Qual-IT - March 2006 | Archived

While the Health Insurance Portability and Accountability Act (HIPAA) provides a broad legal framework governing access to and disclosure of health information, it does not specifically address many of the new questions arising from electronic health information exchange. In addition, the federal law allows states to adopt more restrictive policies, so there is still considerable variation in the legal landscape governing health information privacy and security. To assess the full extent of this variation, and determine whether new standards should be established at the federal level, HHS has commissioned a nationwide study of state laws and health care business practices in this field through the Research Triangle Institute. New York State has applied for federal funding to participate in this study.

States have moved to the forefront in the national HIT discussion, organizing a variety of multi-stakeholder HIT policy coordination initiatives and collaborative bodies. Acknowledging these developments, National HIT Coordinator David Brailer has endorsed state actions to coordinate HIT interoperability efforts as a major building block of a future national HIT network. In a recent review of these state policy initiatives, the United Hospital Fund found a number of interesting developments:

Arizona. In August 2005 Governor Janet Napolitano issued an executive order establishing the Arizona Health-e Connection Roadmap. The order directed the state Government Information Technology Agency (GITA) to convene a statewide summit of health care leaders to “solicit input and participation in the creation of an e-health information infrastructure for Arizona.” The Governor also appointed a steering committee to work with GITA on developing specific recommendations for Arizona's HIT roadmap, to be completed within six months of the summit.

The executive order highlights several priorities for the steering committee in building this statewide infrastructure, including:

• Identifying existing resources (including funding), technology options, and options for meeting consumer health information needs;
  
• Ensuring privacy and security in electronic health information exchange;
  
• Facilitating statewide adoption of electronic health records standards, to promote interoperability within the state and nationally; and
  
• Creating organizational and governance structures.

While the steering committee is providing strategic direction and general oversight, five task groups are developing specific recommendations focused on clinical, financial, technical, legal, and governance issues. Task group leaders meet regularly to coordinate and identify potential interdependencies across these topic areas.

Florida. In 2004 Governor Jeb Bush issued an executive order creating the Governor's Health Information Infrastructure Advisory Board, under the auspices of the state Agency for Health Care Administration. In its 2005 interim report, the Board recommended creation of the Florida Health Information Network (FHIN), to establish standards and serve as the communications hub for interoperable health information exchange across the state. To further advance this vision, in December 2005 the state awarded planning and implementation grants to several multi-stakeholder organizations throughout the state for the purpose of forming regional health information networks; a second round of state grant funding is now being planned. While the Governor's advisory board continues to provide policy guidance on the design and operation of a statewide network, FHIN has been incorporated as an independent non-profit organization, charged with implementing the resulting plan.

Maine. With the Maine Health Information Center (MHIC), an independent health data research organization, acting as convener, health care stakeholders from across the state met in 2004 to develop a vision for a statewide clinical information sharing network. MHIC conducted a feasibility study later that year, and in 2005 began detailed planning and initial implementation efforts. MHIC serves as project manager, and is on the steering committee of the public-private Maine Health Information Network Technology (MHINT); other committee members include representatives of the Maine Health Access Foundation, the state Bureau of Health, and the Maine Quality Forum. Plans are now underway to establish a permanent governance structure for MHINT, and to issue an RFP for development and testing of a statewide network.

In other state developments:

• Task forces have now been convened in Wisconsin, Missouri, and Maryland to develop recommendations on state policy activities to accelerate the adoption of electronic medical records and HIT interoperability standards;
  
• The Kentucky eHealth Network Board, established through legislation in the spring of 2005, had its first meeting last November to begin planning for various state-level HIT initiatives;
  
• Vermont's legislature provided seed monies for the Vermont Information Technology Leadership group, which is developing a data exchange pilot program;
  
• Rhode Island issued an RFP for a technical model for data exchange involving pharmacies and laboratories.

In the fall of 2005, the New York State Department of Health (DOH) issued a request for grant applications for the first phase of HIT project funding under the auspices of the Health Care Efficiency and Affordability Law for New Yorkers (HEAL-NY) Capital Grant Program. These grants will support capital costs associated with various types of HIT initiatives, including projects on electronic prescribing, electronic medical records, and clinical data exchange; each project must involve at least two distinct health care stakeholders. DOH has received over 100 applications, and is now in the final stages of evaluating the proposals and deciding on the final awards.

A number of those applications came from partnerships of health care organizations in New York City. For the last several months, many of these organizations—as well as the United Hospital Fund—have participated in an informal work group convened by the Greater New York Hospital Association to establish priorities for collaboration on key policy and technical issues affecting clinical data exchange projects. Initially, the group has focused on issues both legal (such as data use agreements) and technical (such as patient identification strategies).

DOH has also convened a planning committee to develop an ongoing formal HIT stakeholder organization in New York, as recommended by the Fund's November report Advancing the Health Information Strategy in New York: Options and Recommendations for Creating Sustainable Multi-Stakeholder Collaboration. Qual-IT will report on the committee's deliberations in a future issue.

States are playing an increasingly prominent role in shaping and implementing the HIT policy agenda across the nation, and New York continues to provide important leadership in this. The specific forms and directions of these efforts vary, from the development of broad policy frameworks to implementation of detailed technical architectures for health information exchange. But one important thread running through all these efforts is the basic principle that any strategy to advance HIT adoption and use will require multi-stakeholder coordination and collaboration at the local level.

Arizona Government Information Technology Agency. Information is available online at www.azgita.gov/tech_news/2005/ehealth/E_Health.htm

Department of Health and Human Services. 2004. The decade of health information technology: Delivering consumer-centric and information-rich health care. Framework for strategic action. Available online at www.hhs.gov/healthit/documents/hitframework.pdf

Florida Governor's Health Information Infrastructure Advisory Board. Information on the development of the Florida Health Information Network is available online at http://ahca.myflorida.com/dhit/ (follow link to Board Meetings for the most up-to-date developments).

Maine Health Information Center. Information is available online at www.mhic.org

Maine Health Information Network Technology. Progress report available online at www.mhint.org/meetings/MHINT_Progress_Rpt_2005.pdf

Research Triangle Institute. Information on the Health Information Security and Privacy Collaboration is available online at www.rti.org/hispc

United Hospital Fund. 2005. Advancing the health information strategy in New York: Options and recommendations for creating sustainable multi-stakeholder collaboration. Available online at www.uhfnyc.org/usr_doc/Advancing_the_HI_Strategy_1205.pdf

Update on New York's HIT Initiatives