Source: CSC's Global Healthcare Group Posted on: 28th October 2009

 

The United States is on the verge of significant health reform today, and the American Recovery Reinvestment Act (stimulus) passed in February made a downpayment on reform by recognizing health information technology (health IT) as one of its key foundational elements.

An evolution is taking place as we move from paper records to electronic ones in parallel with networking the information, or making it ”interoperable”. Eventually we will be able to use the digital information for population analytics and personalized care.

The funding provided in the stimulus legislation is coming in waves to support this evolution. The first covers health information exchange (HIE), followed by incentives for “meaningful use” of electronic health records (EHRs). The states are tasked with playing a key role in securing and coordinating these funds, presenting a tremendous opportunity for visibly enhancing health IT and ultimately, patient care.

States Must Act Quickly

In August, the federal Office of the National Coordinator for Health Information Technology (ONC) issued requests for proposals from states, territories and designated non-profit entities to facilitate widespread adoption and use of EHRs and health IT. ONC views the states as force “multipliers” for its efforts. By October 16, every state and qualified U.S. territory had applied for state-level HIE funds and received preliminary determinations of their portion of the $564 million ONC is making available over the next four years. Once funds are awarded in January, states will have between three and eight months to complete strategic and operational plans for their HIE implementations.

The funds have a “use or lose it” flavor to them since they are only available for four years, and state matching requirements increase every year. There is in fact no matching requirement in year one (this year). In addition to the HIE grants, there is $598 million planned for Regional Extension Centers to help doctors implement health IT and EHRs in their practices and an estimated $45 billion in incentive payments for doctors and hospitals demonstrating meaningful use of EHRs.

While the new responsibilities require states to have high levels of organization, expertise and support, they are literally all over the map on their approach to facilitating health IT and HIE. Some, like New York, have already committed considerable state funding over the past few years. Many others have private or public / private grassroots efforts underway. Still others are conducting pilot programs in specific areas, such as Medicaid or public health. The majority of states, however, have no large scale HIE underway today.

Looking to Successes for Guidance

HIE in Massachusetts and Rhode Island, where the New England Healthcare Exchange Network (NEHEN) has been performing live data exchange since 1997, can provide a model for other states just getting up to speed. NEHEN is multi-stakeholder and public / private in nature – it has been built with investment from hospitals and commercial health plans, as well as from Massachusetts state government. It has used earlier federal grants for seed funding, but not for sustainability. It is standards-based, in terms of the format of the data exchanged and its deployed technology. It has provisions for all sizes of healthcare organizations to participate by providing tiered pricing and hosting / cloud computing options for smaller organizations. And NEHEN includes administrative and payment processing in its exchange, along with clinical information sharing – providing a low-cost replacement for functions its participants are already engaged in, with a clear and immediate return on investment. NEHEN has already proven to its participants that HIE can drop costs from dollars to pennies per transaction.

Key Considerations for States Planning a Health Information Exchange

To qualify for ongoing funding ranging from $4-40 million per state, states must have ONC-approved plans organized around five domains: governance, finance, technical infrastructure, technical and business operations and legal / policy. We recommend that they consider many of the elements NEHEN’s system already has in place and is delivering across Massachusetts and Rhode Island. Also, a shortage of qualified technology partners is predicted as the federal milestones approach, making it essential for states to choose their technology partners – particularly those with the experience and expertise to get health IT and HIE done right – carefully and soon.

Beyond this initial effort, all the pending congressional bills propose insurance exchange or co-operatives to help residents find affordable health insurance. The Commonwealth Connector in Massachussetts, the first statewide insurance exchange, can serve as a model for states as health reform places states in another force multiplier role.

This is an exciting time for advancing both health IT and reform. As part of a global IT company, we are working to transform healthcare with better information for better decisions to be made by patients, doctors, payors, government, and researchers. Amid all the exciting technology, software and hardware, it is important to remember that the reason for all this is to improve the care of patients, improving lives and saving money.

For more information on health information exchange and state HIT grants:

www.csc.com/healthforstates
The Massachusetts Health Connector: Lessons Learned from the Builders of the Health Insurance Exchange: http://www.csc.com/health_services/insights/32538-the_massachusetts_health_connector_lessons_learned_from_the_builders_of_the_health_insurance_exchange
Health Information Exchanges: At the Intersection of Healthcare, IT and Business: http://assets1.csc.com/cscworld/downloads/10_CSCWORLD_DEC08_HEALTH.pdf

Greg DeBor, Partner, CSC’s Global Healthcare Group
Robert Wah, MD, Chief Medical Officer and Vice President, CSC’s North American Public Sector; and former deputy national coordinator for Health IT at the Dept. of HH