Coordinate with community partners and encourage the adoption of certified EHR technology that promotes health care quality and the exchange of health care information. Ensure the new Montana MMIS contains the functionality needed to support HIT and the Montana MPIP upon deployment. 2.0 HIT 2.1 Stakeholders engaged in HIT/E activities within Montana What stakeholders are engaged in any existing HIT/E activities and how would the extent of their involvement be characterized? Does the SMA have HIT/E relationships with other entities? If so, what is the nature (governance, fiscal, geographic scope, etc) of these activities? Specifically, if there are health information exchange organizations in the State, what is their governance structure and is the SMA involved? ** How extensive is their geographic reach and scope of participation? 2.1.1 Federal Partners Federal partners engaged in HIT/EHR activities within Montana include: Centers for Medicare and Medicaid Services (CMS) Office of the National Coordinator (ONC) Indian Health Service (IHS) Veteran’s Administration (VA) Centers for Disease Control (CDC) 2.1.1.1 Centers for Medicare and Medicaid Services (CMS) CMS is a key federal stakeholder for the of Montana. CMS established the Medicaid Incentive Payment Program (MPIP) via formal federal rulemaking, publishing the final rule in July 28, 2010. The final rule, establishes parameters and requirements for the MPIPs that States such as Montana will follow. CMS also assisted the ONC with the development of standards, implementation specifications, and certification criteria for EHR technology. In addition, CMS is working with the Office of Civil Rights (OCR) and ONC to ensure privacy and security precautions are addressed for the Medicaid Provider Incentive Program. Lastly, CMS provides oversight regarding the MPIP reviewing and approving the Implementation Advanced Planning Document (IAPD) for Health Information Technology (HIT) and the State Medicaid Health Information Technology Plan (SMHP).
release that this system has the capacity to support other HIE. Montana Medical Association (MMA) The Montana Medical Association (MMA) represents Montana physicians regarding important issues that concern them. Montana Primary Care Association (MPCA) The Montana Primary Care Association (MPCA) represents Federally Qualified Health Centers (FQHCs) regarding important issues that concern them. Montana Dental Association (MDA) The Montana Dental Association (MDA) represents dentists
regarding important issues that concern them. City/County Health Departments The state of Montana and the network of city and county health departments collect and share extensive data, including communicable diseases, vital statistics, Medicare and Medicaid. Urban Indian Health Clinics Approximately 45% of the receive Medicaid reimbursement as Federally Qualified Health Centers (FQHC) and others receive fees for service under Medicaid for allowable services, i.e. behavioral services,
2.3.2 MMIS Replacement What other activities does the SMA currently have underway that will likely influence the direction of the MPIP over the next five years? On December 3, 2010, Montana DPHHS released a Request for Proposals for the Design, Development, Implementation, and Operation of a new MMIS. This project has an anticipated completion date of April 2014. In addition to advanced capabilities related to the handling of standard electronic health record data, DPHHS has also included the scope and functionality of the MPIP into the requirements of the new MMIS. Our goal is to fully integrate the administration of the incentive program with our MMIS in order to take advantage of advanced provider management functionality that will be incorporated in the new Medicaid processing system. This process will allow Montana to further our goals of offering seamless interaction to providers for all Medicaid related activities via a single web interface. Through this process, our intent is to reduce the overall burden and impact on providers for not only traditional provider enrollment and credentialing activities, but also the attestation and meaningful use requirements related to compliance with the rules of the incentive program. 2.3.3 State Law or Regulation impact on EHR incentives Have there been any recent changes (of a significant degree) to State laws or regulations that might affect the implementation of the MPIP? Please describe. No significant changes in Montana laws or regulations have been identified that would impact our MPIP. 2.3.4 State Broadband Access in Montana To what extent does broadband internet access pose a challenge to HIT/E in the State’s rural areas? Broadband penetration across Montana is similar to that in all states, with greater access in more urban areas than in small and rural parts of the State. While any individual provider can implement an EHR system internal to the organization, the ability to participate in an exchange network is limited or impossible if broadband access is unavailable or unreliable. Montana’s
The planning portion of this project will focus on outreach and facilitation to identify and prioritize broadband access needs and solutions in local communities and across the State. Department of Commerce Broadband Technology Opportunities Program (BTOP) Awards Expanding Infrastructure and Services University Corporation for Advanced Internet Development “The project proposes a large-scale, public-private partnership to interconnect more than 30 existing research and education networks, creating a dedicated Gbps nationwide fiber backbone with 3.2 terabits per second (TBps) total capacity that would enable $62,540,162.00 200
advanced networking features such as IPv6 and video multicasting. The project plans to connect community anchors across all disciplines into virtual communities with shared goals and objectives, including colleges, universities, libraries, major veterans and other health care facilities, and public safety entities, with additional benefits to tribes, vulnerable populations, and government entities. Department of Commerce BTOP Public Computer Centers Montana State Library By investing in public libraries, our $ 1,829,473
project will make sustainable broadband enhancements available to 86% of the Montana population. It will increase average facility broadband speeds at participating libraries to 21 mbps, while cutting wait times in half by increasing the total number of computers. It will extend health, education, and job services to vulnerable populations in most need. Department of Commerce BTOP Sustainable Broadband Adoption Communication Service for the Deaf, Inc. This project intends to expand broadband adoption among people who are deaf and hard of $14,988,657
to all the Internet has to offer, including sign language interpreters, captioned video services, and other content and functionalities designed especially to advance their educational, employment, and healthcare interests.” United States Department of Agriculture (USDA) Broadband Initiative Program (BIP) Last Mile Non-Remote Area Reservation Telephone Cooperative This project, using technology, brings affordable and reliable broadband access and video services to underserved rural areas in western North Dakota and eastern Montana communities in and around the Fort Berthold Grant request $ 10,950,000 Loan request $ 10,950,000
Indian Reservation, including the remote Squaw Gap service area and the partially remote Mandaree, New Town, Parshall and Roseglen service area. USDA BIP Last Mile Project Telephone Company The project will expand high-speed Internet service on the Crow Indian Reservation in southeastern Montana, providing broadband access to approximately 1712 locations. Grant Request: $11,662,109.00 Loan Request: $3,887,370.00 Other Funding: $165,000.00 USDA BIP Last Mile Nemont Telephone Inc. This project will provide to all locations within the Fort Peck Indian Reservation exchanges of Brockton, Grant Request: $23,394,510.00 Loan Request: $2,599,390.00 Funding: $566,000.00 Total: $26,000,000.00
rapidly to change MMIS capability must include a way to calculate cost sharing and benefit limits so providers obtain current information Enterprise view to align technology and business needs Data from silo systems must be integrated for an enterprise look at programs and other agency data The MMIS must meet federal/state Medicaid and HIPAA standards and be certified Privacy and security of health information is critical enabling the sharing of information across agencies and systems. Business functions must drive technical solutions and the MMIS capability must be flexible to meet future needs including new
Does the State have Federally-Qualified Health Center networks that have received or are receiving HIT/EHR funding from the Health Resources Services Administration (HRSA)? Please describe. Does the SMA have data on EHR adoption by of provider (e.g. children’s hospitals, acute care hospitals, pediatricians, nurse practitioners, etc.)? The of Montana has 15 Community Health Care Centers of which 13 have and EHR (Table 2.6). Table 2.6 Current HIT Landscape for Federally Qualified Health Centers (FQHC) Facility City Provider Type EHR Software Deployed Ashland CHC Ashland Physician Assistants (PA), Physician one day a month eClinical (eCW) Bullhook CHC Havre Practitioner (NP), Dentist EHS Butte CHC Physician, Dentist, PA, NP Currently do not have an EHR Central Montana CHC Lewistown Physician, NP eCW Community CHC Great Falls Physician, Dentist, PA, NP Sage Community Health Partners Livingston Physician, Dentist, PA, NP Next Gen
Cooperative Health Center Helena Physician, Dentist, PA, NP eCW Custer County CHC City NP eCW Flathead CHC Kalispell Physician, Dentists, NP eCW Glacier County CHC Cutbank Physician, Dentists, NP eCW Northwest CHC Libby Physician, Dentists, NP, PA eCW Partnership Health Center Missoula Physician, Dentists, NP, PA eCW River Stone Health Billings Physician, Dentists, NP, PA eCW Sweet Medical Center Chinook Physician, NP, PA EHS Montana Migrant and Seasonal Farm Workers Council Billings NP, others on contract Currently do not have an EHR
In 2008, five of the 15 centers received HIT related funding to set-up a network (Table 2.7). During 2009 – 2010, six of the 15 centers used stimulus funding to help with hardware & software needs. Table 2.7 Recovery Act Funding for Community Health Centers in Montana Health Center Grantee Name City Project Type Award Amount Ashland Community HC Ashland Capital Improvement Construction Program $293,820 Bullhook Community HC, Inc Havre Capital Improvement Construction Program $332,110 Butte Primary Health Care Clinic Butte Capital Improvement Construction Program $784,170 Cascade Health Department Great Falls Capital Improvement Construction Program $438,020 Central Montana Community HC Lewistown Capital Improvement Construction Program $251,610 Community Health Partners, Inc. Livingston Capital Improvement Construction Program $559,295
Custer County Community HC, Inc Miles City Capital Improvement Construction Program $268,657 Flathead City - County Health Dept Kalispell Capital Improvement Construction Program $241,438 Glacier Community HC, Inc. Cut Bank Capital Improvement Construction Program $336,625 Lewis & Clark City-Co. Health Dept. Helena Capital Improvement Construction Program $469,345 Lincoln County Community HC Libby Capital Improvement Construction Program $435,220 Missoula City/County Health Dept/Partnership HC Missoula Capital Improvement Construction Program $571,545 Montana Migrant Council, Inc. Billings Capital Improvement Construction Program $433,855 Sweet Medical Center, Inc. Chinook Capital Improvement Construction Program $333,300
adopt, implement, or upgrade to certified EHR technology Objective 1.1 – Encourage Medicaid providers to take first steps towards adoption by phasing out paper-based processes; this will help encourage adoption for Meaningful Use stage 2 as well as provide efficiency and reduction in administrative expenses. – Objective 1.3 – Encourage Medicaid providers to adopt, implement, or upgrade by leveraging and expanding the current MPQH REC scope of efforts for outreach, education, and technical support in Montana 2 1
Goal – Obtain a solution for incentive program administration Objective 2.1 – Obtain an efficient and economical solution to administer the incentive program for Montana. Objective 2.2 – Use existing DPHHS tools and methods to support audit and oversight Goal 3 – Support implementation and sustainability of the statewide HIE Objective 3.1 – Provide outreach to providers to encourage participation in the HIE. Goal 4 – Leverage MITA Objective 4.1 – Include the HIE in planning for statewide sharing of health information, including access to State government assets such as immunization Objective 4.2 – Initiate efforts from the to develop the required Service Oriented (SOA)
efficient, effective, equitable, patient-centered care. HIE is also useful to multiple public health authorities to assist in analyses of the health of the population and the effectiveness of treatments. Health Information technology (HIT) Encompasses a array of technologies involved in managing and sharing patient information electronically, rather than through paper records and non-standard transmittals. Version Date Description 1.0 January 6, 2011 Original document 1.1 June 30, 2011 Minor revisions requested by CMS as condition of approval of SMHP