NC HIMSS Fall Breakfast Meeting

• 7:00 - 7:30 am: Breakfast & Networking
• 7:30 - 7:40 am: Opening Remarks, Todd Royals
• 7:40 - 8:00 am: Committee Reports
• 8:00 - 8:45 am: Dr. Prashant Palvia, Director of the McDowell Center for Global IT at UNC Greensboro, will discuss "Healthcare Technology Issues: Hospital CEO and CIO Perspectives." Dr. Palvia will be presenting on results of a recent study conducted by the center. The study surveyed CEOs and CIOs from hospitals across the U.S.
• 8:45 - 8:50 am: Closing Remarks

The Tactical & Practical Realities of Meaningful Use: CIO Perspectives
CIOs across the State and nation face similar challenges to comply with meaningful use (MU) requirements. Although each organization has its own overall IT strategy to achieve MU, common threads of problems and challenges exist for all healthcare CIOs. This panel will be comprised of three CIOs and a moderator to address 4-5 shared problems/challenges/initiatives and how each organization has addressed or is planning to address them.

Sample challenges include:

• IT Governance -- Addressing significant ongoing operational issues and technology solutions required for both MU and the hospital's overall business initiatives (e.g., assuring that MU initiatives are aligned with the hospitals overall business plan)
• Ongoing Prioritization -- Maintaining focus and managing "trade-offs" to support the strategic direction (CPOE, clinical documentation, ambulatory strategy, HIE, infrastructure upgrades, HIPAA, DR/BCP, etc.)
• Employed and Community Physician Support - developing and deploying ambulatory strategies to assist the physician community with MU
• IT Resources -- Addressing constraints and growing/maintaining a capable IT organization
• Vendor Management - Addressing common issues such as assuring the best and brightest resources are assigned to your account; renegotiating contracts to enhance SLAs; holding the vendor to contractual dates and timeslots
• Federal/State Mandates/Initiatives - Addressing integration and HIE requirements from the Feds and State

The CIOs will offer their perspectives on MU efforts for community hospitals, regional health systems and large health networks.

• Identify common problems shared by all CIOs to achieve MU
• Describe real strategies, approaches and lessons learned by CIOs to address these common problems

This presentation will focus on how community physicians are responding to quality of care issues, federal regulations, and patient expectations that have implications on their investments in health IT, HIE and other areas, and will overview physician approaches and lessons learned. The presentation will also provide insight into how these physicians are affected and how they may be supported by activities of the local health system to achieve health IT goals and meaningful use status.

Topics include:

• Key community physician challenges and their health IT implications
• HITECH -- can we achieve meaningful use in time to receive stimulus dollars?
• Looking to our health systems and federal/state organizations to help fund health IT investments and achieve meaningful use
  

Session Objectives:

• Identify common challenges of community physicians and physician practices
• Describe ideas, approaches, and lessons learned by those working in the physician environment to address HIT and HIE, including federal regulations and state-related considerations
  

Achieving Value in Community Health IT: Recognizing the Emerging Path & Avoiding the Pitfalls
The HITECH Act and health reform legislation are enabling more changes to the health industry than have been seen in a generation. Emerging federal government and state agency programs are positioned to facilitate greater health IT adoption and outcomes. To achieve outcomes, government, provider and health information exchange (HIE) leaders need to focus on the combination of technologies, business processes and policies that will foster sustainability and mobilize data to provide a capable information foundation. This presentation will discuss prerequisites for value and meaningful use of health IT from a community and population perspective. It will touch on both conceptual and practical needs important in architecting a health IT foundation for value and sustainability as well as approaches for marshalling community resources to these goals.

The presenter will discuss the relationship between EMR adoption and HIE in providing value to community participants, examine the conceptual architecture and technical and operational needs for meaningful use, address the relationship between network design and community priorities in marshalling community resources for HIT, and consider the role of health data services in developing sustainability plans and aligning incentives. The presenter, through his role as CMO of a large technology company and his prior role with HHS/ONC, will bring an insider's perspective to these topics.

Session Objectives:

• Describe the intent and promise of health reform and the role of the HIE and Extension Center grants
• Describe how standards adoption, health IT services, and the alignment of incentives for participants will create an effective exchange platform and a complete health information ecosystem
• List ways that HIE, technical services and business process improvements will build a foundational platform to support sustainable outcomes
  

Order Sets:  Developing, Implementing, Maintaining & Understanding All the Pieces
Most hospital have order sets in use, whether on paper or in CPOE. Order sets may be developed for a specific physician using his/her current practice. This allows for multiple order sets being in the system for the same purpose, just sponsored by different physicians. But in reality, order sets must be developed using evidenced-based practice to guide towards positive outcomes for the patients. How to develop, implement and maintain order sets can be very challenging.

Order sets can be developed internally or purchased. Many would argue there are benefits to both. Issues to consider include the content, the research for evidence-based practice, the cost and the outcomes desired. In addition, there may be internal drivers that require attention. At Durham Regional Hospital, the decision was made to develop order sets internally using available resources within the Health System.

Implementation of order sets into current practice needs to be flexible yet somewhat structured.  A project management approach is useful in this process. As order sets are developed and implemented, there is ongoing need for maintenance because of regulatory changes and/or updates to best practices. These issues can drive maintenance on a daily basis. Therefore a defined process to maintain all order sets is necessary. This presentation will review the components of order set development, implementation and maintenance looking at both internal development and external purchasing. The presenters will also address the challenges with maintenance.

Session Objectives:

• Describe how to begin the process for developing order sets
• Discuss the importance of appropriate ownership of order sets
• Describe the basics of project management when used in the development of standardized, evidence-based physician order sets
• Identify the process needed for a successful order set standardization
• Develop a mechanism for tracking, auditing and maintaining order sets
  

Session Objective:

• Identify key issues in consumer protection of electronic health information
  

The Patient-Centered Medical Home: Solving Health Reform's Impact on Medicaid
Health Reform is projected to drive significant increases in Medicaid enrollment and costs in the coming years. According to analysis by Oliver Wyman, an international management consulting firm, Medicaid enrollment will grow by nearly 40% nationally in the next seven years, and this will drive an increase of $1.6B in North Carolina's annual Medicaid bill. While Congress will help cover a portion of the cost increase for states, a considerable incremental cost will still hit state coffers (for example, just absorbing the growth in medical cost for this increased enrollment represents over a half billion dollars per year).

States have predicted an insufficient supply of Medicaid providers (stemming from the 37% Medicaid enrollment growth) and accelerated medical cost growth that will outstrip their budget capacity. Thus, the states are looking to large healthcare organizations, medical societies and the Department of Health & Human Services for cost offset solutions. These solutions must also address the need for quality care improvements and better access to both care and information for providers and patients.

Session Objectives:

• Describe how providers can move proactively to address these Medicaid challenges while further developing a leadership position in the industry through the advancement of the patient-centered medical home.
• Discuss how these changes will impact providers clinically and administratively, and how they can move proactively to reposition their business in conjunction with market changes.
  

To meet a patient's health care needs, it is necessary to acquire, organize and communicate patient-related information effectively. It is therefore essential that information technology (IT) in health care service be applied such that correct information is available at the right time and place to health care professionals, patients and administrators. This applies to information concerning the individual patient as well as to professional knowledge. An effective health IT strategy must: Contribute directly to the improvement of quality, service and coherence in patient care; Ensure better communication between all parties delivering health care services; and Contribute to the fast and safe access of the individual patient health record. One cannot lose sight of the continuous improvements and necessary processes associated with the administration, management and reimbursement of health care services delivered.

To facilitate improved access and reimbursement of services, IT must ensure that the patient experiences one continuous flow of events, and that the exchange of patient data is seamless among departments and service providers. IT must also be an instrument to facilitate and supplement communication with other health care professionals internally in an institution and between disparate institutions. Finally, IT must leverage the modernization of procedures and distribution of work tasks across institutions and disciplinary boundaries.

This presentation will describe a dynamic process that seamlessly works with disparate systems to provide an efficient and effective way to manage and access patient information required to deliver care and the reimbursement of services delivered.

Session Objectives:

• Discuss the immediate benefit of intermediary systems with rapid adoption among physicians and connection to EMR systems
• Describe the importance of systems that streamline workflow for inbound and outbound communications, including paper documents, electronic forms and files, and voice recordings
• Identify tools that empower departments to greatly improve patient satisfaction, allocate resources efficiently, reduce length of stay, and reduce claims denials
  

Clinical informatics involves the integration of technology and workflow processes. In order to be successful in implementing technology, a clinical informatics team requires diverse members with knowledge of clinical processes from all areas of the hospital. Clinical informatics also provides a means to disseminate information and educate all team members about clinical workflow and applications throughout the clinical arena. This allows the team members to understand how systems are integrated and fosters collaboration on technology implementations.

The presentation will include a review of the purpose and benefits to using a clinical informatics approach and identify roles and responsibilities of a clinical informatics team. In addition, time will be spent exploring the importance of building strong clinical informatics project teams and the collaboration necessary to ensure positive patient outcomes.

Session Objectives:

• Define clinical informatics
• Discuss the benefits to having a clinical informatics approach to technology-based implementations
• Describe how to structure clinical informatics initiatives
  

Organizational Risk Management is most often administered at the highest levels of management with input from a number of organizational units. The most realistic definition of risk involves the probability of the occurrence of one or more threats resulting in loss (e.g., monetary, reputation) due to exploited vulnerabilities leading to unauthorized access, loss, or corruption of the target information. The impact of the information loss is determined by the effects of the loss to individuals, the number of individuals involved, the regulated cost of notification and penalties, and the effect on the organizational reputation.

Presenters will emphasize the responsibilities within the Technical and Information Security units who are charged with protecting and enabling access to organizational information. The primary focus for these units are the vulnerabilities within the technical architecture and infrastructure, and the implementation of controls and countermeasures, both for within the organization and as the information is transmitted externally. Assessment involves understanding the threat sources, identifying the vulnerabilities that can allow exploitation, and determining the appropriate controls and countermeasures.

Because the technology is never static and threat sources are increasing rapidly, management of the process involves tactical and strategic responsibilities requiring a disciplined, ongoing approach to managing architectural change. Assessment and management of external transmission must be conducted jointly with external receiving organizations, including carefully crafted agreements which determine demarcations of liability for the loss due to vulnerability exploitation.

Session Objectives:

• Identify expanding threat sources and technical vulnerabilities
• Describe the disciplines of tactical and strategic management
• Recommend assessment and management strategies
  

While the interoperability of these systems that share patient records is in the process of being standardized, how can we simplify the current paper-intensive workflow processes that occur between organizations? How is technology being used to facilitate physician adoption by simplifying processing of referrals, medical equipment orders, prior authorizations and other orders? How can technology provide a transition path from paper-based to electronic records for physicians and other members of the healthcare community?

In this panel, hear from two physicians with different perspectives (one based in a large institution, the other exclusively serving patients in their homes) as they compare what the application of health IT means to them and their patients. They will examine how incorporating electronic workflow solutions that go beyond the walls of individual offices or closed systems can support transition from paper-based to electronic systems, and how facilitating the exchange of patient healthcare information and expediting forms processing can result in better patient care. Panelists will also provide examples of workflows used to support multiple communications preferences for physicians, home nursing and equipment care providers as well as health insurers.

Session Objectives:

• Define the challenges that lie beyond the adoption of EHRs, specifically communicating with home care
• Plan a technology pathway to transition healthcare records and workflows from paper to electronic - "Fire that fax machine!"
• Discuss the physician's perspective around migrating from paper to electronic communications
• Identify how the advantages of the national agenda for EHRs relate to home care communications and e-prescribing

The Carolina Center for Health Informatics (CCHI) oversees the continuing development and maintenance of the North Carolina Disease Event Tracking and Epidemiologic Collection Tool (NC DETECT) in collaboration with the NC Division of Public Health. The NC DETECT database integrates data from hospital emergency departments, the statewide poison center, and statewide EMS systems. Over 15,000 new records are loaded daily. Sensitive information contained within these data must be collected, stored and disseminated in a secure manner. Implementing the various encryption technologies requires a thorough understanding of the underlying business rules and legal restrictions in addition to the technology framework in which they will be used.

Presenters will discuss how CCHI utilizes Java-based Triple DES for encrypting and the Microsoft Capicom DLL for hashing sensitive information in a SQL Server environment. They will also discuss the complexities of secure role-based access on a web interface, including ensuring the protection of patient information and maintaining an audit trail, while meeting the needs of multiple user groups.

Session Objectives:

• Identify various methods of securing PHI
• Identify business rules that need to be defined before a specific encryption technology can be selected
• Describe role-based access on a web interface
  

Building the North Carolina Health IT Workforce
How ready is the State of North Carolina to successfully implement two national healthcare initiatives virtually simultaneously? Are there adequate numbers of trained health IT professionals to manage the change? If not, then how short are we? And what are the steps to take to ensure success in 2013 for the ICD-10-CM/PCS conversion, and in 2014 for broad use of EHRs ?

This presentation will address the following:

• Assessment: The presenter will provide a detailed review of the state of academic readiness for health IT training in NC, including location and graduation rates of existing college programs, and an evaluation of areas where training gaps exist.
• Evaluation of Skill Sets: What competencies are health IT graduates expected to possess as they enter the healthcare workforce? The presenter will provide a review of the four academic model curricula from certificate programs through Master degree programs.
• Gap Analysis: The health IT workforce is composed of existing healthcare workers who will need retraining, as well as individuals new to healthcare enrolled as students in health IT academic programs. We will evaluate the types of training each will need in order to meet the challenges of the national initiatives, and the effect the ARRA legislation has had on making this training possible.
• Employer Receptiveness: In the end, the schools can prepare graduates to assume new health IT responsibilities, but are employers ready to hire them? We will evaluate the Mayo Clinic model as a best practice for employer/college partnerships.

Session Objectives:

• Identify academic centers providing HIT education in North Carolina in 2010, and discuss enrollment and graduation rates
• Describe the skill sets needed for the ICD-10 and the EHR national initiatives
• Create a strategy to maximize availability of health IT trained workers

As an example, Greene County Health Care (GCHC), a federally funded community health center, partners with the regional community care plan of NC and HealthAssist (a regional healthnet) on eligibility assistance and specialist referrals. GCHC provides the comprehensive care through an integrated care model including medical, dental and medical family therapy services. The partnership greatly improves the coordination of care and access to specialist services.

GCHC partners with Community Partners HealthNet (CPH), a health center-controlled network that delivers integrated IT products. CPH also provides data warehousing, high quality clinical tracking and report writing capabilities, as well as industry standard disaster recovery and security functions. The usage of the CCHIT-certified EHR leads to safer care through medication interaction, allergy, and other alerts built into the system. It meets the required meaningful use criteria of creating a clinical data repository, clinical documentation, clinical decision support and e-prescribing. The PMS provides claim filing and eligibility capabilities. The three systems are integrated with bi-directional interfaces. The data warehouse was designed to track any clinical quality measures required. The security and disaster recovery infrastructure and operations comply with HIPAA and HITECH requirements. The economies of scale of doing this at a network level rather than individual practices are enormous. GCHC is partnering with Coastal Connect to develop health information exchange (HIE) capabilities. Ensuring that the appropriate medical information is available to providers when they need it is one of the crucial goals of HIE.

The combination of all these components creates an advanced medical home that is cost effective and sustainable. The purpose of this presentation is to highlight best practices in developing advanced medical homes.

Session Objectives:

• Identify the components of an advanced medical home
• Discuss how to develop the collaborations necessary to implement an advanced medical home
• Describe how to develop quality reporting, data warehousing,and disaster recovery capabilities in a collaborative manner
  

Before implementing a certified meaningful use Electronic Medical Record system, this session will explore the many other activities involved in transitioning from a paper medical record system to an Electronic Medical Record/Practice Management system for a public health department.  Topics such as how to prepare a clinical staff of 100+ novice computer users for an information system to aid in a smooth transition from a paper-based system; steps involved in scanning 20,000 active client paper medical charts (and 20,000 non-active charts) while still conducting business and maintaining service levels; using Laserfiche in the clinic to access scanned medical charts; managing the custom development work based on the priority needs determined in the requirements definition phase, but were not included in the packaged solution; the affects of external factors on an implementation timeline; and the benefits of establishing a project team. 

Session Objectives:

• List the steps involved in preparing novice computer users for an information system
• Identify challenges associated with transition from a paper medical record system to an electronic medical record system, including external factors that affect an implementation timeline
• Describe goals the health department expects to attain when the electronic medical record is operational

Protecting & Securing Patient Electronic Health Records
With the growing need for information to be secure, timely and accurate, we must have an understanding of where that information resides and how we access it, and govern its uses.
Current technology has brought our everyday lives to a place where our expectations have begun to dictate the need for information to follow us as we move. Using proven cases and best practice concepts, a panel of IT, security and healthcare law experts will bring clarity to misconceptions concerning information breach, loss or theft. Topics include: data loss prevention, encryption, monitoring and governance-risk-compliance tools.

Session Objectives:

• Describe the current state of data loss prevention (DLP) methods
• Identify existing known threats to protected patient data
• Discuss the planning requirements and concepts for today and tomorrow
  

This presentation seeks to educate attendees on EHR-based interventions, such as process redesign, documentation and reporting, that support preventive healthcare quality improvement and the barriers practices must overcome to implement those interventions. The presentation will educate attendees on the relationship of clinical documentation and clinical measure reporting which is integral to the ability to meet CMS meaningful use criteria. The lessons learned from this presentation are applicable to providers who will be trying to meet the goals of meaningful use for the CMS EHR incentives.

Session Objectives:

• Apply EHR-based care management interventions to your EHR
• Describe the relationship between documentation of clinical information and reporting clinical measures
• Discuss the challenges providers face when redesigning clinical processes
  

Security, Privacy, & Availability for Wireless & Web Services in a Healthcare Environment
Implementing state-of-the-art technologies such as wireless connectivity and web services provides increased flexibility and mobility of electronic devices in a healthcare environment. Some examples would be home healthcare functions, use of wireless by emergency responders, and broadcast of healthcare alerts via public networks. However, use of these technologies for healthcare-related purposes presents new challenges in order to provide the levels of privacy, security and availability mandated by the Health Insurance Portability and Accountability Act (HIPAA) and Title XIII of the American Recovery and Reinvestment Act (ARRA).

This presentation provides an overview of the security risks, privacy exposures and availability requirements that need to be addressed when implementing these technologies. It discusses the privacy and security standards that have been developed by the Institute of Electrical and Electronics Engineers (IEEE) Standards Association, the Organization for Advancement of Structured Information Standards (OASIS), and the National Institute of Standards and Technology (NIST). For wireless connectivity, it addresses requirements for encryption and the relative effectiveness of security methods such as Wired Equivalent Privacy (WEP) and Wi-Fi Protected Access (WPA). For web services, it provides an overview of the unique requirements of Service Oriented Architecture (SOA) and the use of the Security Assertion Markup Language (SAML) and eXtensible Access Control Markup Language (XACML) for authentication and authorization. Finally, we will discuss the need for additional standards in these areas.

Session Objectives:

• Describe the threats and risks that may be present in a healthcare IT environment when wireless connectivity and web services are implemented
• Discuss the regulations relating to privacy and security that are contained in the HIPAA Privacy and Security Final Rules, and the ARRA Title XIII legislation
• Describe how to access and obtain the IEEE 802.11 standards and NIST Special Publications that contain implementation details for ensuring privacy and security in a healthcare environment
  

Albemarle Health - northeastern North Carolina's largest regional health and wellness provider - undertook an initiative to address the multiple interoperability and data-sharing requests they were receiving from providers throughout the community. Albemarle determined that three principal components were necessary to successfully meet these requests. First, they needed a means to exchange information between the hospital and practices deploying EHRs across the community. Second, they wanted to give physicians a single point of access to patient information originating from both the hospital and outpatient environments. Third, they wanted to publish patient summary data to non-Albemarle entities for specific use cases, such as referrals.

This session will share Albemarle's experience - covering the business, clinical and technical considerations involved with embarking on such an initiative, including: community collaboration efforts; business and quality drivers; cost justification; ARRA and meaningful use implications; physician satisfaction and experience; and participation in regional and statewide health information exchanges (HIEs). The audience will gain important insight into the lessons learned in implementing such a program in their community and how it prepares their organization for regional and state collaboration today and in the future.

Session Objectives:

• Describe the business and clinical drivers associated with being a leader for HIE across a small community
• Identify the technical and staffing requirements required to support such an effort
• Explain the benefits of participation to providers and patients across the community
  

NC Regional Extension Center & NCHICA Business Partner Alliance Roundtable
The NC Area Health Education Centers Program is a federally-designated Regional Extension Center (REC) that provides EHR consulting. The NCHICA Business Partner Alliance provides expert market and technology advice on methods and processes to help providers achieve "Meaningful Use." This roundtable discussion is open to anyone interested in the Business Partner Alliance, the NC REC, and how business partners can assist them. 

Session Objectives:

• Describe the timeline and milestones of the NC REC
• Discuss the expected role business partners will perform for the NC REC
• Describe the critical success factors for the NC REC and contributions expected from business partners

“Clinical Connectivity” - How to Use Gateways to Get Data Across the Street
NCHICA has been a participant in the Nationwide Health Information Network since its inception in 2005, and is currently working on an Emergence Implementation for the Office of the National Coordinator. The objective is to implement a CONNECT Gateway to allow a mature HIE to connect to the Nationwide Information Health Network.

This session will demonstrate how two disparate entities can exchange patient data using a CONNECT Gateway. Attendees will see the transaction flow from the requesting entity to the responding entity and back. This session will address the capabilities and limitations of a Gateway relative to the key exchange elements of patient matching (within an entity and between entities) and security of PHI data.

Session Objectives:

• Explain how two disparate entities can develop standards- based data and exchange patient data using a CONNECT Gateway
• Describe how the use of open source tools can prepare for standards-based exchange of information within a community and across the nation
• Discuss the efforts made to connect the WNC Health Network HIE to the NHIN Exchange and how to replicate locally