Florida’s statewide Health Information Exchange, Florida HIE, has been operational since 2011, and in the past five years, the healthcare landscape has continued to change, requiring providers and healthcare organizations to invest in new health information technologies. Leaders of the Florida HIE, have, in turn, been challenged with operating an HIE organization that is both sustainable and flexible to keep up with these changes.
In 2010, Florida’s Agency for Health Care Administration (AHCA), the chief health policy and planning agency for the state, was awarded a $20.7 million grant from the Office of the National Coordinator for Health Information Technology (ONC) HIE Cooperative Agreement program to establish the Florida HIE. After a competitive procurement process, Harris Corporation, a Florida-based international communications and information technology company, was then awarded a four-year contract by AHCA to build the HIE infrastructure.
AHCA and Harris began implementing the statewide HIE in 2011 and the organization now offers three services that enable healthcare providers to share information with consent – Direct Messaging, Patient Look-UP (PLU), and Event Notification Service (ENS). The Florida HIE also is a participant in the eHealth Exchange for interstate health information exchange.
The Direct Messaging service provides healthcare organizations and providers with a way to securely send and receive messages and attachments containing a patient’s clinical data. The service is nationally accredited through Direct Trust and allows for HIPAA-compliant, encrypted transmission of protected health information (PHI).
PLU enables patient-authorized exchange of clinical data between participants through the PLU “network of networks,” which connects already existing HIEs, such as a regional network or a health system. The Florida HIE also offers a PLU Hybrid Service that enables physicians to connect to the PLU network through Direct Messaging. As of November, there were 15,000 PLU-covered hospital beds in the state of Florida, which is 23 percent of the state’s hospitals beds. Volume has steadily grown and in November 2015 there were 375,000 queries through the PLU with 23,000 matched patient records.
ENS is an automated alerting service that provides alert notifications when patients are discharged from a hospital or emergency department to health plans and accountable care organizations (ACOs), and then subsequently, the primary care provider. That service went live in the fall of 2013, and there are currently four Florida health plans subscribed – Wellcare of Florida, Sunshine State Health Plan, Molina Healthcare and South Florida Community Care Network. As of October 2015, more than 1 million Florida residents are covered by the ENS service.
In the first part of a two-part interview, Healthcare Informatics Assistant Editor Heather Landi spoke with Pamela King, Florida HIE Outreach Coordinator, and Janet Hofmeister, product line manager, Florida HIE Systems, Harris Corporation, about the steps taken to implement the Florida HIE and the challenges of keeping up with the ongoing evolution of the healthcare landscape.
Why was AHCA interested in receiving the ONC funding for a statewide HIE?
King: The bottom line for any organization implementing an HIE is to improve healthcare by getting key patient clinical information into the hands of care providers efficiently. The Agency for Health Care Administration, operating under a mission of Better Health Care for All Floridians, encourages the adoption of health technology in the state of Florida, in an effort to improve healthcare outcomes. The Agency also administers with the U.S. Centers for Medicare and Medicaid Services (CMS) electronic health record (EHR) Incentive Program, enabling hospitals and practitioners to purchase electronic health record systems and meet federal requirements for electronic exchange to improve care.
What were the initial steps to set up the Florida HIE?
Hofmeister: We at Harris were excited to enter into the contract in Florida especially since Harris is headquartered in Florida; it’s our home state. Initial work involved defining requirements with Heidi Fox, AHCA administrator and Florida HIE project director, and other members of the team. Then we began reaching out to organizations to gage interest in participation in the Florida HIE. We knew early in the project that there were several significant healthcare organizations, like Florida Hospital, who were interested in being early adopters. We began with applications for 20 licenses procured for the HIE, and funding to help 20 organizations join initially. After several rounds of application reviews, we selected applicants with a certain patient population, and evaluated their technical capabilities. Once the organizations were ready, our technical teams began to set up the gateway exchange of the data.
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