The Iowa Health Information Network (IHIN) plans to begin its messaging pilot in July 2012, with full implementation planned by December 2012. This will be the first HIE activity of its kind in the state.
Iowa e-Health Executive Director Kim Norby says that among the core components and services of the messaging pilot will be access, authentication, and authorization controls, as well as 24/7 customer support. IHIN secure messaging, based on Direct standards, will support all items including a provider directory, certificates, and HISP to HISP transport, he adds. ACS, owned by the Norwalk, Conn.-based Xerox, along with subcontractors, including Informatics Corporation of America (ICA) of Nashville, Tenn., Genova Technologies of Cedar Rapids, Iowa, and LightEdge Solutions of Des Moines, will help IHIN to implement the health information exchange and an advanced analytics product.
“Payers will be receiving a specific set of services that allow them to both capture and analyze patient data for their own members better and set up customized care quality tools that can help those providers who care for their members in a variety of ways,” says Norby.
IHIN got its start when the 2008 Iowa legislature directed Iowa’s Department of Public Health to bring together a multi-stakeholder collaborative, which would eventually become Iowa e-Health, to discuss statewide health information exchange. Iowa e-Health, a collaboration of hospitals, consumers, healthcare providers, payers, and other stakeholders, governs and directs IHIN operations. “For the development of the statewide health information network, it allowed a neutral body to bring together disparate stakeholders that may have competitive reasons not to join,” says, Mariannette Miller-Meeks, M.D., director, Iowa Department of Public Health.
As part of the American Reinvestment and Recovery Act/Health Information Technology for Economic and Clinical Health (ARRA/HITECH) Act, Iowa received an $8.375 million grant from the Department of Health and Human Services to create the HIE as a state-run entity. The 2011 Iowa General Assembly enacted legislation creating a workgroup to develop a business and financial sustainability plan for IHIN, and last November, it submitted its plan to the executive board for approval. A month later, the plan was submitted to the legislature.
In the business and financial sustainability plan is a section about pondering future governing structures. “Implementation of the IHIN would lose some level of focus if a governance structure change was undertaken and the business stability of the entity that we were asking our stakeholders to invest in would have more uncertainty for a period of time, so it was decided not to introduce that risk,” says Norby. “A workgroup that was created by 2011 legislation to study sustainability recommended staying the course to meet the timeline to get the IHIN up and operational during the HIE Cooperative Agreement program.”
The governance structure issue will most likely be reviewed in late 2013, as the report gives pros and cons of different structures. Miller-Meeks says the governing structure could change in the future. “I’m not sure about what the tenor of the legislature will be and what their desires will be,” she says. “For us we want to present the options as objectively as possible to the legislature to determine that.”
Financial Sustainability Discussions
The statewide discussions around financial sustainability began a little more than a year and a half ago when developing an RFP, which was won by the Tampa, Fla.-based HIE company Hielix. The sustainability report suggested sources of operational revenue to include hospitals, provider practices, state government agencies, payers, long-term care centers, home health providers, pharmacies, and labs. Participation fees are based on the type and size of the organization. “One foundational element is that everybody that plays, pays,” says Norby. “A second [element] that we have is to split the projected cost up by some judgment of value. It also started on a principle of thirds with the three big beneficiaries, providers, payers, and the citizen/healthcare consumer, represented by the state.”
Iowa e-Health has approached the four largest hospitals, businesses, and the two largest payers, Medicaid and Wellmark, to sign a memorandum of understanding that states the organizations will pay their level of fee for five years.
The proposed sustainability plan also advocates for a separate fund within the state treasury to be created for IHIN to prevent any overage fees from being channeled into the general state treasury fund. “It was important that we have the funds be kept for the utilization of the statewide health information network rather than returning back into the general fund of the state,” says Miller-Meeks.
Miller-Meeks says among the many challenges IHIN faces beyond getting a master-patient index (MPI) uploaded and operational and bringing providers online as quickly as possible, is getting the sustainability bill passed through the legislature. “Not only is it an election year, it’s an election year where there has been redistricting. For incumbents, they’re running in districts that could be relatively new for them, so I think that is always a challenge,” she says.
“There are numerous changes taking place in the healthcare space alone and providing enough time and information for each stakeholder or interested party to fully understand what is both possible and desired is a challenge,” says Norby. “Luckily for Iowa, a collaborative spirit has been foundational in our effort, and something we do well, and this has helped move things along despite the hurdles.”