Form #1 Form #1 Needs Assessment

Technical Assistance for Health IT and Health Information Exchange in Medicaid and SCHIP

Attachment C_DRAFT Needs Assessment Revised_v4

Needs Assessment

OMB: 0935-0137

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RTI Draft revised needs assessment 4/14/08

Form Approved
OMB No. 0935-XXXX
Exp. Date XX/XX/20XX

SECTION 1 - QUESTIONS ABOUT THE STATE’S MEDICAID/SCHIP HEALTH INFORMATION TECHNOLOGY (Health IT) PROJECTS

Our purpose for conducting this needs assessment is to better understand how we can assist Medicaid and SCHIP agencies nationwide to plan or implement Health IT and/or health information exchange (HIE) initiatives that will improve the quality of care for all beneficiaries and improve efficiency.

During the first part of this interview, we will focus on Health IT initiatives. By Health IT we mean any system that is used to electronically collect, store, retrieve, and transfer clinical and administrative health information used for communication and decision making related to the provision of health care services. The most common types of health IT include electronic health records (EHR), electronic prescribing, remote disease monitoring, and personal health records (PHR).

During the second part of the discussion we will talk about Health Information Exchange activities. By Health Information Exchange (HIE) we mean the sharing of clinical and administrative health information electronically among health care information systems. Participating entities in a Health Information Exchange network agree to certain information sharing policies and procedures.

To prepare for these discussions, our team reviewed existing literature and data gathered so that we would have an understanding of what each agency is planning or implementing. Based on our review, we have identified the following initiatives that your agency is planning or implementing:

Initiative 1___________________________________________________________

Initiative 2___________________________________________________________

Initiative 3___________________________________________________________

Initiative 4___________________________________________________________

1. Is this a complete and accurate list of the Medicaid/SCHIP Health IT initiatives currently underway in your state?

 Yes  CONTINUE

 No  ADD UNRECORDED INITIATIVES OR UPDATE INACCURATE INITIATIVES, THEN CONTINUE.

Public reporting burden for this collection of information is estimated to average 4 hours and 10 minutes per response, the estimated time required to complete the survey. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: AHRQ Reports Clearance Officer Attention: PRA, Paperwork Reduction Project (0935-XXXX) AHRQ, 540 Gaither Road, Room # 5036, Rockville, MD 20850.

Now we would like to learn more about each of the initiatives you have identified. The next series of questions are going to be asked one at a time for each initiative listed above. I will start with <INSERT Initiative FROM ABOVE>.

2. Are you currently planning or implementing <this initiative>?

 Currently planning  CONTINUE 

 Implementing  GO TO 4

3. When are you planning to implement <this initiative>?

 4^th Quarter 2008 (Oct, Nov, Dec)

 1^st Quarter 2009 (Jan, Feb, Mar)

 2^nd Quarter 2009 (Apr, May, Jun)

 3^rd Quarter 2009 (July, Aug, Sep)

 Other (specify)___________________________________________________

4. What specific goals or outcomes is your agency expecting to achieve through <this initiative>?

____________________________________________________________________________________________________________________________________

5. How do you plan to evaluate the goals or outcomes of <this initiative>?

____________________________________________________________________________________________________________________________________

6. Over the next three years, what major challenges to the implementation of <this initiative> will your agency face? (PROBE if “no challenges”: “Do you foresee any staffing, financial or political problems that could hinder your agency’s participation in this initiative over the next 3 years?”)

____________________________________________________________________________________________________________________________________

7. Do you know what the cost of your agency’s participation in <this initiative> is?

 Yes  Total Costs? ______________

Monthly or Maintenance costs?____________________

 No  CONTINUE

8. Does your agency have plans to evaluate the cost/value of <this initiative>?

 Yes  CONTINUE

 No  GO TO 10.

9. How do you plan to evaluate the cost/value of <this initiative> to the agency?

10. Over the next three years, what major challenges will your agency face in trying to evaluate the success of <this initiative>?

____________________________________________________________________________________________________________________________________

11. Have any models or experiences from other states helped your agency to prepare and/or implement <this initiative>? If yes, what are they?

____________________________________________________________________________________________________________________________________

12. In your agency’s experience preparing and/or implementing <this initiative>, has your agency identified any “best practices” or “lessons learned” that would be helpful to other states as they prepare or implement a similar initiative? If yes, what are they?

____________________________________________________________________________________________________________________________________

IF MORE INITIATIVES TO DISCUSS, CONTINUE USING ANOTHER FORM

IF NO MORE INITIATIVES, GO TO 13.

13. Are there any Health IT initiatives that the agency considered but did not pursue due to their cost?

 Yes  CONTINUE

 No  GO TO SECTION 2.

14. What are they and what were the expected costs?

Initiative 1 _____________________________________________________
Cost_____________________________________________________________

Initiative 2_____________________________________________________
Cost______________________________________________________________

Section 2 - QUESTIONS ABOUT THE STATE’S MEDICAID/SCHIP HEALTH INFORMATION EXCHANGE (HIE) PLANS

Now we would like to discuss any plans that the state has for the Medicaid and SCHIP agencies to participate in Health Information Exchange (HIE). By Health Information Exchange (HIE) we mean the sharing of clinical and administrative health information electronically among health care information systems. Participating entities in a Health Information Exchange network agree to certain information sharing policies and procedures.

15. We have identified the current Health Information Exchange initiatives in your state. Are you aware of any of the following HIE initiatives?

 Yes  No (Initiative 1)_______________________________________________?

 Yes  No (Initiative 2)_______________________________________________?

16. Are you aware of any other local, state, or regional health information exchange initiatives not mentioned above? If so, what are they?

Initiative 1___________________________________________________________

Initiative 2___________________________________________________________

IF NO INITIATIVES RECOGNIZED OR IDENTIFIED, GO TO 31.

IF 1 OR MORE INITIATIVES IDENTIFIED, CONTINUE.

17. Is your Medicaid and/or SCHIP agency currently playing a role in any of the state’s Health Information Exchange (HIE) initiatives?

 No  GO TO 31.

 Yes  CONTINUE 

18. Can you describe what roles your agency currently plays in each of the HIE initiative(s) it is involved in?

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

19. Can you describe what specific goals or outcomes your agency hopes to achieve for each of the HIE initiative(s) it is involved in?

20. Can you describe what plans your agency has made to evaluate the goals or outcomes for each of the HIE initiative(s) it is involved in?

21. What challenges does your agency face to participating in your state’s HIE initiative(s)? (PROBE if “no challenges”: “Do you foresee any staffing or financial problems that could hinder your agency’s participation in this initiative over the next 3 years?”)

22. Do you know what the cost of your agency’s participation is for each of the HIE initiative(s) your agency is participating in?

 Yes  GO TO 24.

 No  CONTINUE

23. Does your agency have plans to evaluate the cost/value of these HIE initiative(s)?

 Yes  GO TO 25.

 No  GO TO 26.

24. What are the costs for each of the HIE initiatives your agency is participating in?

Initiative 1 ____________________________________________________
Cost__________________________________________________________

Initiative 2____________________________________________________
Cost__________________________________________________________

25. What has your agency done or what plans have been made to evaluate the cost/value of each of these HIE initiative(s)?

26. What challenges does the agency face trying to estimate costs and value?

27. What major challenges will your agency face in your efforts to evaluate the agency’s participation in <this HIE initiative>?

28. Have any models or experiences from other states helped your agency in participating in <this HIE initiative>? If yes, what are they?

29. In your agency’s experience participating in <this HIE initiative>, has your agency identified any “best practices” or “lessons learned” that would be helpful to other states planning to participate in HIE initiatives? If yes, what are they?

30. What role or roles do you see Medicaid/SCHIP playing in health information exchange initiatives in the future? (check all that apply)

____ Facilitator/convener

____ Funder

____ Data contributor

____ Data exchange participant

____ Policy/regulatory role

____ Member of board overseeing effort

____ Member of planning working committees

____ Member of implementation committees

____ Other (please explain: _____________________________________)

GO TO SECTION 3

(INTERVIEWER: QUESTIONS 31-39 ARE FOR AGENCIES WITH FUTURE PLANS TO PARTICIPATE IN HIE BUT NO CURRENT HIE PARTICIPATION)

31. Does your agency currently have any plans to engage in Health Information Exchange (HIE) initiatives in the next 3 years?

 No  GO TO 38.

 Yes  CONTINUE 

32. What specific HIE initiative(s) does your agency plan to implement or engage in over the next 3 years?

Initiative 1_________________________________________________________

When is your agency planning on implementing this initiative?

 4^th Quarter 2008 (Oct, Nov, Dec)

 1^st Quarter 2009 (Jan, Feb, Mar)

 2^nd Quarter 2009 (Apr, May, Jun)

 3^rd Quarter 2009 (July, Aug, Sep)

 Other (specify)_____________________________________________

Initiative 2_________________________________________________________

When is your agency planning on implementing this initiative?

 4^th Quarter 2008 (Oct, Nov, Dec)

 1^st Quarter 2009 (Jan, Feb, Mar)

 2^nd Quarter 2009 (Apr, May, Jun)

 3^rd Quarter 2009 (July, Aug, Sep)

 Other (specify)_____________________________________________

33. What specific goals or outcomes does your agency hope to achieve by participation the HIE initiative(s) it is planning?

34. What plans has your agency made to evaluate the goals or outcomes for the HIE initiative(s) it is planning?

35. What challenges does your agency face in the next 3 years by participating in your state’s HIE initiative(s)? (PROBE if “no challenges”: “Do you foresee any staffing or financial problems that could hinder your agency’s participation in this initiative over the next 3 years?”)

36. What plans has your agency made to evaluate the cost/value of participating in each of the HIE initiative(s) your agency is planning on participating in?

37. What are the major challenges to evaluating of your agency’s participation in HIE?

GO TO SECTION 3

38. Did any of the following factors play a role in your agency’s decision not to engage in any Health Information Exchange (HIE) initiatives at this time?

a. Cost?

 No  GO TO b.

 Yes  CONTINUE 

How did cost factor into your agency’s decision not to engage in a Health Information Exchange Initiative at this time?

_______________________________________________________________________________________________________________________________________________________________

b. Political landscape?

 No  GO TO c.

 Yes  CONTINUE 

What about the political landscape factored into your agency’s decision not to engage in a Health Information Exchange Initiative at this time?

_______________________________________________________________________________________________________________________________________________________________

c. Lack of knowledge about initiatives?

 No  GO TO d.

 Yes  CONTINUE 

What knowledge gaps factored into your agency’s decision not to engage in a Health Information Exchange Initiative at this time?

_______________________________________________________________________________________________________________________________________________________________

d. Something else?

 No  GO TO 39.

 Yes  CONTINUE 

What else factored into your agency’s decision not to engage in a Health Information Exchange Initiative at this time?

39. We would like to better understand the reasons why your agency does not have any plans to engage in any Health Information Exchange initiatives. What would you say is the main reason that your agency is not planning any HIE initiatives at this time?

____________________________________________________________________________________________________________________________________

SECTION 3 – IDENTIFICATION OF AREAS OF NEED FOR TECHNICAL ASSISTANCE AND PARTICIPATION IN THE TA PROGRAM ACTIVITIES

One of the purposes of this study sponsored by the Agency for Healthcare Research and Quality (AHRQ) is to provide Medicaid and SCHIP agencies with Technical Assistance to help implement their Health IT and Health Information Exchange initiatives. Now, we would like to discuss the specific types of Technical Assistance that would help your agency to implement your Health IT or Health Information Exchange initiatives over the next 3 years.

TARGETED TECHNICAL ASSISTANCE

AHRQ will be developing a series of intensive 2- or 3-day workshops that will provide targeted assistance to small groups of states with specific needs for information or tools in shared, common areas. The final decision about topics for the workshops will be made based on the results of this needs assessment.

To help us gauge interest in topics for workshops, please look at the list of topics provided and rank order them based the areas that you would say are key areas of need for your agency.

40. Please rank the following topics related to Overall Health IT/HIE Policy Issues from 1 to 4 with 1 being the highest priority and 4 being the lowest priority for your agency’s plans to implement Health IT and HIE initiatives.

Overall Health IT/HIE Policy Issues

RANK (1 to 4) TOPIC

______	Federal and state regulations/laws/guidance which impact Medicaid/SCHIP plans for Health IT and HIE initiatives
______	Defining and refining the Medicaid/SCHIP agency’s Health IT/HIE policies and plans
______	Overview of national Health IT and HIE initiatives, standards, and products
______	Prioritizing Health IT/HIE projects and opportunities

41. Please rank the following topics related to Health IT/HIE Privacy and Security Issues for Medicaid and SCHIP Agencies from 1 to 6 with 1 being the highest priority and 6 being the lowest priority for your agency’s plans to implement Health IT and HIE initiatives.

Health IT/HIE Privacy and Security Issues for Medicaid and SCHIP Agencies

RANK (1 to 6) TOPIC

______	Overview of privacy and security issues that affect the implementation of Health IT and HIE projects and activities for Medicaid/SCHIP agencies
______	Overview of federal and state legal and regulatory environment on privacy and security for Medicaid and SCHIP
______	Privacy and patient consent approaches (opt-in, opt-out, notice-only)
______	Standards for capturing, maintaining and transmitting electronic patient consent directives
______	Certification criteria on privacy and security standards for EHR products
______	Security approaches to user identification, authentication, authorization, access control and audit trails

42. Please rank the following topics related to Adoption and Use of Data and Technical Standards from 1 to 4 with 1 being the highest priority and 4 being the lowest priority for your agency’s plans to implement Health IT and HIE initiatives.

Adoption and Use of Data and Technical Standards

RANK (1 to 4) TOPIC

______	Implementation of HIPAA and other administrative and financial transaction standards through Health IT and HIE
______	Understanding, adopting and implementing the new harmonized interoperability standards from the Health Information Technology Standards Panel (HITSP)
______	Understanding, adopting and implementing health care vocabulary and terminology standards for health information exchanges (SNOMED, LOINC and others)
______	Utilizing the certification criteria from CCHIT to evaluate and implement Health IT products

43. Please rank the following topics related to General Health IT Projects and Initiatives from 1 to 3 with 1 being the highest priority and 3 being the lowest priority for your agency’s plans to implement Health IT and HIE initiatives.

Medicaid/SCHIP Health IT Projects and Initiatives - General

RANK (1 to 3) TOPIC

______	Business process analysis for the implementation of Health IT projects in Medicaid/SCHIP agencies
______	Cost/benefit analysis to support the implementation of Health IT projects by Medicaid/SCHIP agencies (assessing resource requirements and cost/value to agency)
______	Evaluating Medicaid/SCHIP Health IT vendors and technology partners

44. Please rank the following topics related to EHRs from 1 to 5 with 1 being the highest priority and 5 being the lowest priority for your agency’s plans to implement Health IT and HIE initiatives.

Specific Medicaid/SCHIP Health IT Projects and Initiatives - EHRs

RANK (1 to 5) TOPIC

______	Overview of EHR approaches and components
______	Evaluation of EHR options and opportunities
______	Integration of EHR with MMIS, MITA and other internal Medicaid/SCHIP systems
______	EHR privacy and security issues (including management of consent, authentication, authorization, access control, audit directives)
______	Interoperability of EHRs and interaction with provider EHRs, EHRs from other payers

45. Please rank the following topics related to PHRs from 1 to 5 with 1 being the highest priority and 5 being the lowest priority for your agency’s plans to implement Health IT and HIE initiatives.

Specific Medicaid/SCHIP Health IT Projects and Initiatives - PHRs

RANK (1 to 5) TOPIC

______	Overview of PHR approaches, components, cost-benefits, value
______	Evaluation of PHR options and opportunities
______	Integration of PHR with MMIS, MITA and other internal Medicaid/SCHIP systems
______	PHR privacy and security issues (including management of consent directives, authentication, authorization, access control, audit)
______	Interoperability of PHRs and interaction with PHRs and EHRs from providers, payers and others

46. Please rank the following topics related to Medication Management and e-Prescribing from 1 to 4 with 1 being the highest priority and 4 being the lowest priority for your agency’s plans to implement Health IT and HIE initiatives.

Specific Medicaid/SCHIP Health IT Projects and Initiatives – Medication Management and e-Prescribing

RANK (1 to 4) TOPIC

______	Overview of e-Prescribing and Medication Management approaches, components
______	Evaluation of e-Prescribing and Medication Management options and opportunities for Medicaid/SCHIP agencies
______	Integration of e-Prescribing and Medication Management with MMIS, MITA and other internal Medicaid/SCHIP systems
______	Integration of e-Prescribing and Medication Management with EHRs, PHRs, and HIE

47. Please rank the following topics related to Health Information Exchanges from 1 to 6 with 1 being the highest priority and 6 being the lowest priority for your agency’s plans to implement Health IT and HIE initiatives.

Medicaid/SCHIP and Health Information Exchanges (HIEs)

RANK (1 to 6) TOPIC

______	Overview of national and regional HIE efforts, characteristics, components and technical approaches
______	HIE organizational and operational options
______	HIE privacy and security issues (including consent directives including authentication, authorization, access control, audit)
______	HIE patient and user identification issues
______	Identifying opportunities where active, collaborative participation in local and regional HIEs will result in improvements for enrollees and the program in general

48. Please rank the following topics related to the Role of Health IT and HIE in Quality Improvement and Business Process Improvement from 1 to 7 with 1 being the highest priority and 6 being the lowest priority for your agency’s plans to implement Health IT and HIE initiatives.

The Role of Health IT and HIE in Quality Improvement and Business Process Improvement

RANK (1 to 6) TOPIC

______	The relationship of Health IT and HIE to quality measurement, business process improvement. (For example, pay for performance, reducing/eliminating health disparities, evidence-based utilization management/utilization review, management of prescription drugs)
______	Identifying and implementing tools to assist the agency to turn data into useful information to help achieve the agency’s access, cost containment, quality of care, or other goals.
______	Identifying and implementing warehousing/data mining tools to assist in collection, management and analysis of the program’s data
______	Preparing and training agency workforce for the use of data analysis and knowledge management tools.
______	Evaluating the costs/value of adopting new Health IT/HIE

49. Are there any topics that you feel are a priority for your agency that we did not ask about? (If yes, where would you rank this topic, near the top, the middle or near the bottom?)

__________________________________________________________________

RANK: Top Middle Bottom

50. Please rank the following TA topic areas from 1 to 9 with 1 being the highest priority and 9 being the lowest priority for your agency’s plans to implement Health IT and HIE initiatives.

Overall Health IT/HIE Policy Issues (including the following topics)

RANK (1 to 9) TOPIC AREA

______	Overall Health IT/HIE Policy Issues
______	Health IT/HIE Privacy and Security Issues for Medicaid and SCHIP
______	Adoption and use of data and technical standards
______	Medicaid/SCHIP Health IT Project Initiatives – General Topics
______	Medicaid/SCHIP and EHRs
______	Medicaid/SCHIP and PHRs
______	Medicaid/SCHIP and Medication Management/e-Prescribing
______	Medicaid/SCHIP and Health Information Exchanges
______	The Role of Health IT and HIE in Quality Improvement and Business Process Improvement

51. If the Agency for Healthcare Research and Quality hosted a 2-day workshop on one or more of the topics you have identified as priority areas for your agency, would a representative from your agency attend the workshop? (Please note that the workshops will be free but would require travel to the location and expenses for travel would be the responsibility of the agency.)

 Yes  GO TO 53

 No  CONTINUE 

52. Why would a representative from your agency not attend?

 No one would be interested in attending

 No one would be able to take the time to attend

 Agency would not be able to afford to send a representative

 Other (specify)______________________________________________

53. If a representative were to attend a 2-day workshop, how much lead time would your agency need to plan and get any necessary approvals to travel and participate?

___________ Number of days

 Is that number of business days or calendar days?

 Business days

 Calendar days

54. Why would that amount of time be necessary?

BROAD-BASED ASSISTANCE: WEBINARS

In addition to 2-day targeted workshops, AHRQ is also planning a series of 2-hour webinars that will address specific topics of broad-interest to Medicaid and SCHIP agencies planning or implementing Health IT or HIE projects. To help us plan those webinars, we would like to ask you about the topics you feel would be most beneficial to your Agency’s Health IT or HIE plans.

55. If the Agency for Healthcare Research and Quality hosted a 2-hour webinar on one or more of the topics you have identified as priority areas for your agency, would a representative from your agency attend the webinar? (Please note that the webinars will be free but would require registration.)

 Yes  GO TO 59

 No  CONTINUE 

56. Why would an agency representative not attend?

________________________________________________________________________________________________________________________________________________________________________

PEER-TO-PEER LEARNING--COMMUNITY OF PRACTICE

Another important component of the AHRQ Technical Assistance program to support Medicaid and SCHIP agencies with their Health IT and HIE programs will be the development of a community of practice (COP). Medicaid and SCHIP staff will be able to join their peers in a nationwide Learning Network that will provide peer-to-peer learning experiences through facilitated meetings, both face to face and on the Web. The community of practice will feature access to experts, tools and literature through the repository of information on the National Resource Center’s Medicaid and SCHIP website and the portal area.

The COP will allow members to:

Share their experiences.
Identify promising practices.
Point out gaps where innovation is needed.
Raise issues for national consensus-building organizations.
Provide an on-the-ground perspective to participate in setting national priorities for improvement.

As part of the COP, AHRQ is planning to host a series of facilitated peer-to-peer meetings which may be in-person or on the web. To help us plan those peer-to-peer meetings, we would like to ask you about the topics you think would have the most immediate impact on helping your Agency meet its goals related to Health IT or Health Information Exchange.

57. To help us gauge interest in appropriate topics for peer-to-peer meetings, please describe the top four technical assistance topic areas that you would say are key areas of need for your agency’s plans to implement your Health IT or Health Information Exchange program(s)?

Topic 1_________________________________________________________

When would a peer-to-peer meeting on this topic be needed most?

 4^th Quarter 2008 (Oct, Nov, Dec)

 1^st Quarter 2009 (Jan, Feb, Mar)

 2^nd Quarter 2009 (Apr, May, Jun)

 3^rd Quarter 2009 (July, Aug, Sep)

 Other (specify)_____________________________________________

Topic 2_________________________________________________________

When would a peer-to-peer meeting on this topic be needed most?

 4^th Quarter 2008 (Oct, Nov, Dec)

 1^st Quarter 2009 (Jan, Feb, Mar)

 2^nd Quarter 2009 (Apr, May, Jun)

 3^rd Quarter 2009 (July, Aug, Sep)

 Other (specify)_____________________________________________

Topic 3_________________________________________________________

When would a peer-to-peer meeting on this topic be needed most?

 4^th Quarter 2008 (Oct, Nov, Dec)

 1^st Quarter 2009 (Jan, Feb, Mar)

 2^nd Quarter 2009 (Apr, May, Jun)

 3^rd Quarter 2009 (July, Aug, Sep)

 Other (specify)_____________________________________________

Topic 4_________________________________________________________

When would a peer-to-peer meeting on this topic be needed most?

 4^th Quarter 2008 (Oct, Nov, Dec)

 1^st Quarter 2009 (Jan, Feb, Mar)

 2^nd Quarter 2009 (Apr, May, Jun)

 3^rd Quarter 2009 (July, Aug, Sep)

 Other (specify)_____________________________________________

58. If AHRQ hosted a peer-to-peer meeting in-person on one or more of the topics you have identified as priority areas for technical assistance for your agency which would require travel to the site, would a representative from your agency attend the peer-to-peer meeting? Please note that the meetings will be free but will require the agency to pay for travel and expenses. ? (Please note that the workshops will be free but would require travel to the location and expenses for travel would be the responsibility of the agency.)

 Yes  GO TO 63

 No  CONTINUE 

59. Why would a representative from your agency not attend?

 No one would be interested in attending

 No one would be able to take the time to attend

 Agency would not be able to afford to send a representative

 Other (specify)______________________________________________

60. If AHRQ hosted a peer-to-peer meeting via the web on the topics you have identified as priority areas for your agency, would a representative from your agency attend the meeting? (Please note that the webinars will be free but would require registration.)

 Yes

 No  CONTINUE 

61. Why would an agency representative not attend?

________________________________________________________________________________________________________________________________________________________________________

Thank you for participating in this study. Your input is very helpful and valuable to us.

File Type	application/msword
File Title	SECTION 1 - QUESTIONS ABOUT THE STATE’S MEDICAID/SCHIP HEALTH INFORMATION TECHNOLOGY (Health IT) PROJECTS
Author	Linda Dimitropoulos
Last Modified By	wcarroll
File Modified	2008-04-28
File Created	2008-04-28