With the help of the American Recovery and Reinvestment Act (ARRA), Oklahoma got a jumpstart to create its own statewide health information exchange (HIE) called the Oklahoma Health Information Exchange. John Calabro, CIO of Oklahoma City-based Oklahoma Health Care Authority, spoke to HCI Associate Editor Jennifer Prestigiacomo on how Oklahoma decided to structure and govern its HIE.
Healthcare Informatics: Can you tell me a little about how the Oklahoma Health Information Exchange (HIE) got started and what the overarching goals were?
John Calabro: Two years ago the Oklahoma Health Care Authority felt the need to have health information exchange to improve the quality of medical care for the SoonerCare [Oklahoma's Medicaid program] population. About two years ago we ended up sending a request to the legislature to give us funding to do it. The government's budget started to decline, and it [our request] did not get funded. But right around the same time, February 2009, the Recovery Act [ARRA] passed, and there were grants from the State Health Information Exchange Cooperative Agreement Program [administrated through the Office of the National Coordinator for Health Information Technology].
THE NO. 1 CHALLENGE WAS GOVERNANCE. WE PROBABLY SPENT A YEAR TALKING ABOUT HOW GOVERNANCE SHOULD LOOK AND OPERATE TO GET TO WHERE WE ARE TODAY WITH THE PUBLIC TRUST.
Originally, we were only looking at the SoonerCare population when we did it, but the Recovery Act grant provided funding to develop a statewide health information exchange. The Governor's Office of Oklahoma designated the Health Care Authority to be the lead agency to apply for the grant. So by fall we put together a team of about 40 different medical institutions to help write the grant and submit it October 16. Oklahoma was awarded $8.8 million on February 12, spread over a four-year period of time. We are currently in the planning phase and are putting together our strategic plan and long-term sustainability plan, called an operations plan. Those are due August 31 of this year.
Our legislature meets February through May, and we introduced legislation in our section to create a public trust for health information exchange. So its long-term life will exist in the public trust.
HCI: What is the purpose of the Health Information Infrastructure Advisory Board?
Calabro: In Oklahoma, we have our own commissions, our own boards, our own budgets. [The challenge is] to break down those barriers and agree on the approaches. That would make it easier for the public trust to enable the statewide HIE to operate more smoothly. So, [the purpose of] that board is to keep all 10 of the state agencies moving in a common direction.
HCI: Why was the Oklahoma HIE created as a public trust rather than another type of entity?
Calabro: There are three [available] models. There's a public trust, a state agency, and a 501(c)(3). A public trust is not a state agency, so it has some of that autonomy. At the same time a public trust carries with it some court protection, probably the item that swayed people most. One major lawsuit could bring a 501(c)(3) down. And some of that protection of being able to operate under Oklahoma court protection swayed people that it was a more survivable kind of enterprise in this state.
HCI: What kind of hospital and provider support have you gotten so far for the Oklahoma HIE?
Calabro: The hospitals are very engaged to get all of their members up to speed to meet meaningful use. The provider community is very confused. There are a little under 7,000 physicians in Oklahoma, and it's a lot harder to get that group educated and up to speed. There are quite a number that are very active, they're realists. They know it will take five to 10 years for this to mature.
HCI: What kind of consulting/education will you be doing to help participating doctors implement EHRs?
THE NO. 2 OBSTACLE IS PRIVACY, THE VARIOUS LAWS AND RULES WRAPPED AROUND WHAT YOU CAN SHARE, CAN'T SHARE, HOW YOU SHARE IT.