Oregon is looking to a new subsidized Direct secure messaging project to be the onramp that many providers take to board the health information exchange superhighway. This program, administered by CareAccord, Oregon's health information exchange (HIE), began enrolling providers in April, and now has 25 approved accounts using this service.

“Developing the Direct secure messaging standards for a more ubiquitous pathway for push-type information exchange was a unique and unprecedented collaborative approach,” says Carol Robinson, administrator for the Oregon Office of Technology and the State Coordinator for Health IT. “We decided that was a great onramp for health information exchange and the right avenue to do this in phasing. As more and more providers adapt and become familiar with electronic health records [EHRs] and utilizing means for health information exchange, that desire for additional electronic services will grow.”

Oregon’s Direct program is available at no cost through September 2013 for providers, whether or not they have an electronic health record system. CareAccord is administered by the Oregon Health Authority (OHA), which has contracted with Harris Healthcare Solutions (Falls Church, Va.) to implement these messaging and identity verification services. CareAccord is also working to build a provider directory for the state.
 
Phase 2 of Oregon’s state HIE activities will include future services like linkages between regional health information organizations (RHIOs); e-alerts of care events like ED visits and medication list updates; record locator services; and care coordination tools, says Robinson. Unlike Phase 1, Phase 2 will require financial participation. Robinson notes that CareAccord will be exploring other models beyond subscription-based models, and will seek broad buy-in from stakeholders.

ACOs in Oregon
In addition to Direct messaging, Oregon Health Plan (OHP), the state Medicaid program, has begun its demonstration project, Care Coordination Organizations (CCOs), its version of accountable care organizations (ACOs). State legislation in 2011 and 2012 dramatically changed the payment model for Medicaid to support patient-centered care practices, and CCOs will seek to better coordinate services and focus on prevention and chronic illness management. So far, eight organizations have been certified and are entering into contracts this month, says Robinson. Some CCOs will begin as soon as August 1, and as other CCOs form, OHP clients will be enrolled between September and November.

Robinson says Oregon faces significant challenges, in that it lacks natural economic drivers for information exchange, and is “looking at changing the financial incentives for better coordination of care through electronic means.” “I think that looking for those leverage points, either with pilots or with our Coordinated Care Organization legislation, [will] really create the economic drivers for different behavior,” she adds. “We hope to have some proposed legislation in 2013 that helps drive that.”

Oregon ranks sixth in the U.S. for physician adoption of EHRs, according to a December 2011 report by the Centers for Disease Control and Prevention. The mail survey of office-based physicians found state rates of adoption of any EHR system ranging from 40 percent (Louisiana) to 84 percent (North Dakota). Oregon, at 74.7 percent, ranked behind North Dakota, Utah, Minnesota, Wisconsin, and Washington.

The survey found a national average EHR adoption rate of 57 percent. It also found that between 2010 and 2011, the percentage of physicians reporting having a basic system increased by 36 percent. Also, 44 percent of Oregon physicians told surveyors they intended to participate in the EHR incentive payment program, compared with a national average of 52 percent.