Several states have recently issued strategic plans and requests for proposals (RFPs) for technology vendors to help build the core infrastructure to support their statewide health information exchange efforts. A look at their technology needs reveals some interesting things about the decisions they have made about policies and priorities. One is a recognition that many small physician practices will need to access data through a web portal.
In Maryland, the not-for-profit Chesapeake Regional Information System for Our Patients (CRISP) is soliciting bidders to provide health information exchange core infrastructure solutions for the state of Maryland.
In its RFP, one of the first points CRISP highlights is that only 20 percent of physician practices in the state use EHRs, and that without wider adoption, the HIE will be of little value.
One way CRISP wants to deal with this is for the HIE to include a provider portal for web-based access into HIE-transmitted health information as physicians migrate to a fully functional EHR.
CRISP will use a service-oriented architecture approach that combines a federated system, where data resides at the participating facilities, with a consumer option for data also to reside in a health record bank account that the consumer controls. CRISP's leaders note that they are planning for a future market in which health record banking may become prevalent, with consumers actively selecting to exert control of the flow of their health information within the exchange. Consumers must also be able to opt-out of participation entirely, CRISP notes.
The West Virginia Health Information Network (WVHIN) RFP notes that the state has many small, paper-based physician practices, or ones with outdated EHRs and practice management systems that will not meet meaningful use requirements. It is seeking a vendor that can provide very low-cost, simple tools to serve as an entry point for these mostly rural providers to begin moving toward meaningful use. Like Maryland, West Virginia envisions a portal providing access to multiple applications and data sources.
It describes this as creating an "iPhone experience" for users of the system, which in its first tier of applications would offer clinical messaging, referrals, inquiry, e-prescribing, public health reporting and alerts, and encounter data.
A proposed strategic plan for the Pennsylvania Health Information Exchange (PHIX) notes that startup funding will include approximately $17.1 million in HITECH funding and the Governor's Office of Health Care Reform's current PHIX budget of $1 million. For ongoing funding, it recommends an assessment on all medical claims paid by insurers as the most equitable means to provide the necessary funds to cover the ongoing costs of implementation. This is the approach rolled out in Vermont last year.
On the infrastructure side, Pennsylvania plans to enter into an intergovernmental agreement with Delaware to leverage the existing Delaware Health Information Network (DHIN) contract for HIE services. The proposed strategic plan notes that "partnering with DHIN will substantially accelerate start-up time for PHIX and will support clinicians in maximizing their incentive funds."
Not everyone is pleased with that idea. Kelly Lewis, president and CEO of TechQuest Pennsylvania, operated by the Technology Council of Central Pennsylvania, wrote an op-ed in the Central Pennsylvania Business Journal in November asking why the Commonwealth would enter into a contract with Medicity for the HIE infrastructure without going through an open and transparent bidding process.
"Many people are questioning why the state is not using the state procurement code to buy the HIE technology," Lewis wrote. "Rumors, allegations and speculations are swirling. In fact, these controversies will slow down or stop the deployment of HIE technologies."