Like most states, Arizona is in a transition period in terms of health IT initiatives. It has made great progress in EHR adoption (80 percent) and has a statewide health information exchange with a sustainable business model that includes funding from both hospitals and payers. But as federal grant funding for HIE and regional extension center outreach work subsides, Arizona is shifting gears to focus on reaching more providers and expanding the types of services the HIE offers.
The Arizona Strategic Enterprise Technology Office funded the creation of the recently published Health IT Roadmap 2.0, which received input from more than 300 stakeholders and describes 19 key initiatives to advance HIT/HIE in Arizona. This morning I had the chance to speak with Arizona Health-e Connection CEO Melissa Kotrys about a few of those initiatives.
The first one that caught my eye was the study of a statewide unique patient identifier. Last fall I saw a debate at the AMIA conference in Washington, D.C., about whether AMIA should advocate for a unique health identifier for care and research purposes and if so, what kind of standard should it support under what conditions? There were strong feelings on both sides. An audience poll following the debate seemed to suggest that a majority wanted AMIA to advocate a unique health identifier, but there was widespread recognition that political headwinds continue to make consensus on the right direction unlikely.
I mentioned that meeting to Kotyrs, and she agreed with my description of it as a political hot potato. “It is a controversial issue,” she said, “but when we convened stakeholders to talk about key issues, this topic of the difficulty of patient identification came up, even with master patient index solutions. So there was enough interest to explore this topic further.”
According to the Arizona Health IT Roadmap 2.0 document, the lack of a unique identifier for every patient causes difficulty in ensuring that: 1) patient records are always matched to the correct patient and 2) all records belonging to a patient are identified and associated with the patient. As the number of patients and the number of organizations participating in HIE grows, the complexity of correct patient record matching is magnified.”
Arizona plans to explore best practices and identify alternative approaches it can use to address the increasing complexity of correctly matching patients to all of their available records across multiple organizations.
Another change Kotrys mentioned was that during the course of developing the roadmap, AzHeC tightened its affiliation with the statewide HIE organization, the Health Information Network of Arizona (HINAz). AzHeC will continue to serve as the multi-stakeholder organization that handles policy development, education, stakeholder engagement and various HIT/HIE programs such as the Arizona Regional Extension Center, while HINAz will serve as the “network” under the AzHeC umbrella that connects providers through the statewide HIE.
Here are a few other interesting initiatives on Arizona’s to-do list:
An HIE Consent Management Engine: This would develop a technical infrastructure to support the common statewide patient consent approach and processes. The consent management engine should be able to:
• Manage consent from multiple sources (providers, HIEs, and patient-generated sources)
• Manage consent for various types of health information
• Support current levels of consent for secure sharing of patient information
• Support increasing levels of granularity of patient consent
• Harmonize approaches and consent engines from multiple organizations to ensure there is consistent compliance with a patient’s consent for the sharing of their information
• Integrate with other technologies to deliver notices to providers if there is additional information in the HIE that has not been consented to be shared – as appropriate within current laws and regulations.
Integration of Physical, Behavioral HIEs: Arizona has an existing network for sharing data between behavioral providers. It is called the Behavioral Health Information Network of Arizona. Kotrys said there are efforts underway first to offer providers on BHINAZ to access data from the statewide exchange and eventually to work through the more difficult regulatory and granular consent issues to allow physical providers to access the behavioral health information about their patients.
Arizona HIE Marketplace: The Arizona Health Information Exchange (HIE) Marketplace is a program established by AzHeC through ASET funding to get providers on the HIE on-ramp by using Direct secure messaging. Kotrys said that the first-phase uptake was low, but that meaningful use requirements should lead to greater usage.
I came away from our conversation impressed with both the scope and level of detail of the initiatives in Arizona’s roadmap. I’ll check back with them in six to nine months to get a progress report.