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The Many Flavors of Health Information Exchange

May 20, 2010
by John DeGaspari
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States are following widely different strategies in planning implementing health information exchanges.

As various states work toward health information exchanges (HIEs), it is becoming clear that each is developing its own path to reach that goal. That’s the consensus of three panelists taking part in a virtual roundtable discussion on HIEs sponsored by the Mountain View, Calif.-based Symantec Corp. this week. Each of the participants has taken the lead in planning for and implementing HIEs in his or her state or health organization.

As various states work toward health information exchanges (HIEs), it is becoming clear that each is developing its own path to reach that goal. That’s the consensus of three panelists taking part in a virtual roundtable discussion on HIEs sponsored by the Mountain View, Calif.-based Symantec Corp. this week. Each of the participants has taken the lead in planning for and implementing HIEs in his or her state or health organization.

The Buffalo, N.Y.-based HEALTHeLINK, the Western New York Clinical Information Exchange, has relatively long HIE experience. One of about a dozen regional health information organizations (RHIOs) in the state, HEALTHeLINK began operation 10 years ago as a collaboration among three major payer organizations. Its initial focus was administrative, enabling providers’ offices to do eligibility queries on patients and returning information on the patient’s insurance carrier and coverage. Four years ago, HEALTHeLINK joined with four major hospital systems to apply a similar strategy to the clinical side. It now links data from hospitals, laboratories and standalone diagnostic imaging centers, making the information available to providers in western New York State.

Steve Allen, operations director of the group, attributed HEALTHeLINK’s success to “a very high degree of collaboration among entities that, under many circumstances, compete fiercely, both on the payer side and the hospital side.” The group currently receives funding from state grants, stakeholders, and the federal stimulus. He believes HEALTHeLINK will achieve financial sustainability when it reaches a critical mass of adoption and use. At that point, “we can put in place a model where the entities in the communities that are gaining the most value from a cost perspective and a quality-of-care perspective can start picking up the tab,” he said.

In Texas, the HIE initiative is being driven by the Texas Health Services Authority (THSA), a public-private partnership in Austin created three years ago by the state legislature. Still in its early stages, the group has received $28.8 million in federal stimulus funds to plan and implement HIEs across the state. Manfred Sternberg, THSA chairman, says the group is using the funds to create stakeholder groups that will help define the governance model, technical infrastructure, and electronic health record (EHR) adoption and consumer engagement.

Sternberg is careful to draw a distinction between stimulus funds, which will eventually run out, and lasting value that will result from reducing inefficiencies in healthcare. And while that effort may meet with resistance by some insurance companies, involvement by consumers — who should remain in control of their own health information — is essential to making reforms possible, he said.

In Oregon, the state’s plan for health information technology is being coordinated by the Salem-based Health Information Technology Oversight Council (HITOC), a governor-appointed entity that was established with the passage of Oregon’s Omnibus Health Reform Bill of 2009. Carol Robinson, HITOC’s director, describes the effort as a robust public process.

Oregon already has a very high rate of EHR adoption by providers in the state. According to a recent HITOC survey, over 65% of its providers have some sort of EHR system in their offices, she said — far higher than many other states. Robinson added that Oregon has a burgeoning culture of health information organizations cropping up in regions around the state. “We have a competitive marketplace in terms of HIE already developing,” she said.

HITOC is still early in the planning process, which Robinson describes as a phased approach. It will submit a strategic and operational plan in August. During the first phase, it will establish rules for local and regional RHIOs and health information organizations as well as look at a financial sustainability model and examine the state of quality reporting and public health data. “We will be analyzing gaps across our state and where those regional efforts aren’t meeting the needs of regional providers to exchange information effectively, we will develop strategies address those,” she said.

Robinson calls Oregon’s HIE strategy cautious, in terms of designating a state entity and jumpstarting an organization. But she believes the approach will pay off in broad public support, stakeholder support, and consumer awareness about the goals of the effort. Overall, she said, state-by-state development of HIEs is not a one-size-fits-all proposition. “A lot of it is going to be how this shakes out in an emerging industry and what kinds of market forces arise in different states.”

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