Mississippi’s Progress Since 2010 in Implementing Electronic Health Records
Executive Summary
Introduction
H. B. 392, Regular Session 2014, amending MISS. CODE ANN. § 41-119-19 (1972), requires PEER to report by December 1, 2014, on progress in implementing the electronic health records system in the state of Mississippi.
For this report, PEER reviewed implementation of electronic health records by the University of Mississippi Medical Center (UMMC) and the Division of Medicaid (DOM). The University of Mississippi Medical Center was selected because it is one of the state’s largest health care providers and the Division of Medicaid was selected because it is one of the largest providers of health care coverage to persons in the state. PEER sought to determine what progress these two entities have made in implementation since issuance of PEER Report #542, A Review of Requests for Proposals Used by the Division of Medicaid and University of Mississippi Medical Center to Procure Electronic Health Records Systems in 2010.
PEER also reviewed the Mississippi Health Information Network because it is tasked with developing the statewide health information exchange that will encompass UMMC, DOM, and other providers and entities throughout the state.
While H. B. 392 tasked PEER with evaluating the state of Mississippi’s “progress in implementing the electronic health records system,” PEER limited this review to evaluating the progress of the previously named three entities in implementing electronic health records (EHR).
Background: Electronic Health Records and Health Information Exchanges
Electronic health information technology is the use of technology to collect, store, retrieve, and transfer by electronic means a patient’s clinical, administrative, and financial health information. For purposes of this report, the major components that make up the electronic health information technology structure are electronic medical records, electronic health records, health information exchanges, and community health records. (See the Glossary in Appendix A, page 33, of the report for definitions of terms related to electronic health records.)
Factors that have influenced the development and implementation of electronic health records and health information exchanges in Mississippi are:
In its 2010 report, PEER concluded that UMMC and DOM had complied with best practices to date for procurement of their electronic health records systems. At that time, UMMC estimated that its system would cost $70 million and DOM projected that the cost of its system would be less than $10 million. At the time of that report, it was not yet possible to know what portion of American Recovery and Reinvestment Act funds that Mississippi providers would receive with which to implement health information technology.
What progress has the University of Mississippi Medical Center made since 2010 in implementing its electronic health care information system?
UMMC’s electronic health care information system, known as Epic, replaced twenty existing legacy systems and officially went live June 1, 2012. Epic is a comprehensive, unified electronic health care information system, including electronic health records, a centralized patient portal, a centralized master patient index, research support, and improved administrative and billing components, including tying billing to the electronic health records.
UMMC reports that Epic complies with applicable EHR requirements. Epic currently maintains required EHR certification with the Office of the National Coordinator for Health Information Technology. UMMC also reports that Epic complies with all requirements of the Health Insurance Portability and Accountability Act of 1996. Further, UMMC and its providers remain on track for meeting the Electronic Health Records Incentive Program requirements (e. g., “meaningful use”), generating over $24 million in incentive payments to date for progress in adopting and implementing electronic health records.
UMMC funds Epic through patient revenues. Through May 30, 2014, UMMC had spent approximately $97 million on training, staffing, consultants, software licensing fees, Epic implementation fees, and hardware costs to implement Epic. UMMC expects to spend from $15 to $17 million per year in FY 2015 and FY 2016 to operate and maintain Epic.
What progress has the Division of Medicaid made since 2010 in implementing electronic health records?
The Division of Medicaid initially implemented an electronic health records system on June 4, 2010, prior to the 2011 federal requirements for certified electronic health records. Neither DOM’s original contracted provider nor a second contracted provider could provide an electronic health records system that met federal EHR and Medicaid acceptance standards. Consequently, in 2014, after consultation with the Centers for Medicare and Medicaid Services, DOM made the decision to provide clinical data repositories instead of supplying Medicaid providers with electronic health records systems. A contract was subsequently assigned to Mede/Analytics in 2014 to proceed with a clinical data repository system.
The Division of Medicaid’s new clinical data repository system includes a clinical data repository in which providers can search patient records, a master patient index, and a secure provider portal. The Division of Medicaid is partnering with the Mississippi Health Information Network to capture Medicaid-specific provider data at the hospital and clinical level to add to the clinical data repository. Many of the federal regulations specific to an EHR system no longer apply, aside from Health Insurance Portability and Accountability Act and other privacy and security requirements. DOM reports that it is in compliance with remaining applicable federal and state EHR requirements.
From FY 2009 to FY 2014, the Division of Medicaid spent $14.1 million to attempt to procure and implement a statewide electronic health records system.
What progress has the Mississippi Health Information Network made since 2010 in implementing electronic health records?
MISS. CODE ANN. § 41-119-7 (1972) tasked the Mississippi Health Information Network with developing the Mississippi Health Information Exchange, an electronic exchange of health information in Mississippi that allows providers access to a patient’s community health record.
While the exchange system is mostly in place, the MS-HIN is still in the early stages of adding providers to the system, with most early participation being from the Gulf Coast and the Delta. The MS-HIN continues to build and develop the exchange to expand opportunities to the remainder of the state’s medical providers. MS-HIN has application modules in place as part of the exchange to assist providers in meeting meaningful use requirements as well as for meeting components of the Patient Protection and Affordable Care Act.
MS-HIN has received approximately $12.8 million in federal, state, and private funding and has expended approximately $11.2 million to create and implement the Mississippi Health Information Exchange. While one goal of MS-HIN is to be self-sufficient, it has not yet reached a point where it has sufficient revenues to cover operational and additional build-out costs completely. Furthermore, MS-HIN expects additional expenditures for providing patients with a searchable system projected to commence in 2016, for which the specific costs are unknown to date.