HIE Study Heidi Fox Office of HIE Administrator

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HIE Study Heidi Fox, Office of HIE Administrator 1

HIE Study Heidi Fox, Office of HIE Administrator 1

Background • A study of the HIE environment in Florida conducted by North Highland,

Background • A study of the HIE environment in Florida conducted by North Highland, includes an assessment of the current state and recommendations for achieving an ideal state. • Areas of interest for this assessment included: – Infrastructure and services in Florida (adoption, utilization, and reported benefits) – Information access and sharing across systems & geographic locations (barriers and best practices) – Real time access to eligibility information GOALS FOR THE HIE STUDY Understanding of the Current Landscape of HIE in Florida Roadmap to Ideal Future State of HIE Program Identify the Ideal State for HIE Infrastructure and Services Recommend Solutions which Positively Impact Implementation and Adoption 2

Project Approach Completed ALIGN FOCUS & DIAGNOSE Future PRIORITIZE 1 DESTINATION 2 CURRENT STATE

Project Approach Completed ALIGN FOCUS & DIAGNOSE Future PRIORITIZE 1 DESTINATION 2 CURRENT STATE 3 OPPORTUNITIES 4 ROADMAP INITIATION Confirm focus areas, gain leadership alignment on success, craft future state vision. • Visioning Sessions • Workgroups Conduct As Is Assessment to determine current state of HIE. • Stakeholder interviews • Electronic Survey • Begin Environmental Scan Analyze As Is Assessment to reveal gaps in current state and define ideal state, document relative impact, and provide recommendations. • Comprehensive Environmental Scan • Initiative Development Implement solutions around high priority opportunity areas, understand organizational impacts and needed changes. • Finalize timelines & priorities • Communicate HIE Study outcomes to stakeholders • Pursue Initiatives • Foster long-term stakeholder engagement 3

As Is Assessment - Methods Electronic Survey Stakeholder Interviews Environmental Scan All stakeholder groupings

As Is Assessment - Methods Electronic Survey Stakeholder Interviews Environmental Scan All stakeholder groupings Market Scan Association distribution In-person and telephone Request for Information (RFI) 272 unique responses 45 interviews conducted Literature Review

As Is Assessment - Results HIE ADOPTION LEADERSHIP & GOVERNANCE Widespread adoption of HIE

As Is Assessment - Results HIE ADOPTION LEADERSHIP & GOVERNANCE Widespread adoption of HIE remains low, particularly when compared to EHR adoption levels. Leadership role for AHCA to set and clearly articulate the vision and goals for HIE in Florida. HIE UTILIZATION CULTURAL ISSUES Few fully utilize HIE due to workflow and integration challenges. e. Fax & paper methods remain prevalent. Pervasive culture of fear and distrust prevents more willing and expanded exchange of data. VALUE PROPOSITION REGULATORY ENVIRONMENT Lackluster demonstration of HIE value propositions & value-add deter the decisions to adopt/utilize HIE. Competing priorities in an ever-changing regulatory landscape. Public Health/ HHS siloed & disjointed. COST & COMPLEXITIES ACCESS The financial & organizational resource burdens and trade-offs to adopt/use HIE is too high for some. Insufficient access to meaningful, timely data. Haphazard application of privacy/consent & standards. AWARENESS & EDUCATION INTEROPERABILITY Inadequate awareness & understanding of HIE. More proactive stakeholder engagement & education Limited exchange across the continuum of care coordination. Further inclusion is strongly desired.

To Be Assessment • Objectives: – Increase Access – Decrease Cost & Complexity –

To Be Assessment • Objectives: – Increase Access – Decrease Cost & Complexity – Employ Interoperability – Improve Culture • Strategic Initiatives: – Structure Statewide Governance – Motivate & Encourage Exchange – Increase Awareness & Engagement 6

Recommendations: Motivate & Encourage Exchange • Optimize Federal Funding – 90: 10 matching funding

Recommendations: Motivate & Encourage Exchange • Optimize Federal Funding – 90: 10 matching funding –Legislative appropriations and procurement authority • Align Incentives & Behaviors –Pilot programs –Community and vendor partnerships • Intra- and Inter-Agency Collaboration –Public Health and DOH Collaboration –Medicaid-related Agency Collaboration • Leverage Existing HIE Capabilities

Activities: Motivate & Encourage Exchange Florida HIE In-flight Activities: – Enhance Existing Florida HIE

Activities: Motivate & Encourage Exchange Florida HIE In-flight Activities: – Enhance Existing Florida HIE Services • • LTPAC engagement as ENS data sources and data subscribers Engagement of ENS data source hospitals as data subscribers Enhancements to PROMPT interface Facilitate FL connectivity between e. Health Exchange & Carequality • Enable auto-building patient panels for ENS data sources based on ADTs – Support Emergency Preparedness Efforts • Family Reunification – utilization of alerts to locate missing persons • PULSE – query-based exchange between connected health care systems and emergency response 8

Activities: Motivate & Encourage Exchange Potential opportunities for the Florida HIE Services: – Coordination

Activities: Motivate & Encourage Exchange Potential opportunities for the Florida HIE Services: – Coordination with DOH: • County Health Departments onboarding to the State Gateway • PDMP Query Integration • Facilitate registry reporting from hospitals utilizing ENS ADT feeds • Opioid Alerting – utilization of ENS alerts to identify and route or map encounters related to overdose – Agency utilization of ENS Alerting for Medicaid program activities 9

Recommendations: Structure Statewide Governance • Assess & Define HIE Governance Roles – Define role

Recommendations: Structure Statewide Governance • Assess & Define HIE Governance Roles – Define role types – Consider and assess types of governance boards • Optimize Existing HIE Governance Structure – Engage stakeholders and ad hoc workgroups – Update, modify, and articulate governance: • • • Responsibilities Processes Policies Procedures Membership

Activities: Structure Statewide Governance • In-flight governance activities: – HIECC Membership realignment – Medicaid

Activities: Structure Statewide Governance • In-flight governance activities: – HIECC Membership realignment – Medicaid Enterprise (MES) Collaboration Ongoing • Potential for an Inter-Agency Workgroup – To focus on optimization of exchange between and within State Agencies. • Next HIECC Meeting: – Consider HIECC Roles and Responsibilities – Provide Recommendations for specific activities – Outline funding pursuits

Recommendations: Increase Awareness & Engagement • Stakeholder Management – Enhance Stakeholder Engagement Plan –

Recommendations: Increase Awareness & Engagement • Stakeholder Management – Enhance Stakeholder Engagement Plan – Build HIE Champions Network • Strategically Communicate – Enhance Communication Plan – Expand distribution and maximize reach • Educational Clearinghouse – Identify and feature use cases, value proposition – Identify and aggregate existing resources and toolkits – Provide updates on funding opportunities, national technical standards

Activities: Increase Awareness & Engagement • Enhance Existing Outreach Activities – Capitalize on momentum

Activities: Increase Awareness & Engagement • Enhance Existing Outreach Activities – Capitalize on momentum from the HIE Study – Consider new venues & markets – Enhance Communications and Engagement plans • Prospective Educational Clearinghouse – Explore potential to leverage Florida. Health. Finder. gov – AHCA to begin investigation of scope and resources needed 13

Timeline for Funding NOW Budget authority for activities under 90: 10 funding. Could request

Timeline for Funding NOW Budget authority for activities under 90: 10 funding. Could request funding approval for projects that fall within existing authority Effective (funding available) October 2018 JUNE 2018 Agency Legislative Budget Request For large scale initiatives Effective (funding available) July 2019 April 2019 Submit new funding request to CMS for 90: 10 funding Effective (funding available) October 2019 14

Next Steps • Review of HIE Study by Stakeholders • Solidify Roadmap & Timelines

Next Steps • Review of HIE Study by Stakeholders • Solidify Roadmap & Timelines • Leverage momentum from HIE Study to pursue these immediate projects: – Enhance Florida HIE Services – Educational Clearinghouse – Optimize Utility of Governing Bodies