocean Medical Center• Riverview Medical Center• Southern Ocean Medical CenterFederally Qualified Health Center:• Monmouth Family Health Center

MOHIE (ICA)Hospitals:• Bayshore Community Hospital• Community Medical Center• Jersey Shore University Medical Center• Kimball Medical Center• Monmouth Medical Center• Ocean Medical Center• Riverview Medical Center• Southern Ocean Medical CenterFederally Qualified Health Center:• Monmouth Family Health Center

Health-e-cITi-NJ (IGI Health / ORBIT)Hospitals:• Christ Hospital• East Orange General Hospital• Jersey City Medical Center• Meadowlands Hospital Medical Center• Newark Beth Israel Medical Center• Saint Michael's Medical Center• St. Joseph's Hospital (Paterson, Wayne) • UMDNJ-University HospitalFederally Qualified Health Centers:• Newark Community Health Centers, Inc.• Newark Homeless Health Care• Horizon Health Center• North Hudson Community Action Corporation Health

Center• Metropolitan Family Health NetworkHome Health • Visiting Nurse Association of Central Jersey

Health-e-cITi-NJ (IGI Health / ORBIT)Hospitals:• Christ Hospital• East Orange General Hospital• Jersey City Medical Center• Meadowlands Hospital Medical Center• Newark Beth Israel Medical Center• Saint Michael's Medical Center• St. Joseph's Hospital (Paterson, Wayne) • UMDNJ-University HospitalFederally Qualified Health Centers:• Newark Community Health Centers, Inc.• Newark Homeless Health Care• Horizon Health Center• North Hudson Community Action Corporation Health

Center• Metropolitan Family Health NetworkHome Health • Visiting Nurse Association of Central Jersey

Jersey Health Connect (McKesson RelayHealth)Hospitals:• CentraState Medical Center• Children's Specialized Hospital• Clara Maass Medical Center• Hackensack University Medical Center• Holy Name Medical Center• Hunterdon Medical Center• JFK Medical Center• Morristown Memorial Hospital• Newton Memorial Hospital• Overlook Hospital• Robert Wood Johnson University Hospital (New

Brunswick, Hamilton, Rahway)• Saint Barnabas Medical Center• Saint Clare's Hospital (Denville Campus, Dover

General, Sussex)• Saint Peter's University Hospital• Somerset Medical Center• Trinitas Regional Medical CenterPhysicians• Summit Medical Group• Central Jersey HIE Project (CHIEP)Long Term Care• PARKER

Jersey Health Connect (McKesson RelayHealth)Hospitals:• CentraState Medical Center• Children's Specialized Hospital• Clara Maass Medical Center• Hackensack University Medical Center• Holy Name Medical Center• Hunterdon Medical Center• JFK Medical Center• Morristown Memorial Hospital• Newton Memorial Hospital• Overlook Hospital• Robert Wood Johnson University Hospital (New

Brunswick, Hamilton, Rahway)• Saint Barnabas Medical Center• Saint Clare's Hospital (Denville Campus, Dover

General, Sussex)• Saint Peter's University Hospital• Somerset Medical Center• Trinitas Regional Medical CenterPhysicians• Summit Medical Group• Central Jersey HIE Project (CHIEP)Long Term Care• PARKER

Trenton Health Team (Covisint)Public Health Department•City of TrentonHospitals:• Capital Health Regional Medical Center• Capital Health Medical Center – Hopewell• St. Francis Medical Center

Federally Qualified Health Center:• Henry J. Austin Health Center, Inc.

Trenton Health Team (Covisint)Public Health Department•City of TrentonHospitals:• Capital Health Regional Medical Center• Capital Health Medical Center – Hopewell• St. Francis Medical Center

Federally Qualified Health Center:• Henry J. Austin Health Center, Inc. Atlantic

Bergen

Burlington

Camden

May

Cumberland

Essex

Gloucester

Hud

son

Hunterdon

Mercer

Middlesex

Monmouth

Morris

Ocean

Somerset

Cape

Union

PassaicSussex

Warren

Salem

www.nj.gov/njhit

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State Data Sources:•Immunizations•Medicaid•Blood Screening•Bio surveillance•DMV Demographics•Other registries

Health Entity Directory•Web Services Registry•Provider Directory (supporting DIRECT)•Provider Credentialing

Certificate Authority

NJHIN Core Services

State Gateway Services •Relay Service (External Queries) •Patient Discovery & Document Exchange •Statewide Data Aggregation

GATEWAY

NJHIO Nodes•Pt Discovery & Document Exchange Gateways•HIO-level MPI•HIO-level Record Locator•Consent Mgmt (interim)•DIRECT Services•Security Compliance

Surescripts & Labs

NJHIN•Onboarding•Security Compliance

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* Physicians in these hospitals access data within their own hospitals only

www.nj.gov/njhit

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Use Case Name Description

1. Medication History Patient medication histories are made available for Emergency Room admissions only. This Use Case will include the Cross Community Patient Discovery (XCPD) Profile to support accurate patient identification.

2. Public Health Data (Immunization Data)

To provide patient immunization history directly to the physician EHR. The State registry connection will be direct to the physician EHR.

3. Diagnostic Results Available to All HIE Customers

To provide patient laboratory test and radiology images results (later Use Case will address the Order side as well as open order/pending result). This Use Case will include the radiology report and not the image.

4. ED/Acute Discharge Summary

The transfer of patient information in the form of discharge notes to the PCP or specialists at the time of discharge. Near term – ED/Acute Hospital discharge information only.

5. Transition of Care-Referral Information

This Use Case is to enhance communications between PCP and specialist with an opportunity to use “Direct” as a near-term way to conduct secure exchange of health information.

12Source: EHR Incentive Program Registrations and NJHA survey

Hospital EHR Adoption

Hospitals Count EHR Adoption EHR Adoption %

Total Hospitals 111 63 57%

General Acute Care 71 61 86%

Comprehensive Rehabilitation 14 1 7%

Special 15 1 7%

Psychiatric 11 -- --

www.nj.gov/njhit

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County Population PCPs in Patient Care

Atlantic 270,609 244Bergen 889,915 1,527Burlington 445,492 434Camden 517,739 626Cape May 96,470 42Cumberland 156,784 94Essex 767,075 1,191Gloucester 288,168 189Hudson 592,111 506Hunterdon 129,806 279Mercer 364,571 490Middlesex 785,324 1,242Monmouth 641,864 984Morris 486,946 717Ocean 569,662 336Passaic 488,364 457Salem 66,194 36Somerset 323,160 587Sussex 151,431 77Union 521,816 551Warren 109,897 117

NJ TOTAL 8,663,398 10,726

County Health Rankings 2011Primary care physicians include practicing physicians specializing in general practice medicine, family medicine, internal medicine, pediatrics, and obstetrics/gynecology. The measure represents the population per one provider.

The data on primary care physicians were obtained from the Health Resources and Services Administration’s Area Resource File (ARF) for 2009. The ARF data on practicing physicians come from the AMA Master File (2008), and the population estimates are from the U.S. Census Bureau’s 2008 population estimates.

County Health Rankings (CHR) Web site. CHR is a program of the Robert Wood Johnson Foundation (RWJF) and the University of Wisconsin Population Health Institute.

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Physician EHR Adoption

Physicians TotalEHR

Adoption #EHR

Adoption %

Total Licensed Physicians 33,840 8,330 25%

Active Physicians 25,629

Active Patient Care Physicians 21,958

Hospital-Based 3,428

Target Priority: Office-Based 18,530 6,411 35%

Primary Care Physicians 10,726 3,305 31%

Specialists 7,804 3,106 40%

BME: New Jersey Board of Medical ExaminersAAMC: Association of American Medical Colleges, EstimateSK&A: Research Vendor County Health Rankings, NJ-HITEC

www.nj.gov/njhit

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Medicare EHR Incentive Payments

Provider TypeProvider

CountMedicare Incentive Payment Amount

Eligible Professionals

1,878 32,930,174

Eligible Hospitals 14 37,070,065

Total: $70,000,239

NJ Medicaid EHR Incentive PaymentsProvider Type

Provider Count

Medicaid Incentive Payment Amount

Eligible Professionals

699 14,621,421

Eligible Hospitals 37 45,800,838

Total: $60,422,259

CMS, June 5, 2012

Total EHR Incentive Program Registrants: • Eligible Professionals = 5,884• Eligible Hospitals = 57

www.nj.gov/njhit

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Highest utilizers of HIOs – office staff, medical records staff, nurse practitionersReal cost savings seen in the administrative processes – referrals, prior authorizationCommunication with the patientPoint of care remindersPCP’s who have EHR’s now want HIE

www.nj.gov/njhit

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HIE to HIE and the NJHIN – slowTrust agreements – difficult Implementation – climb the wall, reenergize Moving closer to the “tipping point”New focus on accuracyConsent – a bearIntegration/Interoperability – hardCollaboration is vital!

www.nj.gov/njhit

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Reference:www.nj.gov/njhit