PACKAGE LEAFLET

What State activities are currently underway or in the planning phase to facilitate HIE and EHR adoption? What role does the SMA play? Who else is currently involved? For example, how are the regional extension centers (RECs) assisting Medicaid eligible providers to implement EHR systems and achieve MU?

State activities

Minnesota state agencies, providers, and others are promoting HIE and EHR in a large variety of ways, such as:

 State legislation requiring the Minnesota health care providers to have an interoperable EHR system by 2015 (see the answer to Question 12)

 State legislation requiring providers to establish and use an e-prescribing system by January 1 2011 (see the answer to Question 12)

 Development of the Minnesota Model for Achieving Interoperability through MN e-Health and MN e-Health Connect (see general information on the MN e-Health Initiative and its workgroups in the answer to question 5, and information about MN e-Health Connect in the answer to Question 10)

 MN e-Health Connect (MDH 3013 State HIE Cooperative Agreement) and its health information organization (HIO) oversight mechanism (see the answer to Question 10)

 REACH

 Minnesota EHR Loan Program

 The Direct Project with Minnesota’s Hennepin County Medical Center The State Health Policy Consortium

 MN HIE and CHIC/NHIN (see the answers to Questions 7 and 13)

As noted above, many of these activities are explained in response to other questions. Below are descriptions not provided elsewhere, including the Minnesota e-Health Initiative’s Minnesota Model for Achieving Interoperability, REACH, the Direct Project, and the State Health Policy Consortium. The response to question 9 highlights the role played by the SMA in these areas.

Minnesota Model for Achieving Interoperability

MDH, DHS, and stakeholders are working to develop the Minnesota Model for Achieving Interoperability through the MN e-Health Initiative and MN e-Health Connect. The initiative’s advisory committee developed and adopted a model for achieving interoperability as part of the Statewide Implementation Plan: A Prescription for Meeting Minnesota’s 2015 Interoperable EHR Mandate (MDH, 2008). The Minnesota model outlines the major steps to adopt, implement and effectively use an interoperable EHR (Figure A2):

 Adopt: the sequential steps of assess, plan and select

 Utilize: to implement and effectively use an EHR product

 Exchange: readiness to exchange electronically with other partners, and implementing regular, ongoing exchange between interoperable EHR systems

Figure A2. Minnesota Model for Adopting Interoperable EHRs

EHR Adoption Continuum

Achievement of 2015 Mandate

Adopt Utilize Exchange

Assess Plan Select Implement Effective Use Readiness Interoperate

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The Minnesota e-Health Initiative identified several characteristics or prerequisites for effective EHR system use. These include adequate planning, intelligent use, system supports, and the achievement of demonstrable value (Table A14).

Table A14: Characteristics of Effective EHR System Use The system is:

Adequately planned for, selected and implemented Efficiently and properly populated and intelligently used Not used to merely replicate old paper processes

The system is both supported by and supports continuous commitment of individuals and organizations to:

Improve patient safety

Provide optimal and comprehensive care to clients and populations

System use achieves demonstrable value for individuals, families, organizations and populations across the continuum of care, regardless of the setting.

System implementation and use represents concrete progress toward achieving Minnesota’s 2015 interoperable EHR mandate.

After the adoption of the Minnesota Model in 2008, the Minnesota e-Health Initiative guided providers working to adopt and use EHRs. In 2009, the initiative turned its attention to addressing the third category on the Minnesota Model: HIE.

REACH: Minnesota-North Dakota Regional HIT Extension Center

The Regional Extension Center for HIT, known as REACH, is the nonprofit HIT Regional Extension Center in Minnesota and North Dakota. REACH works with providers to improve the quality and value of care through adopting and meaningfully using HIT/EHR. REACH is a program of Key Health Alliance. Key Alliance is a partnership of Stratis Health, the Rural Health Resource Center, and the College of St. Scholastica, which collaborates with North Dakota Health Care Review and the University of North Dakota, School of Medicine and Health Sciences, Center for Rural Health.

The REACH Council is led by the Key Health Alliance and includes representatives of the following organizations:

 Minnesota Academy of Family Physicians Minnesota Department of Health

 Minnesota Department of Human Services/State Medicaid Agency Minnesota Hospital Association

 Minnesota Medical Association

 University of Minnesota, Academic Health Center The Council has the following roles and responsibilities:

1. Guide the strategy, approach, and implementation of the HIT Regional Extension Center efforts in Minnesota

2. Identify opportunities and issues in HIT that may affect the Regional Extension Center’s work, and coordinate with other ARRA-funded HIT efforts

3. Provide feedback on the Regional Extension Center’s programs and services in Minnesota 4. Participate in the National Learning Consortium supported by the federal Office of the

National Coordinator, if requested

5. Assist in the development of connections and relationships with other organizations that are committed to and support HIT and EHR implementation and effective use

6. Support the Regional Extension Center’s programs and initiatives by promoting a positive image of the Regional Extension Center, add areas of expertise where willing, and being willing to be affiliated with the Council (for example, listing Council members on appropriate websites, brochures, or other materials)

7. Help to build awareness of the Regional Extension Center programs

To help meet national HIT Regional Extension Center Program goals, REACH aims to provide technical assistance services and support to 5,100 priority primary care physicians, clinicians and CAHs over the next four years. More than 4,600 providers at over 400 practices have expressed their interest in program participation and TA services. In addition to primary care practices and small hospitals, REACH services will be available to all provider types across the continuum of care.

The Direct Project

In 2010, the ONC sponsored the Direct Project to assemble consistent standards and support secure exchange of basic clinical information and public health data. Minnesota and Rhode Island were the first two states to have pilot programs wherein providers and public health agencies are exchanging health information using the Direct Project specifications. Since mid- January, Hennepin County Medical Center (HCMC), a level 1 Adult and Pediatric Trauma Center, has been successfully sending immunization records to MDH. James I. Golden, PhD, Minnesota’s state HIT coordinator in 2010, stated, “This demonstrates the success that is possible through public-private collaborations. This is an important milestone for Minnesota and a key step toward the seamless electronic movement of information to improve care and public health.” http://www.hhs.gov/news/press/2011pres/01/20110202a.html

State Health Policy Consortium Grant – Upper Midwest HIE Consortium (UM HIE)

In March of 2010, the State Health Policy Consortium (SHPC) was established through an HHS contract with RTI International. Sponsored by the ONC, the SHPC facilitates groups of states working to resolve policy issues to enable the interstate exchange of electronic health

information. Minnesota initiated collaboration with five other states to submit a Request for Support Services to SHPC as the Upper Midwest HIE Consortium (UM HIE). SHPC’s 2010 submission was the sole proposal awarded first round funding. Participating states are Wisconsin, Iowa, South Dakota, North Dakota and Illinois.

Through UM HIE, Minnesota works with other states to create concrete regional solutions to barriers affecting HIE for treatment purposes. Participating states developed template language for interstate agreements or other similar mechanisms that enable interstate HIE for treatment purposes despite differences in individual state consent laws. UM HIE consulted with stakeholder groups for review and input on the SHPC project. In Minnesota, this consultation included the

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MN e-Health Advisory Committee: Privacy, Legal and Policy Workgroup. UM HIE completed its work in 2011, creating three tools for exchanging patient health information across state borders.

These are:

 Consent Matrix - The health care provider uses this matrix to determine if patient consent is required to release health information.

 Common Consent Form - The patient completes and signs this form; instructions are included.

 Request for Health Information Exchange - The health care provider completes this form to identify the specific health information being requested.

More information can be found at http://www.health.state.mn.us/divs/hpsc/ohit/umhie.html or http://www.rti.org/shpc.

SMA Role

The SMA plays a significant role in facilitating HIE/EHR adoption by working collaboratively with the previously described organizations and initiatives:

 The SMA supported several major pieces of legislation recently enacted to promote EHR, including the requirements for e-prescription (2011) and for all providers to have an interoperable EHR system by 2015 (see the answer to Question A12).

 The SMA is an active and engaged participant in the Minnesota e-Health Initiative.

The SMA’s role with the initiative is described in the answers to Questions A5 and A6. The SMA’s continued role in working with e-Health in future MEIP planning implementation is outlined in the introduction to Section C.

 Through MN e-Health Advisory meetings, the SMA is aware of and coordinates with, a large variety of organizations and interests from across the state, provider settings, and perspectives. For example, the December 2013 meeting including updates on Minnesota ARRA/HITECH and other federally-funding programs (including CMS MU incentives, REACH, MN e-Health Connect, the HIT University Partnership for Health Informatics, the Midwest Community College HIT Consortium, the EMR Disability Determination Project, UM HIE, Research and Beacon Community Collaboration (Mayo Clinic)). Participants also received updates on the HIO exchange oversight activities and MN e-Health work group updates related to EHR adoption, MU, HIE, standards and interoperability, communications and outreach, and privacy/legal/ policy issues.

 The SMA and REACH partner to promote EHR and HIE in a variety of significant ways.

 See the answers to Questions A10 and C30.

 The SMA coordinates with the Minnesota Office of HIT (MDH) and contributes to MDH’s MN e-Health Connect (the 3013 cooperative agreement) (per Question 10).

 The SMA strongly supports HIE/EHR adoption through the planning and implementation of the Minnesota EHR Incentive Payment program. Beyond the already-mentioned activities, for example, the SMA has established a website and issued other communications to give providers HIE/EHR information and resources (Section C describes these activities).

 The SMA has been involved with HIE organizations and their certification; see the answers to Questions 5, 6, 7 and 10.