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HIE Sustainability and Interstate Collaborations

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HIE musings from HIMSS12

As I was telling someone this week, I’m still digging out from HIMSS12 that took place last week in Las Vegas. Not only did I conduct a lot of great interviews with interesting folks like MAeHC’s Micky Tripathi, Huntington Hospital’s Rebecca Armato, and NeHC’s Kate Berry, I sat in on a ton of great sessions.

A couple of sessions that stuck out were from the HIE Symposium which delved into timely topics of HIE sustainability and interstate collaborations. I thought Texas’ strategy of creating a network of networks, instead a gargantuan statewide HIE makes complete sense; Texas after all is the largest state in the lower 48. Trust me, as a native Houstonian, the fact that it takes 30 minutes to get anywhere in that city leads me to believe this is the right way to go for the Lone Star State.  

Steve Palmer, director, Texas Health and Human Services said at the symposium, “We are moving toward statewide exchange, but we are not building a statewide exchange. So we are developing the necessary technical services at the state level to allow communication between local HIEs, but we are not developing a statewide HIE implementation per se.”  

Palmer said that Texas is focusing on its local HIE grant program that funds the planning and implementation of local HIEs, of which there are 16 grantees and 12 local HIEs now in the midst of implementation. Texas is also funding connections between providers and local HISPs through its  whitespace strategy, a voucher program for the HISP marketplace, where there are currently no local HIEs. “One important aspect of the local HIE program and the white space program is that we do not want to create culture of dependency associated with the local dollars. We felt like it was very important that all these local HIEs be putting in a certain amount of money in the program, and they all have local action requirements,” said Palmer.

This network of networks approach reminds me of what Oklahoma is doing with SMRTNet, which is a conglomeration of eight exchanges that defines its own goals and parameters around governance and has a central management committee.
During the interstate collaborations session symposium, one particular collaboration among Florida, Michigan, Kentucky, Alabama, New Mexico, and Nebraska seemed really innovative. The Behavioral Health Data Exchange Consortium is working together to develop common data exchange procedures and policies that comply with 42 CFR, part 2 (the Federal statute outlining confidentiality requirements for the disclosure of drug and alcohol abuse patient records) and the various state statutes requiring more stringent disclosure rules about interstate exchange of other behavioral health information such as mental health data. HCI Senior Contributing Editor David Raths has reported about Nebraska’s inclusion in this collaborative.

Lee Stevens, program manager, State HIE Program, ONC said at the symposium that a subset of states would be conducting a Direct-enabled pilot to provide a proof-of-concept demonstration that the policies and procedures align with the technical capacity to execute the exchange. The pilot will also test the ability of the components, such as a patient authorization/consent form, to withstand real-world use.


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