Colleen Woods Health IT Coordinator State of New Jersey March 7, 2012 Connecting Patients to a Greater State of Health.

Colleen WoodsHealth IT CoordinatorState of New Jersey

March 7, 2012

Connecting Patients to a Greater State of Health

New Jersey Health Information Technology

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The Condition of Healthcare

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

“Where Wisdom Lives”

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Healthcare Transformation

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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Seeing ResultsPrimary 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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NZ AUS UK NET SWE GER US NOR FR CAN0

25

50

75

100 92 91 89

5449

3626

19 15 14

Primary Care Practices with Advanced Electronic Health Information Capacity by Country

* 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

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Percentage of Office-Based Physicians planning to apply for Meaningful Use Incentives*

Source: 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

New Jersey (31%) has a lower percentage of physicians potentially able to meet meaningful use core criteria when compared with national average

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

New Jersey (16%) has the lowest percent of physicians in the country using any EMR/EHR system

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New JerseyHIT

Overview

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Conceptual Technical ArchitectureFull Operation

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

State Gov’t HIO

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

NwHIN, Health Plans

GATEWAY

Health-e-cITi

Trenton Health Team

Camden

Hospital

Physician Office

Hospital

Long Term Care

EMS

Behavioral Health

Home Health

IDN

Assisted Living

EMS

Physician Office

MOHIE Jersey Health

Connect

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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MOHIEBayshore Community Hospital Community Medical CenterJersey Shore University Medical CenterKimball Medical CenterK. Hovnanian Children’s Hospital Monmouth Medical CenterOcean Medical CenterRiverview Medical CenterSouthern Ocean Medical Center FQHC - Monmouth Family Health Center

Hudson

HIOs and IDNsHealth-e-cITi-NJNewark Beth Israel Medical Center St. Michael’s Medical Center East Orange General Hospital Meadowlands Hospital Christ HospitalUniversity Hospital St. Joseph’s Healthcare System Jersey City Regional Medical CenterFQHC - Newark Community Health Center

Jersey Health ConnectAtlantic Health Morristown Memorial, Overlook, NewtonCentraStateChildren's Specialized HospitalCJHIEP (Physician Organization)Hackensack University Medical Holy Name Medical CenterHunterdon HealthcareJFK Health SystemParker Memorial Home (LTC)Robert Wood Johnson University HospitalRobert Wood Johnson – HamiltonRobert Wood Johnson- RahwaySaint Barnabas Medical CenterSaint Clare’s Health Services Saint Peter’s Healthcare System Somerset Medical CenterTrinitas Regional Medical Center

CamdenCooperLourdesVirtuaUnderwoodKennedyFQHC – Camcare / Project Hope

Trenton Health TeamCapital Health SystemSt. Francis Medical CenterCity of TrentonFQHC - Henry J. Austin Health Center IDNs

AtlantiCare Regional Medical Center Barnabas Healthcare SystemSouth Jersey Health SystemVirtua Health

Atlantic

Bergen

Burlington

Camden

May

Cumberland

Essex

Gloucester

Hunterdon

Middlesex

Morris

Ocean

Passaic

Salem

Somerset

Sussex

Warren

Cape

Union

Monmouth

Mercer

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Use Cases

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 HIO 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.

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Where Are We Today?

2014: EHRs for All New JerseyansWe envision a New Jersey Health IT environment by 2014 where all NJ consumers have a secure electronic health record that includes all health related information and services (including behavioral health & addiction services)!

Health IT Goals for New Jersey

www.nj.gov/njhit

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EHR Adoption

EHR Adoption

Metric Actual Target Variance %

Physicians (MDs and DOs) Using an EHR system at Any Practice Location

8,330 26,819 18,489 31.1%

Total Hospitals Adopting EHRs

54 71 17 76%

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$81+ mil. in EHR Incentives Paid in NJ

Medicare EHR Incentive Payments

Provider Type Provider Count

Medicare Incentive Payment Amount

Eligible Professionals 872 15,696,000

Eligible Hospitals 9 25,835,214

Total: $41,531,214

NJ Medicaid EHR Incentive Payments

Provider Type Provider Count

Medicaid Incentive Payment Amount

Eligible Professionals 120 2,542,917

Eligible Hospitals 31 37,277,985

Total: $39,820,902

www.nj.gov/njhitAs of 2/18/2012

Health-e-cITiCamdenJersey Health ConnectTrentonMOHIE

Stages of Health Information Organization Development

Stage 1 Stage 2 Stage 3 Stage 4 Stage 5 Stage 6 Stage 7Starting Organizing Planning Piloting Operating Sustaining Innovating

New Jersey HIOs--Stages

Stage 4: Well under way with implementation - technical, financial and legal. (Pilot project or implementation with multiyear budget identified and tagged for a specific need)Stage 5: Fully operational health information organization; transmitting data that is being used by healthcare stakeholders.

www.nj.gov/njhit

HIOs Momentum: Connecting Hospitals and Physicians to HIOs, IDNs

Almost 2,000 Physicians Sharing/Exchanging Data within a NJ HIO or IDN

48 Hospitals Members16 Hospitals Exchanging Data within a NJ HIO or IDN

www.nj.gov/njhit

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Aligning Behavioral HealthWith

Health IT

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NJ Behavioral Health IT Initiatives

Camden CoalitionCatholic Charities of TrentonBehavioral Health Information Collaborative

Bergen Regional Medical Center/CAMCare

The Nicholson FoundationNJAMAA Subcommittee Participation

NJ Health IT Vision Statement - “We envision a New Jersey HIT environment by 2014 where: All NJ consumers have a secure electronic health record that includes all health related information and services (includes behavioral health & addiction services)”

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Aligning for the Future

Medicaid Waiver Programs are providing a combination of both traditional medical services as well as non-medical services to those who meet both the established clinical and financial criteriaEMR system being purchased for State InstitutionsAdministrative Service Organization for the Management Behavioral Health Care Organization (ASO/MBHO Model)

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HIT Privacy and Security

HIPAAConsent for Sensitive DataFor Example:

All patients are auto-connected to the hospital via a Personal Health Record

•Initial consent is either “all in” or “all out”•Once in the PHR, the patient can: •Manage granularity of sensitive data•Assign relationships to physicians•See who has looked at their record

2012: Moving from Local to StatewideHIOs Continue ImplementingConnect HIO to HIOIntegration of BH and CHNew Jersey SHARE

State Health Access and Records Exchange

Health IT Goals for New Jersey

www.nj.gov/njhit

NJ HIT Program Focus for 2012+

Phase 4: Framework Design Financial Sustainability Medicaid Incentive Program and

Meaningful Use Stage 1 NJHIN Planning Use Case Development #1-5• Legislation and Regulation

= CompletedPhase 7:

Personal and National• Disease Management• Syndromic Surveillance• Full EHR Adoption• Connect NHIN• Interstate Exchange• Meaningful Use Phase 3

Phase 1: Strategy Planning Funding Request Strategic Planning Organizational Structure

Phase 5: Implementation• Implement Financial

Sustainability• HIO Trust Agreements• Establish NJHIN• HIO Connection• Research pilots• PHR Focus• SHARE (State HIO)

Phase 6: Focus on Exchange

• Data Exchange and Analytics• State HIO• State Health Registries• Long term Care Integration• Behavioral Health Integration• Meaningful Use Stage 2

2013

2012 Q2-Q4

2011 Q4 – 2012 Q4

Phase 2: Planning Funding Governance HIO Initial Build Policies Initial Stakeholder Outreach Operational Plan State Medicaid HIT Plan

Consumer & Stakeholder Outreach

EHR Adoption

Enabling New Jersey

Health Information Exchange

Phase 3: Foundation Standing Up Regional HIOs Architecture & Standards Quality Measures Legal Framework Use Cases for Care

Coordination 2011 Q1 Q2

2011 Q2 –Q423

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NJ Health IT Champion Program

Thank you, NJ Health IT Champions!

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Questions?

Reference:www.nj.gov/njhit