With the help of the American Recovery and Reinvestment Act (ARRA), Oklahoma got a jumpstart to create its own statewide health information exchange (HIE) called the Oklahoma Health Information Exchange. John Calabro, CIO of Oklahoma City-based Oklahoma Health Care Authority, spoke to HCI Associate Editor Jennifer Prestigiacomo on how Oklahoma decided to structure and govern its HIE.
Healthcare Informatics: Can you tell me a little about how the Oklahoma Health Information Exchange (HIE) got started and what the overarching goals were in setting it up?
John Calabro: Two years ago the Oklahoma Health Care Authority felt the need to have health information exchange to improve the quality of medical care for the SoonerCare [Oklahoma’s Medicaid program] population. About two years ago we ended up sending a request to the legislature to give us funding to do it. The government’s budget started to decline, and it [our request] did not get funded. But right around the same time, February 2009, the Recovery Act [The American Recovery and Reinvestment Act] passed, and there were grants from the State Health Information Exchange Cooperative Agreement Program [administrated through the Office of the National Coordinator for Health Information Technology].
Originally, we were only looking at the SoonerCare population when we did it, but the Recovery Act grant provided funding to develop a statewide health information exchange. The Governor’s Office of Oklahoma designated the Health Care Authority to be the lead agency to apply for the grant. So by fall we put together a team of about 40 different medical institutions to help write the grant and submit it October 16. Oklahoma was awarded $8.8 million on February 12, spread over a four-year period of time. We are currently in the planning phase and are putting together our strategic plan and long-term sustainability plan, called an operations plan. Those are due August 31 of this year.
Our Legislature meets February through May, and we introduced legislation in our section to create a public trust for health information exchange. So its long-term life will exist in the public trust. The legislation for our health information exchange passed the House and Senate unanimously, and the governor signed it and it went into law July 1. We’re now in the process of taking nominations for the trustees of the public trust, and we’re hoping that we’ll have it [the trust] created at the end of August when our operations plan is due, so it can vote on the plan and submit it. There will be a total of seven trustees, three from the governor’s office, two of them nominated by the speaker of the House, and two of them nominated by the speaker pro tem of the Senate. At the same time, the governor’s office will name the first Obama health information technology coordinator. So the coordinator will make sure all these grants act as a uniform program for Oklahoma.
HCI: What is the purpose of the Health Information Infrastructure Advisory Board?
Calabro: In Oklahoma, we have our own commissions, our own boards, our own budgets. So one of our objectives we had passed in the 2009 legislative session [was that] we created the [Health Information Infrastructure Advisory] Board. [The issue is] how do all the state purchasers of health participate in this statewide HIE and not look like 10 different agencies doing 10 different things? How do we help the Health and Human Services agencies that are purchasing healthcare using state dollars look and operate like one entity, so that the public trust doesn’t have to navigate, ‘Well here’s how the health department does something, here’s how the department of mental health does something.’ [The challenge is] to break down those barriers and agree on the approaches. That would make it easier for the public trust to enable the statewide HIE to operate more smoothly. So, [the purpose of] that board is to keep all 10 of the state agencies moving in a common direction.
HCI: How did the Oklahoma HIE grow out of the Oklahoma Health Care Authority?
Calabro: When the Recovery Act came out, the governor’s office took different sections of the act and asked the cabinet secretaries to look at what impact the different sections have on Oklahoma, and if there is an impact or deficit to Oklahoma, [and then] put together workgroups or teams to work on the. And if there were grants in that area, go for them. The secretary of health in Oklahoma was assigned the HITECH [Health Information Technology for Economic and Clinical Health] portion of the Recovery Act to take responsibility to look at how it impacts Oklahoma. Secretary [of Health and commissioner for the Oklahoma Department of Mental Health and Substance Abuse Services] Terri White asked me to look at all of the health information technology pieces of the Recovery Act to act as a chair of workgroups to study it and make recommendations. And if grants come out then I put together workgroups to work on the grants.
HCI: Why was the Oklahoma HIE created as a public trust rather than another type of entity?