Qual-IT - April 2005 | Archived

As concerns relating to health care costs, access, and quality have increased, health care has moved to the forefront of state policy agendas, and interest in health IT has grown.

State governments have a major stake in health care: they administer the Medicaid, SCHIP, and state employee health benefits programs; regulate insurers and many types of health care providers; and protect public health through disease surveillance and prevention activities. Speeding the adoption and use of IT could provide direct and substantial benefits to states in all of these programs, although state laws governing professional scope of practice, confidentiality of health information, and prescription of controlled substances must be considered as IT is applied within and across various health care settings.

States also provide access to capital financing through bonds and other mechanisms for hospitals and other facilities to purchase and implement IT projects. Finally, given the emergence of regional health information organizations (RHIOs), states may need to take steps to facilitate data exchange activities within and between local entities.

Following the Institute of Medicine's report Crossing the Quality Chasm, the Secretary of Health and Human Services requested in 2002 that the Institute develop recommendations for several demonstration projects to be conducted by states and in large health care markets around the country in order to foster rapid advances in health care redesign.

IT was one of the top priorities identified for these demonstrations, with specific emphasis on internet-based communication, real-time access to patient information, and knowledge management and decision support to readily translate clinical information, many features inherent in interoperable electronic health information systems.

More recently, at its winter 2005 meeting, the National Governor's Association called on the U.S. Congress to establish a National Health Care Innovations Program to support state health reform efforts demonstrating how IT could improve health care quality, safety, and efficiency.

While states' role in promoting health IT is relatively new, several initiatives are emerging that begin to illustrate a variety of ways that state-level coordination can advance this agenda.

CalRHIO was recently formed to foster “widespread access to a statewide health information data exchange system.” By supporting the development of projects, along with one or more RHIOs, CalRHIO will promote policies, technology applications, and financial and business models designed to promote secure health data exchange.

Initial activities will focus on interviews with, and consensus building among, key stakeholders, and identifying promising models for data exchange that are currently under development across the state. As national policies governing health information exchange evolve, CalRHIO hopes to serve as a platform to coordinate their implementation on a statewide basis.

CalRHIO was founded and is managed by HealthTech, a non-profit technology research organization, and received seed funding from the California Health Care Foundation.

The Indiana Health Information Exchange (IHIE) is a new statewide organization formed through the collaboration of several organizations: BioCrossroads, a life sciences-related economic development organization; the Regenstrief Institute, a health care academic research organization that has already developed numerous clinical data exchange activities; the Indiana State Medical Association; the Indiana State Health Department; the City of Indianapolis; and others.

IHIE will extend and add to the health IT applications already developed by Regenstrief, starting with a common approach to clinical messaging across several major health systems. In addition to capital financing from BioCrossroads, IHIE has received grants through the Health Resources and Services Administration's Connecting Communities for Better Health Program and the Agency for Healthcare Research and Quality's Health Information Technology Program.

Legislation enacted early in 2005 (SB 2) establishes the Kentucky Health Care Infrastructure Authority, whose responsibilities will include “providing leadership in the redesign of the health care delivery system using health information technology” consistent with the aims for health care articulated by the Institute of Medicine.

The Authority will be jointly established and operated by the University of Kentucky and the University of Louisville. The legislation also establishes a board that will oversee development of the Kentucky e-Health Network (Ke-HN), including the establishment of advisory committees to address issues such as clinical decision support, privacy and security of protected health information, electronic data interchange, and review of clinical software.

Ultimately the board will oversee the design and operation of a statewide electronic health network that will support or encourage electronic transactions and activities including drug interaction and allergy alerts; preventive services alerts; electronic access to laboratory and radiology reports; disease management; vital statistics registries; and disease surveillance reporting, to name a few.

Funding for Ke-HN will be provided in part through state appropriations.

Collaborative IT activities in Massachusetts include the Massachusetts Health Data Consortium and the New England Health Care EDI Network, briefly described in the March issue of Qual-IT.

The most recent development is the Massachusetts eHealth Collaborative (MAeHC), a non-profit organization comprising the major health care stakeholders, including state government.

Blue Cross Blue Shield of Massachusetts has provided $50 million in funding to support broad adoption of electronic medical records and interoperability across health care settings, initially through three demonstration projects across the state. In December 2004 Governor Romney announced his support for this initiative.

The New York State Health Information Technology Policy Summit, launched in October 2004, is sponsored by the United Hospital Fund and supported by the eHealth Initiative Foundation in partnership with Manatt, Phelps & Phillips, LLP. It was developed by the eHealth Initiative as part of a national effort to engage key stakeholders at the state level in developing strategies and tools to advance broader adoption and use of health IT.

The summit process has four stages:

• research to inventory current New York health IT initiatives and identification of key issues based on interviews with selected health care leaders from across the state;
• development of consensus on guiding principles and priorities to promote health IT adoption;
• development of specific recommendations for state and regional action; and
• finalizing a framework for the next phase of planning and implementation work.

Summit participants—50 to 60 representatives of a broad cross-section of New York State's health care community—met in in January and March 2005, and identified three broad areas as immediate priorities:

• establishing a forum for ongoing collaboration and communication;
• facilitating the sharing of practical tools and resources relating to health IT adoption; and
• securing funding and policy support for local health IT innovation.

New York State's 2005 state budget will provide substantial state funding for various health care reform and restructuring efforts, including health IT initiatives. Health plans across the state are developing a common strategy to promote electronic prescribing. The summit is the first step in a longer term process through which statewide goals and priorities for health IT can be established. The United Hospital Fund is committed to further advancing these developments, and we will provide periodic updates through this newsletter.

California
California Health Care Foundation www.chcf.org
CalRHIO www.calrhio.org

Indiana
Indiana Health Information Exchange www.ihie.org

Kentucky
Kentucky Legislative Research Commission www.lrc.ky.gov

Massachusetts
Massachusetts eHealth Collaborative www.maehc.org
Massachusetts Health Data Consortium http://mahealthdata.org

National Governors Association
White Paper: A National Health Care Innovations Program www.nga.org/cda/files/0502HEALTHCARE.pdf (this link will open an Adobe Acrobat pdf file)

Emerging Technical Issues in Health Information Technology