Qual-IT - December 2005 | Archived

As the HIT policy agenda continues to take shape, it is clear that ongoing multi-stakeholder collaboration is increasingly a central component of national, state, and local HIT implementation efforts.

·         At the national level, Health and Human Services (HHS) Secretary Michael Levitt has convened and serves as chair of the American Health Information Community (AHIC). AHIC comprises a broad spectrum of national health care leaders, charged with developing consensus on short-term priorities that will accelerate HIT adoption and use.

·         At the state level, a number of collaborative efforts to map out HIT strategy have also emerged this year.  Several states have created formal advisory groups, while public-private partnerships are taking the lead in other states.

·         A wide variety of HIT initiatives are also being spearheaded by local and regional organizations, many of which have strong and diverse multi-stakeholder memberships.

Reflecting the importance of these developments, since January 2005 the Fund has partnered with the eHealth Initiative Foundation (with additional assistance from Manatt, Phelps & Phillips LLC) to sponsor the New York State HIT Policy Summits.  Through this initiative, we have engaged key health care stakeholders across the state in identifying critical opportunities and barriers to advancing HIT adoption in New York.

Four summit meetings were held during 2005, exploring the need for ongoing communication and collaboration about HIT policy and implementation. The Fund is now working with the eHealth Initiative to develop a Web-based  tool for information sharing within and across communities in New York, to meet the growing demand for better communication and data exchange. The summits also clarified the need for a formal vehicle for ongoing stakeholder collaboration in New York, as the national and state policy agendas unfold.

This need has been described in greater detail by the Fund in a report prepared at the request of the New York State Department of Health and released in November. The report, Advancing the Health Information Strategy in New York: Options and Recommendations for Creating Sustainable Multi-Stakeholder Collaboration, lays the groundwork for establishing formal and sustained multi-stakeholder HIT policy efforts in New York.

What is clear, the report notes, is that many key New York stakeholder organizations and early adopters and proponents of HIT are interested in collaborating to advance HIT adoption and use, building on national developments. Within this broad area of agreement, however, there is no clear consensus among leading stakeholders on specific strategies to accomplish that goal statewide. Indeed, even opinions on whether and how a statewide multi-stakeholder organization could help advance HIT efforts in New York diverge widely.

Many of the summit participants interviewed by the Fund for the report support the idea of such a body as a means of coordinating disparate organizations and initiatives, and of addressing common problems and priorities in advancing HIT adoption and use. Many others, however, indicated that what is crucial now is the state government's support of regional market-based initiatives. These participants do not view a statewide HIT stakeholders' group as being needed at this time.  Some also believe that stakeholder interests are too complex and varied to be effectively mediated on a statewide basis.

New York State needs to clearly articulate its HIT policy framework to systematically guide future implementation efforts, the report concludes. Consistent with the national strategic plan for HIT, the state HIT strategy should stimulate public- and private-sector collaboration to support widespread adoption and interoperability across the full spectrum of health care delivery efforts in New York.  By articulating a common set of broad principles and objectives, the report notes, the state can facilitate operational implementation of local and regional HIT initiatives while ensuring that there is some measure of consistency across the state.

The state can play a vital role in advancing these efforts, the report continues, by developing and disseminating information about New York's HIT strategy, and continually updating the strategy as HIT policy and technology evolve; allocating and monitoring the use of state funds to stimulate HIT collaboration in line with that strategy; and promoting the development of a robust, ongoing public-private partnership that can leverage all of the necessary resources to advance HIT adoption and use. The Health Care Efficiency and Affordability Law for New Yorkers (HEAL-NY) grants provide an excellent opportunity to flesh out the specifics of the state government's role in promoting HIT implementation. 

Development of this vision and strategy cannot be adequately accomplished through ad hoc measures, the report notes. HIT strategy requires strong and ongoing multi-stakeholder involvement, collaboration across health care interests, and a long-term and concerted commitment of resources to capitalize and gain the maximum benefit from the resulting HIT infrastructure.  A formal, broadly representative organization will ensure that the entire HIT community in New York is informed about and has an opportunity to shape the direction and alignment of state policies and regional implementation efforts. Thus, the report concludes, the New York State Department of Health should form a planning committee to define the functions, organizational and governance structure, and funding options for an ongoing multi-stakeholder HIT policy body.

From the outset of its HIT-related efforts, the Fund has identified interoperability as a primary concern, to ensure ready access to information across disparate systems and health care settings, while maintaining appropriate privacy and security policies and procedures. The Markle Foundation's Connecting for Health initiative has already established laboratories for the development of prototype interoperable data exchange networks at three pilot sites (see Qual-IT, July 2005). HHS, too, has awarded contracts for further development of technical models for HIT interoperability.  The four consortia involved are charged with developing and testing specific strategies and tools to facilitate standardized health information exchange, including secure and practical solutions to the problems of accurate patient identification and authorization and authentication of data users.

In New York State, HEAL-NY grant criteria require applicants to address interoperability in a number of ways. Applicant organizations must consist of or establish partnerships with at least two distinct health care stakeholder groups in their communities; a wide variety of multi-stakeholder regional partnerships has been developed as a result. Clinical data exchange is one of the three priority areas identified by the state, so many HEAL-NY applicants will be developing and testing solutions to address this need.  All applicants are required to utilize existing and forthcoming data standards, to facilitate interoperable health information exchange. And, once grantees are selected, the state will coordinate technical assistance and information sharing across them to promote dissemination of best practices, including solutions for specific interoperability challenges.

Many complex practical issues hinder the realization of HIT interoperability, but larger policy issues—and how stakeholders envision the health care system of the future—will determine whether and how quickly these initiatives can advance overall improvements in health care:

·         While much attention has been focused, appropriately, on the complex technological aspects of HIT, the driving force in building an infrastructure should be a vision, and a clear set of goals, related to how we expect the health care system to be transformed.  General statements about improved quality, safety, and efficiency are a good starting point. But more specificity is required to ensure that HIT will be deployed in ways that will facilitate purposeful changes in practice patterns and the allocation of health care resources. 

·         Although the principle of multi-stakeholder HIT collaboration has been widely accepted, applying this principle is still very much a work in progress. While acute- and ambulatory care providers have been actively involved, the long-term care and mental health sectors are rarely present in today's regional HIT collaborations, and purchasers and consumers are often underrepresented.  Since payment systems changes are an integral part of advancing HIT adoption and use, health plans, too, need to be engaged early and throughout the process of regional HIT implementation. 

·         Reliance on market forces as the predominant driver in the current strategy to promote HIT adoption and use creates significant variation in the extent and types of HIT initiatives that move forward, whether bottom-up, incremental, decentralized efforts or top-down, formally coordinated ones.  Data and systems standards will help the market operate more efficiently, but standards alone may not produce consistency and equity in HIT implementation. Ensuring that everyone has access to the necessary tools and information resources will require built-in safeguards.

·         Health care access and financing for the uninsured and underinsured are major considerations in the national and state policy agendas. Forty-five million Americans lack health care coverage, and in some states the non-elderly uninsured constitute almost 30 percent of the population. These individuals and families have significant unmet health care needs as a result. HIT could conceivably be enormously beneficial for this population, but persistent and growing gaps in coverage and financing could instead actually undermine the broad, equitable use of HIT across the health care system.

The rapid advance of HIT policies in New York and nationally is a welcome development because it provides a great opportunity to promote systemic changes in health care delivery and financing. But doing this right—with broad multi-stakeholder engagement and specific health care improvement goals—will take time, and the current strategies for advancing interoperable health information systems are largely untested.  All available points of leverage will need to be employed to sustain and expand on these efforts.  The United Hospital Fund will continue to report on these developments through our publication of Qual-IT, thanks in part to generous financial support provided by Empire Blue Cross Blue Shield.

Qual-IT. July 2005. Available online at http://www.uhfnyc.org/info-url_nocat4257/info-url_nocat_list.htm?enews_issue_id=1848

United Hospital Fund. 2005. Advancing the Health Information Strategy in New York: Options and Recommendations for Creating Sustainable Multi-Stakeholder Collaboration. Available online at http://www.uhfnyc.org/usr_doc/Advancing_the_HI_Strategy_1205.pdf

Clinical Research Collaboration and HIT