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Texas Legislative UpdatePresentation to the Texas State
Health Information ManagementSpring Conference
Nora Belcher, Executive DirectorTexas e-Health Alliance
April 25, 2014
This presentation will:– Assess the state of Texas in terms of implementation of
the HITECH Act,– Discuss how legislation and public policy involving HIT
have evolved, and– and provide an overview of HIT trends and an
assessment of the future of HIT in Texas.
Slide 2
Overview
© Ingenix, Inc. 3
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1930 1950 1960 1970 1980 1990 1995 1997 2000 2001 2003 2007
Internet Revolution: Value to Users
Internet use exploded once content became accessible
and useful.
Computer developed - IBM ARPANET
Mosaic Web Browser
Today, health care information technology (HIT) is at the “1997” of the Internet age
Prodigy
WWW HTML
TCP/IP Standard
Source: U.S. Census Bureau, Population Division, Education & Social Stratification Branch, “Reported Internet Usage for Households, by Selected Householder Characteristics,:2007”
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HIT Today
First e-mail sent
• Texas Status Pre-HITECH – Privacy protections in Chapter 181 Health and Safety
Code in 2001– Texas Health Services Authority created in 2007– Most statutes and processes geared toward paper/fax
• HITECH passage in 2009 included 3 key components:– EHR Adoption Incentives and Penalties– HIE Planning and Implementation– Strengthening HIPAA to Protect Patient Privacy
HITECH
HITECH in Texas• State Level Implementation
– HHSC administered EHR Incentive Program and local HIE grant program (over $ 1 billion)
– THSA implementing white space strategy and state-level shared services
– Local HIEs completed planning and moving into implementation
• Federal Implementation– HIPAA final rules implementing HITECH final in January
2013– FDA guidance on mobile medical devices– ONC working through the stages of meaningful use
Texas Legislature
• Before 2005 – 0 health IT bills filed• 2005 – 1 health IT bill filed• 2007 – 6 health IT bills filed• 2009 – 30 health IT bills filed• 2011- 3 health IT bills filed
– Electronic prescribing– Privacy– Telehealth/remote monitoring
• 2013 – 1 health IT specific bill filed
Page 6
Texas Legislature
• Before 2005 – 0 health IT bills filed• 2005 – 1 health IT bill filed• 2007 – 6 health IT bills filed• 2009 – 30 health IT bills filed• 2011- 3 health IT bills filed
– Electronic prescribing– Privacy– Telehealth/remote monitoring
• 2013 – 1 health IT specific bill filed
Page 7
2013 Texas Legislature
• SB 1367 (Duncan/Smithee)- winds down the risk pool at TDI, and provides THSA with $5 million dollars in bridge funding.
• SB 1643 (Williams/Alvarado)- includes the changes needed to allow HIEs to access the prescription drug monitoring program at DPS.
Page 8
2013 Texas Legislature
• Medicaid– SB 7 (Nelson/Raymond)- Medicaid delivery and
quality reforms, including managed care expansion for long term care
– SB 8 (Nelson/Kolkhorst)- Medicaid fraud and abuse program changes
• HB 300 Technical Corrections– SB 1609 (Schwertner/Kolkhorst)- training
clarifications– SB 1610 (Schwertner/Kolkhorst)- breach
notification clarificationsPage 9
2013 Texas Legislature
• Providers– SB 166 (Deuell/Larson)- allows providers to read
and store mag stripe data from driver's license– SB 406 (Nelson/Kolkhorst)- allows for limited but
extended prescriptive authority for ANPS under physician delegation
– SB 945 (Nelson/S. Davis)- mandates that hospital employees involved in direct patient care wear photo IDs
Page 10
2013 Texas Legislature
• Department of Insurance– SB 644 (Huffman/Zerwas)- creates a standardized
prior authorization form for prescription drug benefits
– SB 1216 (Eltife/S. Davis)- creates a standardized prior authorization form for medical care and health care services
• Cancer Prevention and Research Institute of Texas (CPRIT) – SB 149 (Nelson/Keffer)- CPRIT reforms
Page 11
2013 Texas Legislature
• Department of Information Resources– HB 2738 (Elkins/Ellis)- DIR to study state agency
technology efficiency– SB 1102 (Van de Putte/Larson)- Creates a new
position at DIR for a cybersecurity director• Tax Policy
– HB 800 (Murphy/Deuell)- research and development tax credit
– HB 1133 (Otto/Estes)- sales tax exemption for telecom manufacturing
Page 12
Topics for 2015
• Interoperability and use of standards in state agency IT systems
• HHS System Sunset review• Access to public health registries for HIEs• Provider/HIE “safe harbors”• Remote monitoring• Consumer telemedicine
Page 13
Conclusion• Texas was well positioned for success with the passage of HITECH.• The legislature and the related state agencies have been
identifying- and making- needed changes to foster the adoption of HIT.
• Progress is being made in EHR adoption at the physician and hospital level; work remains to be done in long term care and mental health.
• Significant barriers still exist to EHR and HIE adoption, which will need to be overcome for HIT to be successful.
• Policymakers are concerned about privacy and security, costs, quality, and the rate and volume of changes that providers have to react to.
• Policymakers in the future will be responding to growing concerns about patient access to their records and consumer engagement.
Page 15
“Patient Engagement is the blockbuster drug of the 21st Century”
-Leonard Kish, August 28, 2012