1 PROFILES OF PROGRESS: STATE HEALTH IT INITIATIVES
INTRODUCTION
“In today’s global society,it is absolutely critical that we adopt practices that enable healthinformation to be transmitted quickly and accessibly across the Commonwealth and statelines.”–Governor Bob McDonnell of theCommonwealth ofVirginia
The health care reform debate has created a verycontentious period for both the state governmentsand the federal government,but one thing that hasbeen generally agreed upon is that health informa-tion technology will help improve our health caresystem. In February of 2009 the federal govern-ment enacted a multi-billion dollar stimulus bill inan effort to help our ailing economy and,in Marchof 2010,President Obama signed into lawsweeping healthcare reform legislation thattouches nearly every individual in the UnitedStates. Each of those individuals,whether currentlycovered by health insurance or will be covered bythe new law,will be dependent upon the states,stakeholders,and state CIOs vital role in loweringcosts,improving care and increasing efficienciesthrough the use of technology in healthcare.Nowinitsfourthinstallment,the2010compendiumoutlineswherestatehealthITinitiativesstandanddrawsattentiontotheroleofthestateCIOintheseefforts. Thiscompendiumwillfocusonstate-led,orstatedesignatedentities,thatareworkingtowardasuccessfulstatewidehealthinformationexchange.In March 2010 the Office of the National Coordina-tor for Health InformationTechnology (ONC),theprincipal federal entity charged with nationwideefforts to implement the exchange of healthinformation technology,announced the recipientsof the State Health Information Exchange Coopera-tive Agreement Program (State HIE). In total,56states,eligible territories,and qualified StateDesignated Entities (SDE) received awards totalingnearly $550 million.
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The State HIE Cooperative Agreement Programfunds states efforts to build capacity for exchang-ing health information within the state and acrossstate lines. The state or SDE will be responsible forincreasing connectivity and enabling patient-centric information flow as a way to improve thequality and efficiency of care.Paramount to theprojects success is stakeholder collaboration andcontinual advancements in governance,policies,technical services,business operations,and financ-ing mechanisms for each state,territory,or SDE’sfour-year performance period.The state HIE isbuilding on existing efforts to advance regionaland state-level health information exchange whilemoving toward nationwide interoperability withthe National Health Information Network (NHIN).As part of the architecture for the NHIN,the ONCplans to announce the winners of eleven contractsfor developing a health information exchangeframework based on a model originated by federalhomeland security agencies. The National Informa-tion Exchange Model,or NIEM,is a technicalapproach to information sharing that federalagencies developed during the last decade,prompted by the need to share homeland securityinformation quickly and securely. The vendors havebeen enlisted to develop health information
“States play a critical leadership role in advanc-ing the development of the exchange capacity of healthcare providers and hospitals withintheir states and across the nation.Healthinformation exchange will enable eligible health-care providers to be deemed meaningful usersof health IT and receive incentive paymentsunder the Medicare and Medicaid electronic health record incentive program.” –David Blumenthal,M.D.,M.P.P.,National Coordinator for Health InformationTechnol-ogy at HHS.
2 PROFILES OF PROGRESS: STATE HEALTH IT INITIATIVES
INTRODUCTION
exchange definitions and standards within theNIEM framework,along with use cases for testingtransactions.The NIEM framework will incorporateand build upon standards that are already in place.
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NASCIO advocates for NIEM adoption and promotesthe methodology for planning,designing andimplementing collaborative information exchange.In 2006,NASCIO released
which examined the vision of NIEM and how it hasexpandedtoincludehealthinformationtechnology.While the State HIE cooperative agreements have afour-yearperformanceperiod,therecipientshavealsoagreedtomatchaportionofthegrantsbeingawardedinthesecondyearoftheaward,2011. Fortunatelythestates are not limited on how these matching fundscan be acquired and the capital can come fromsources other than the state general revenues. ThestateCIOsroleinastateHIEmaydependuponhowinvolvedthestateiswithoverseeingtheprivacy,security,sustainability,anddependabilityoftheHIE. If public expectations are high for strong governmentpresence it will most likely be a government-ledelectronichealthinformationexchange. Ontheotherhand,ifastatechoosestobelessinvolvedinoversee-ingtheHIEanddeterminingthebusinessmodel,itcan let other actors,such as a non-profit entitycreated by stakeholders,operate the HIE.
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NASCIOsuggests that a state HIE should develop from a fewguiding principles that,regardless of thegovernance model,state CIOs can provide duringthe planning and implementation phases:
An effective statewide HIE will be able tosecurely integrate data and make it accessi-ble in a federated model.
Secure and standardized sharing of data isessential to implementing an efficient anddependable HIE.
A statewide HIEs primary purpose is to shareclinical data from different sources and maketheminteroperablewiththeNHINstandards.
Although an HIE may mature and includeeligibility,biosurveillance,claims data,reporting,and provide communicationfunctions,it is essential to focus on makingthe HIE compatible with clinical use. The lessstringent HIPAA privacy laws in HITECHrequire a clinical use case as a requirement.
The Meaningful Use (MU) provisions thatwhere announced by ONC in July of 2010can not be met with just a state HIE.A stateHIE is a single component,in combinationwith electronic health records (EHRs),Computerized Physician Order Entry (CPOE)systems,financial exchanges,etc.,that work together to achieve MU.
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The HITECH ACT greatly expands the role of statesin planning and implementing health informationexchange.Harmonization between the state-levelHIT coordinators and federal HIT policy organiza-tions is vital to trouble-shooting any gaps that mayexist. As early adopters start to implement HIEs it isimportant that state standards don’t conflict withone another. States should begin to collaborate onhow they will connect to the NHIN and definewhere the NHIN begins and the state HIE ends.Agreatdealofemphasishasbeenplacedontheuseof technology in healthcare and how it can beleveraged to improve patient care,efficiency andreduce costs by electronically exchanging medicalinformation. A statewide HIEs key objective is toprovideanenterprise-widearchitecturethatwillbesecure,efficient,andinteroperablefortheexchangeof informationamongstallstakeholders. ThestateCIOsrecognizethatthereisnobetteropportunitythannowforcarryingoutthesegoals. Themassiveinfluxof federaldollarsprovidesthestateswithanunprece-dentedopportunitytoimplementahealthinforma-tionexchange,butfulfillmentofthisgoalisgoingtorequiretheingenuityofthestates,stateCIOsandstakeholderstomakehealthinformationexchangeasustainablereality. Whilestatespoliciesandprogressvarygreatly,thiscompendiumprovidesacrosssectionofthismomentoustimeinhealthcarereform.
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See < http://www.govhealthit.com/newsitem.aspx?nid=73807 >,May 26,2010.
See < http://www.nga.org/portal/site/nga/menuitem.9123e83a1f6786440ddcbeeb501010a0/?vgnextoid=8074c55482a5f110VgnVCM1000005e00100aRCRD#reports >,2009.
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See < http://thomsonreuters.com/content/press_room/tsh/tr_establishes_best_practices_statewide_health >,March 2010.
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