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From National Health IT to State Uniform Companion Guides Realities and Opportunities to Make Standards Finally Work Presented at the HIPAA COW 2008 Fall Conference Sheboygan, WI – September 19, 2008 Walter G. Suarez, MD, MPH President and CEO - Institute for HIPAA/HIT Education and Research Member, National Committee on Vital and Health Statistics (NCVHS) Member, Board of Directors, Health Information Technology Standards Panel (HITSP)

Presented at the HIPAA COW 2008 Fall Conference Sheboygan, WI – September 19, 2008

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From National Health IT to State Uniform Companion Guides Realities and Opportunities to Make Standards Finally Work. Presented at the HIPAA COW 2008 Fall Conference Sheboygan, WI – September 19, 2008 Walter G. Suarez, MD, MPH - PowerPoint PPT Presentation

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Page 1: Presented at the   HIPAA COW 2008 Fall Conference Sheboygan, WI – September 19, 2008

From National Health IT to StateUniform Companion Guides

Realities and Opportunities to Make Standards Finally Work

Presented at the HIPAA COW 2008 Fall Conference

Sheboygan, WI – September 19, 2008

Walter G. Suarez, MD, MPHPresident and CEO - Institute for HIPAA/HIT Education and ResearchMember, National Committee on Vital and Health Statistics (NCVHS)

Member, Board of Directors, Health Information Technology Standards Panel (HITSP)

Page 2: Presented at the   HIPAA COW 2008 Fall Conference Sheboygan, WI – September 19, 2008

Outline

• Why are we here today?

• Core Health IT and HIE Concepts

• Business Case for NHIN and NHIEs

• A National Coordinated Agenda

• Where Things Stand Today

• Transitioning to State Realities: The Minnesota Statewide

Uniform Companion Guide Development Project

• Take away messages

Page 3: Presented at the   HIPAA COW 2008 Fall Conference Sheboygan, WI – September 19, 2008

Why are we here? Some Critical Health Needs and the National HIT Agenda

• Avoidance of medical errors– Up to 98,000 avoidable annual deaths due to medical errors

• Improvement of resource utilization– Up to $300B spent annually on treatments with no health yield

• Acceleration of knowledge diffusion– 17 years for evidence to be integrated into practice

• Reduction of variability in healthcare delivery and access– Access to specialty care highly dependent on geography

• Empowerment of the consumer– Capitalize on growing consumer trend of active health management

• Strengthening of data privacy and protection– HIPAA becomes reality

• Promotion of public health and preparedness– Surveillance is fragmented, and importance to homeland security brings heightened

awareness

Page 4: Presented at the   HIPAA COW 2008 Fall Conference Sheboygan, WI – September 19, 2008

Core Concepts

Page 5: Presented at the   HIPAA COW 2008 Fall Conference Sheboygan, WI – September 19, 2008

Health IT and HIE - Leading Transformation Factors

• Electronic Health Records

• Personal Health Records

• Interoperable Standards

• Health Information Infrastructure

• Population Health Infrastructure

• Robust Security and Privacy

And…

• A business reason that supports doing all this!

Page 6: Presented at the   HIPAA COW 2008 Fall Conference Sheboygan, WI – September 19, 2008

What is “Interoperability”?

“The ability of different information technology

systems and software applications to

communicate, to exchange data accurately,

effectively and consistently, and to use the

information that has been exchanged.”

Source: National Alliance for Health Information Technology, July 2005; “Consensus

Conventions for the Use of Key HIT Terms” Project – ONC/HHS, 2008

Page 7: Presented at the   HIPAA COW 2008 Fall Conference Sheboygan, WI – September 19, 2008

“Record” Terms

Source: National Alliance for Health Information Technology, Report to the Office of the National Coordinator for Health Information Technology – Defining Key Health Information Technology Terms, April 28, 2008

Page 8: Presented at the   HIPAA COW 2008 Fall Conference Sheboygan, WI – September 19, 2008

“Network” Terms

Source: National Alliance for Health Information Technology, Report to the Office of the National Coordinator for Health Information Technology – Defining Key Health Information Technology Terms, April 28, 2008

Page 9: Presented at the   HIPAA COW 2008 Fall Conference Sheboygan, WI – September 19, 2008

RHIO and HIE – Distinguishing and Common Characteristics

Page 10: Presented at the   HIPAA COW 2008 Fall Conference Sheboygan, WI – September 19, 2008

The Business Case for Regional and The Business Case for Regional and Nationwide HIE InvestmentNationwide HIE Investment

Level of Exchange Primary Interest Support for NHIE

Federal / NationalClinical & Administrative Referrals, Results, Pop. Health

events(Medicare, MHS/VA/IHS/SSA etc.)

Strong interest in NHIE and Mandatory Use of National

Standards

Regional / InterstateReferrals, Results, Pop. Health events

(Nat’l Payers & Self-funded Plans, etc.)

Strong Interest in National Standards;

Interest in NHIE

Statewide / IntrastateClinical & Administrative(Medicaid, State Health Plan, State

BCBS, Pop. Health awareness)

Strong Interest in National Standards;

Mild interest in NHIE

Cross-Communities / HIEsReferrals, Results, Pop. Health events

(Health Systems, Regional Payers, PH)

Interest in National Standards; Mild interest in Intrastate or

NHIE

Intra Medical Trading Area/Community

Referrals, Results Delivery, Administrative

(eRx, Lab, HIPAA claims/pmts)

Interest in StandardsAvoid technical isolation;

Mild interest in Intrastate / NHIE

Enterprise Internal Network(Internal to Practice, PH, Hospital, etc.)

Low Interest in NHIE

Page 11: Presented at the   HIPAA COW 2008 Fall Conference Sheboygan, WI – September 19, 2008

The National Health IT Strategy

Page 12: Presented at the   HIPAA COW 2008 Fall Conference Sheboygan, WI – September 19, 2008

Federal Government Collaborations Among Health IT Initiatives

Page 13: Presented at the   HIPAA COW 2008 Fall Conference Sheboygan, WI – September 19, 2008

ONC-Coordinated Federal Health IT Strategic Plan 2008-2012

Page 14: Presented at the   HIPAA COW 2008 Fall Conference Sheboygan, WI – September 19, 2008

ONC Health IT Strategic Plan (2008-2012)

Page 15: Presented at the   HIPAA COW 2008 Fall Conference Sheboygan, WI – September 19, 2008

National HIT Agenda and Health Information Exchange

PrioritiesPriorities• American Health Information

Community (AHIC)• Business needs and priorities• Use Cases

PrioritiesPriorities• American Health Information

Community (AHIC)• Business needs and priorities• Use Cases

StandardsStandards• Healthcare Information

Technology Standards Panel (HITSP)

• Recognized standards

StandardsStandards• Healthcare Information

Technology Standards Panel (HITSP)

• Recognized standards

NetworkingNetworking• NHIN - network of

networks• Architecture

specifications

NetworkingNetworking• NHIN - network of

networks• Architecture

specifications

PoliciesPolicies• State laws and regulations –• State Alliance for e-Health• State-level Health Information

Exchange• Health Information Security and

Policy Collaboration (HISPC)

PoliciesPolicies• State laws and regulations –• State Alliance for e-Health• State-level Health Information

Exchange• Health Information Security and

Policy Collaboration (HISPC)

CertificationCertification• Certification Commission For

Healthcare Information (CCHIT) Technology

• Criteria development• Testing

CertificationCertification• Certification Commission For

Healthcare Information (CCHIT) Technology

• Criteria development• Testing

AgendaAgenda

Page 16: Presented at the   HIPAA COW 2008 Fall Conference Sheboygan, WI – September 19, 2008

• Recommendations to Secretary on overall policy

directions related to Health IT

• Definition of priority areas (breakthroughs)

• Development of Use Cases for harmonization of

standards

• Transitioning to AHIC 2.0

Setting Priorities - AHIC

http://www.ahicsuccessor.org

Page 17: Presented at the   HIPAA COW 2008 Fall Conference Sheboygan, WI – September 19, 2008

Networking – NHIN and the NHIEs

• NHIN: the nationwide “Network of Networks”… of Networks– Framework for health information

network service providers

– Interconnecting NHIEs

– Business/Technical Issues: Standards, Sustainability, Security

• NHIEs: Local, state, regional HIEs interoperable with NHIN

http://www.hhs.gov/healthit/healthnetwork/background/

Page 18: Presented at the   HIPAA COW 2008 Fall Conference Sheboygan, WI – September 19, 2008

Networking – NHIN and the NHIEs

• Phase 1 (2007) – Prototyping – 4 Consortia

– Core elements of NHIN

• Phase 2 (2008) – Trial Implementations– 15+ sites

– Develop the NHIN HIE Specs

• Phase 3 (2009) - TBD

http://www.hhs.gov/healthit/healthnetwork/background/

Page 19: Presented at the   HIPAA COW 2008 Fall Conference Sheboygan, WI – September 19, 2008
Page 20: Presented at the   HIPAA COW 2008 Fall Conference Sheboygan, WI – September 19, 2008

Where are States with respect to HIEs?

Sources: Health Information Security and Privacy Collaborative (HISPC); State-level Health Information Exchange (SLHIE); January, 2008

Page 21: Presented at the   HIPAA COW 2008 Fall Conference Sheboygan, WI – September 19, 2008

Policies - HISPC• Phase 1 (2006-2007)

– 34 Teams (33 State, Puerto Rico) – 1) Assessments of privacy/security

variations; 2) Analysis of solutions; 3) Develop implementation plans

• Phase 2 (July-Dec 2007) – Each team to implement a

foundational component of their implementation plans

• Phase 3 (2008-2009)– 7 Multistate Collaboratives

developing common, replicable multistate solutions

http://healthit.ahrq.gov/privacyandsecurity

Page 22: Presented at the   HIPAA COW 2008 Fall Conference Sheboygan, WI – September 19, 2008

Policies – State-level HIE

http://www.staterhio.org

• Funded by ONC

• Develop reports and tools:– State-level HIE Development Workbook– RHIO Governance roles– Consensus model HIE policies

Page 23: Presented at the   HIPAA COW 2008 Fall Conference Sheboygan, WI – September 19, 2008

Policies – State Alliance for eHealth

http://www.nga.org

• National Governors Association’s initiative supported by ONC• Initial work (2006/2007) done through 3 Taskforces:

– Health Information Protection– Health Care Practices– Health Information

Communications and Data Exchange

• Reconfigured Taskforces to focus on:– Privacy and Security– Public Programs Implementation

• Taskforce reports provide severalrecommendations to states on privacy, security, Public program (i.e. Medicaid) roles in HIEs, need for harmonizing cross-state regulations on medical practice

Page 24: Presented at the   HIPAA COW 2008 Fall Conference Sheboygan, WI – September 19, 2008

Standards – The Health Information Technology Standards Panel (HITSP)

Page 25: Presented at the   HIPAA COW 2008 Fall Conference Sheboygan, WI – September 19, 2008
Page 26: Presented at the   HIPAA COW 2008 Fall Conference Sheboygan, WI – September 19, 2008
Page 27: Presented at the   HIPAA COW 2008 Fall Conference Sheboygan, WI – September 19, 2008

27HITSP: Enabling interoperability across the health care enterprise

HITSP Information Resources

Please take a copy of the introductory CD-ROM

available at this kiosk or visit our website (www.hitsp.org)

for a downloadable copy of the

CD’s content

Also available on www.hitsp.org

– News, organizational details and information on

upcoming meetings

– HITSP Public Document Library

– Interoperability Specifications (ISs)

and Executive Summaries

– Use Cases

– HITSP Webinars (Free!)

Page 28: Presented at the   HIPAA COW 2008 Fall Conference Sheboygan, WI – September 19, 2008

Standards in the National HIT Agenda

American Health

Information Community

Priorities(AHIC)

Healthcare Information Technology Standards

Panel(HITSP)

Nationwide Health Information Network (NHIN)

Certification Commission for Healthcare Information Technology (CCHIT)

(Stark and Anti-kickback)

Use

Cases

Interoperability

Specifications

Federal Systems and Healthcare Contracts (Executive Order 13410)

SecretaryCurrently

“Accepted”

60(2007)

SecretaryCurrently

“Recognized”

52(2006)

One Year -Testing and

Implementation

Verified

Use

Page 29: Presented at the   HIPAA COW 2008 Fall Conference Sheboygan, WI – September 19, 2008

Certification – The Certification Commission for Health Information Technology (CCHIT)

Page 30: Presented at the   HIPAA COW 2008 Fall Conference Sheboygan, WI – September 19, 2008

CCHIT – Certification Commission for Health Information Technology

CCHIT SCOPE OF WORK

Page 31: Presented at the   HIPAA COW 2008 Fall Conference Sheboygan, WI – September 19, 2008

CCHIT – Certification Commission for Health Information Technology

• Results to-date:

– A total of nine inpatient EHR products have been certified,

representing 36% of the inpatient EHR vendors in the market

• Four additional inpatient EHR product applications were received

recently, bringing total to 50% of the inpatient EHR vendor market

– Over 60 ambulatory EHR products representing more than 35%

of the outpatient EHR vendors in the market

• 14 additional ambulatory EHR product applications recently

received, bringing total to close to 50% of the inpatient EHR

– Moving into specialty areas (i.e., cardiovascular, child health),

network services

Page 32: Presented at the   HIPAA COW 2008 Fall Conference Sheboygan, WI – September 19, 2008

NHIN – Completing the Cycle

Page 33: Presented at the   HIPAA COW 2008 Fall Conference Sheboygan, WI – September 19, 2008

Transitioning to State Realities: The Minnesota Statewide Uniform

Companion Guide Development Project

Page 34: Presented at the   HIPAA COW 2008 Fall Conference Sheboygan, WI – September 19, 2008

• In 2007 the MN Legislature passed a law amending the “MN Health Care Administrative Simplification Act of 1994” (MN Statutes §62J.50 -§62J.61) and requiring the development, adoption and use of state uniform companion guides

• Part of Minnesota’s commitment to the increased use of health IT for both administrative and clinical activities

• Initial set of transactions subject to the new law includes Claims (837P, 837I, 837D, NCPDP), Claim Payment (835), and Eligibility (270/271)

• State law covers all health care providers and group purchasers (health plans, Medicaid, employers and others) doing business in the state; the law requires them to conduct these transactions electronically and use the standard companion guides

Background

Page 35: Presented at the   HIPAA COW 2008 Fall Conference Sheboygan, WI – September 19, 2008

• Commissioner of Health, in consultation with the MN

Administrative Uniformity Committee, is charged with

developing state uniform companion guides

• Companion guides are to be based on billing and coding

rules from the Medicare program, but can depart from them

based on state health care industry’s consensus

• Companion guides will be required to be used, along with

the HIPAA Implementation Guides, when conducting any of

the transactions they cover

Background

Page 36: Presented at the   HIPAA COW 2008 Fall Conference Sheboygan, WI – September 19, 2008

Summary of State Law

The Minnesota Uniform Companion Guide Development Project

Page 37: Presented at the   HIPAA COW 2008 Fall Conference Sheboygan, WI – September 19, 2008

• Part 1 - Requirements for all health care providers and group purchasers to implement uniform electronic transactions

– All group purchasers and health care providers in MN must exchange claims and eligibility information electronically, using the transaction standards prescribed by HIPAA and the companion guides and timelines established by the state law

– Group purchasers may not impose any fee on providers for the use of the transactions prescribed in this legislation

– Direct data entry, web-based methodology allowed, so long as it is consistent with data content component of HIPAA implementation guides and MN uniform companion guides

Summary of State Law(MN Statutes § 62J.536)

Page 38: Presented at the   HIPAA COW 2008 Fall Conference Sheboygan, WI – September 19, 2008

• By January 15, 2009, ALL health care providers and group purchasers

in MN must submit/accept the HIPAA electronic eligibility transaction

(270/271)

• By July 15, 2009, ALL health care providers and group purchasers in

MN must submit/accept the HIPAA electronic health care

claim/encounter information transaction prescribed by HIPAA (837s,

NCPDP)

• By December 15, 2009, ALL health care providers and group

purchasers in MN must submit/accept the electronic health care

payment/RA transaction prescribed by HIPAA (835)

Summary of State Law(MN Statutes § 62J.536)

Page 39: Presented at the   HIPAA COW 2008 Fall Conference Sheboygan, WI – September 19, 2008

• Part 2 - Requirement for the development and use of single, uniform, statewide companion guides for the identified transactions:

– Each named transaction must use a single, uniform companion guide to the HIPAA implementation guides statewide

– Companion guides to be developed as follows:

• Commissioner of Health, in consultation with MN-ACU develops companion guides at least 12 months prior to the timelines required for transaction

• Commissioner of Health issues a Notice of Proposed Rulemaking requesting industry comments on ‘draft’ companion guides

• Commissioner of Health promulgates rules establishing and requiring group purchasers and health care providers in MN to use the uniform companion guides

Summary of State Law(MN Statutes § 62J.536)

Page 40: Presented at the   HIPAA COW 2008 Fall Conference Sheboygan, WI – September 19, 2008

• No group purchaser or health care provider may add or modify the companion guides through their own companion guides or other requirements

• Commissioner shall not require data content that is not essential to accomplishing the purpose of the transaction

• Health care providers also includes dentists, chiropractors, nursing homes, boarding care homes and home care providers

• Other ‘group purchasers’ subject to law includes Workers Compensation and medical component of Auto Insurance

Summary of State Law(MN Statutes § 62J.536)

Page 41: Presented at the   HIPAA COW 2008 Fall Conference Sheboygan, WI – September 19, 2008

• Eliminate proprietary companion guides

• Reduce/eliminate Situational Variability of loops, segments

and data elements in the HIPAA Implementation Guides

• Reduce/eliminate Interpretative Ambiguity of loops, segment

and data elements in the HIPAA implementation Guides

• Reduce and standardize the codes used in data elements,

within a code set

• Identity and define loops, segments and data elements that

are not considered for processing by entities in Minnesota

What are the MN Uniform Companion Guides Doing?

Page 42: Presented at the   HIPAA COW 2008 Fall Conference Sheboygan, WI – September 19, 2008

• Replace HIPAA IGs

• Make implementation inconsistent and incompatible with, or in

violation of the HIPAA Implementation Guides– What is Required by HIPAA IG is Required by MN CG

– What is Not Used in HIPAA IG is Not Used in MN CG

– What is Situational in HIPAA IG is further defined in MN CG

• Disclaimer from the Guide: “… the [companion guide] supplements, but

does not contradict, disagree, oppose, or otherwise modify the HIPAA

Implementation Guide in a manner that will make its implementation by

users to be out of compliance.”

What the MN Uniform Companion Guides are NOT Doing?

Page 43: Presented at the   HIPAA COW 2008 Fall Conference Sheboygan, WI – September 19, 2008

• Multiplicity of companion guides and payer-specific requirements

• Providers need to customize transactions on a payer-by-payer basis

• Inconsistencies in transaction requirements significantly increases administrative burden

• Quality of care delivered to consumers is being affected

Why is this Project Important?

Page 44: Presented at the   HIPAA COW 2008 Fall Conference Sheboygan, WI – September 19, 2008

Understanding Companion Guides

The Minnesota Uniform Companion Guide Development Project

Page 45: Presented at the   HIPAA COW 2008 Fall Conference Sheboygan, WI – September 19, 2008

• A Companion Guide is a document that clarifies,

supplements and further defines specific data content

requirements contained in the Implementation Guides

established for each of the HIPAA transactions

• Generally, companion guides cover four core areas:– Define transaction instructions (EDI information) between trading

partners

– Further define requirement of loops, segments, data elements

– Further define data element content

– Further define data coding used in transaction

What are Companion Guides?

Page 46: Presented at the   HIPAA COW 2008 Fall Conference Sheboygan, WI – September 19, 2008

While there is ONE HIPAA Implementation Guide, there are 1000s of companion guides developed by each payer in the market….

1000s of Companion Guides…

Page 47: Presented at the   HIPAA COW 2008 Fall Conference Sheboygan, WI – September 19, 2008

Process for DevelopingMN Uniform Companion Guides

The Minnesota Uniform Companion Guide Development Project

Page 48: Presented at the   HIPAA COW 2008 Fall Conference Sheboygan, WI – September 19, 2008

• Use MN-AUC Committee and Workgroup Structure

• Establish Companion Guide Development Teams

• Develop Principles and Guidance Document

• Develop Consensus Building Approach and Decision

Making Process Document

• Develop Standard Master Template Companion Guide

Document

• Establish Project Workplan and Timeline

Process for Developing MN Uniform Companion Guides

Page 49: Presented at the   HIPAA COW 2008 Fall Conference Sheboygan, WI – September 19, 2008

• Draft of Companion Guide is prepared

• Notice proposing adoption published - 30-day comment period

• Comments are addressed, changes made to guide

• Notice adopting guide is published

• A one-year period of transition for compliance starts

• Six-month into process, technical review is done– Revisions to adopted companion guide are published for public comments

– Notice adopting final revised companion guide for compliance is published

• Compliance starts

• Annual review and update…

Cycle for Companion Guide Development

Page 50: Presented at the   HIPAA COW 2008 Fall Conference Sheboygan, WI – September 19, 2008

www.health.state.mn.us/auc

Page 51: Presented at the   HIPAA COW 2008 Fall Conference Sheboygan, WI – September 19, 2008
Page 52: Presented at the   HIPAA COW 2008 Fall Conference Sheboygan, WI – September 19, 2008
Page 53: Presented at the   HIPAA COW 2008 Fall Conference Sheboygan, WI – September 19, 2008
Page 54: Presented at the   HIPAA COW 2008 Fall Conference Sheboygan, WI – September 19, 2008

Minnesota Department of HealthMinnesota Administrative Uniformity Committee

MN Companion Guide Project Plan Last Update:January, 2008

Major Milestones/Task Timelines2007-2008

All Companion Guides

May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar13 23 01 08 15 22 29 11 18 25 01 08 15 22 29 05 12 19 26 03 10 17 24 31 07 14 21 28 05 12 19 26 02 09 16 23 30 06 13 22 29 05 12 19 26 31

270

/27

12

70

/27

1N

CP

DP

NC

PD

P8

37

D8

37

D8

37

I/83

7P

837

I/83

7P

835

835

Phase I

Pro

jP

roj

Mg

tM

gt Phase II

Develop Principles/Guidance/Templates

Est

ablis

h W

orkg

roup

CollectBaseInfo

CreateTable

Review/Discuss, Reach Consensus

Identify Parking Lot

Issues

Address Parking Lot Issues

Create/Review CG Doc

MergeTable and CG, add

Appendices

SendCG to AUC Ops

Notice Published;Comments due

10/30

CG Group meets to review comments,

update CG as needed

SendCG to AUC Ops

Notice of AdoptionPublished

12/10

Effective Date of Notice:30 days

post publication

Deadline for Implementation of CG by industry: 01/15/2009

Est

ablis

h W

orkg

roup

Collect Base Info

Create Tables

Review/Discuss, Reach Consensus

Firs

t Mee

ting

Identify Parking Lot Issues

Address Parking Lot Issues

Create CG Docs

MergeTables and CGs, add

AppendicesReview Front Matter

SenddraftCGs

to AUC Ops

Complete Drafting and Review of

CGs

Notice (30-day Public Comment)Published

3/31

Companion Guide (CG) DevelopmentE

stab

lish

Wor

kgro

up

Collect Base Info

Create Table

Review/Discuss, Reach Consensus

Firs

t Mee

ting

Identify Parking Lot Issues

Address Parking Lot Issues

Create CG Doc

MergeTable and CG,

add Appendices

Review Front Matter

SenddraftCG to AUC Ops

Complete Drafting and Review of CG

Notice (30-day Public Comment)Published

3/31Coordinate Parking

Lot Issues with 837P/837I Group

Est

ablis

h W

orkg

roup

Collect Base Info

Create Tables

Review/Discuss, Reach Consensus (Round 1)

Identify Parking Lot Issues

Create CG Docs

Form “Parking

Lot Issues Groups”(100 to

500 Work Groups)

Review/Discuss, Reach Consensus (Round 2)

MergeTables and CGs, add Appendices

Complete 100-500 Review Process

Address Parking Lot Issues from 837D

Address Coding Issues

Senddraft

CG to AUC Ops

Notice (30-day Public Comment)Published

3/31

Address Coding Issues

Review CG Front Matter

EO

B W

orkg

roup

E

stab

lishe

d

Collect Base Info Create Tables Review/Discuss, Reach Consensus (Round 1)

Identify, Discuss, Address Parking Lot Issues

Identify, Discuss, Address Coding Issues

Create CG Doc Review/Discuss CG Front Matter

MergeTable and CG

create/add Appendices

2 0 0 7 2 0 0 8

Complete the development of CGs, and Code set Appendices

Page 55: Presented at the   HIPAA COW 2008 Fall Conference Sheboygan, WI – September 19, 2008

Minnesota Department of HealthMinnesota Administrative Uniformity Committee

MN Companion Guide Project Plan Last Update:October 15, 2007

Major Milestones/Task Timelines2007-2008

All Companion Guides

Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul 01 07 14 21 28 05 12 19 26 02 09 16 23 01 07 14 21 28

270

/27

12

70

/27

1N

CP

DP

NC

PD

P8

37

D8

37

D8

37

I/83

7P

837

I/83

7P

835

835

Pro

jP

roj

Mg

tM

gt Phase II

Deadline for Implementation

of CG by industry:

01/15/2009

Sub

mis

sion

to

AU

C O

psPhase III

Industry Transition, Guide Refinement

Industry Preparedness and Transition

Process for Identification, Review and Adoption of Technical Corrections

CG Periodic

Maintenance

AUC CG Group review comments and update CGs

as needed MD

H R

evie

w -

P

ublis

h N

otic

e of

A

dopt

ion

Deadline for Implementation

of CG by industry:

07/15/2009

Industry Preparedness and Transition

Process for Identification, Review and Adoption of Technical Corrections

Deadline for Implementation

of CG by industry:

07/15/2009

Industry Preparedness and Transition

Process for Identification, Review and Adoption of Technical Corrections

Deadline for Implementation

of CG by industry:

07/15/2009

Industry Preparedness and Transition

Process for Identification, Review and Adoption of Technical Corrections

2 0 0 8 2 0 0 9

Senddraft

CG to AUC Ops

Modify CG as

NeededFrom

AUC Ops Input

Sendfinal

CG to AUC Ops

Notice (30-day Public Comment)Published

7/15

Complete Drafting and Review of CG

Public Comment Period

Sub

mis

sion

to

AU

C O

ps

AUC CG Group review comments and update CGs

as needed MD

H R

evie

w -

P

ublis

h N

otic

e of

A

dopt

ion

Public Comment Period

Sub

mis

sion

to

AU

C O

ps

AUC CG Group review comments and update CGs

as needed MD

H R

evie

w -

P

ublis

h N

otic

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A

dopt

ion

Public Comment Period

Sub

mis

sion

to

AU

C O

ps

AUC CG Group review comments and update CG as

needed MD

H R

evie

w -

P

ublis

h N

otic

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A

dopt

ion

Public Comment Period

Industry Preparedness and Transition

Process for Identification,

Review/Adoption of Technical Corrections

Deadline for Implementation

of CG by industry:

12/01/2009

Page 56: Presented at the   HIPAA COW 2008 Fall Conference Sheboygan, WI – September 19, 2008

• Eligibility (270/271) Companion Guide:

– Completed and adopted by state - December 10, 2007

– Technical revision completed in May 15, 2007

– Implementation date: January 15, 2009 (early voluntary adoption permitted)

• Claim (837P/I/D, NCPDP) Companion Guides:

– Completed and published for comment in March, 2008

– Published notice adopting companion guides in June, 2008

– Technical changes expected to be completed in March, 2009

– Implementation date: July 15, 2009 (early voluntary adoption permitted)

• Claim Payment/RA (835) Companion Guide:

– Under development – expected completion and publication for comment: June, 2008

– Published a Notice of Proposal to Adopt in July, 2008 – Comment Period ended August, 2008

– Currently reviewing and addressing comments, revising companion guide

– Notice adopting final companion guide expected to be published October, 2008

– Six-month technical amendment in April, 2009

– Implementation date: December 1, 2009

• All final guides will be available from the MN AUC website (www.health.state.mn.us/auc)

Status of Project Deliverables

Page 57: Presented at the   HIPAA COW 2008 Fall Conference Sheboygan, WI – September 19, 2008

Take Away Message….

Page 58: Presented at the   HIPAA COW 2008 Fall Conference Sheboygan, WI – September 19, 2008

So, why is all this important to me?

• National and local initiatives are affecting how you do business in health

care

– Increased dependency on electronic health information, connectivity and

interoperability

• HIPAA still a very important implementation issue

– Upcoming Claim Attachments, 5010, NCPDP D.0 and ICD10 standards

• Industry moving into the adoption and use of clinical information exchanges

– Electronic health records, lab information systems, e-Prescribing

• New and emerging areas in health information

– Personal Health Records – will they become mainstream?

– Clinical decision support systems – increasing dependency on standard, codified

electronic health information

Page 59: Presented at the   HIPAA COW 2008 Fall Conference Sheboygan, WI – September 19, 2008

So, why is all this important to me?

• Informed consumers with shifting expectations– Bringing better and more relevant health information to the fingertips of

consumers and improving efficiency of consumer controls over their health information

– Consumers bringing higher expectations on a practice’s ability to maintain and exchange their health information securely and efficiently

– Can my Doctor and I communicate electronically via email and web services?

• Alignment of incentives to adopt health IT– NOW: Pay for Performance – including the adoption of health IT

components such as CPOE

– NEXT: Pay for Conformance – including adopting interoperable, certified health IT products and networks

Page 60: Presented at the   HIPAA COW 2008 Fall Conference Sheboygan, WI – September 19, 2008

Thank You

Walter G. Suarez, MD, MPHPresident and CEO

Institute for HIPAA/HIT Education and Research

Alexandria, VAPhone: (952) 221-3841

Email: [email protected]