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Health Information TechnologyNationwide Activities and Issues
Roy H. Wyman, Jr.Roy H. Wyman, Jr.
May 7, 2009May 7, 2009
Agenda
• What I Couldn’t Do with Plenty of Money and a Clue
• We’re from the Government, and We’re Here to Help
Plenty of Money and a Clue
• How much Money?– $19 Billion through Medicare and Medicaid in grants,
loans and incentive payments– $85 Million to Indian Health Services for HIT– $3.95B to the Workforce Investment Act of 1998– $500M for health centers under the PHS Act– $2B to ONC
• $300M for regional or sub-national efforts toward HIE
• $20M to NIST
Plenty of Money and a Clue
• Give Me the Money!– Medicare/Medicaid: “Meaningful Use”
• ‘‘Meaningful Use Of Certified EHR Technology”
– Certified EHR technology including the use of electronic prescribing
– Connected in a manner that provides for the electronic exchange of health information
– Apply for Loans:
• Be in the Right State• Apply
Plenty of Money and a Clue
• Concerns in Adopting an EHR– Interoperability and Certification (CCHIT)– Work Flow– Interface– Training– Leadership
• Legal Limitations and Considerations– Stark and Anti-kickback Rules– Security and Privacy (yes, Encryption)– Policies and Procedures– Contract Liability
We’re from the Government, and We’re Here to Help
• The “W” Approach:– Bottom-Up– Private Entities or Private-
Public Partnerships– Let the Market Decide
• The Result:– ONC & AHIC– NHIN– CCHIT– HITSP– HISPC
We’re from the Government, and We’re Here to Help
• The New Appr“O”ach:– Institutionalize the Process (i.e., add money)– Governmental Entities– Let the Best Minds Decide
• The Result:– ONC Agency– NHIN– HIT Policy Committee (AHIC?)– HIT Standards Committee (CCHIT? AHIC?)
11
The Nationwide Health Information Network
Health Bank orPHR Support Organization
Community #1
IntegratedDelivery System
Community Health Centers
Community #2
State and Local Gov
Labs
Pharmacies
CDC
VA
IHS
DoD
SSA
The InternetStandards, Specifications and Agreementsfor Secure Connections
Mobilizing Health Information Nationwide
The Health Information Security and Privacy Collaboration (“HISPC”)
• 44 States and Territories• In Three Phases
1. Identify Barriers
2. Work Individually on Barriers
3. Work Together on Fixing them
The Health Information Security and Privacy Collaboration
• 7 Multi-State Collaboratives– Consent 1 – Data Elements– Consent 2 – Policy Options– Harmonizing Privacy Law– Consumer Education and Engagement– Provider Education– Adoption of Standard Policies– Interorganizational Agreements
Where Are We?
• HHS Regulations for Breach by Covered Entities– Destroy or Encrypt– Use NIST standards
• FTC Regulations on Breach by Personal Health Record Vendors– “Breach” means whatever HHS says
• Enforcement by AGs and Tiered HIPAA Penalties in Place
What’s Next?
• Standards, spec’s and cert. criteria: 12/31/09
• Competitive Loan Money to States: 1/1/10• Regional Extension Centers Funded: 2010
(Reg’s by 5/18/09)• Privacy/Security Provisions: 2/16/10• Incentive Payments begin: FY11• EHR Accounting Effective: 1/1/11• Breach Notification Rules: 8/16/09
What’s Next (cont.)
• First Annual Report of Breaches: 2/16/10• Minimum Necessary Rules: 8/16/10• Regulations re: Sale of PHI: 8/16/10• Rules re: CMPs to Victims of Disclosure:
2/16/12• Rules re: De-Identification: 2/16/10• Universal Use of EHR: 2014• Penalties for Non-use Begin: 2015
Roy H. Wyman, Jr. P.O. Box 12109Research Triangle Park, NC 27709919.981.4313