There's disagreement among the HIE community about the timing, according to Lynn Dierker, project director for the Chicago-based American Health Information Management Association's State Level Health Information Exchange Consensus Project. Some argue that it's a good idea to get started, even if establishing the framework is slow and incremental, she says, while others don't see the value in pursuing it yet, given how young most HIEs are.
“I don't know how many HIEs are willing to stick their toes in the water and get certified,” Dierker says. “Maybe there are some who see this as a building block and are willing to try it out.”
Even Mark Leavitt, M.D., chair of the Certification Commission for Healthcare Information Technology (CCHIT, Chicago), admits that it's early to begin testing, but he notes that starting work on certifying networks by 2008 is part of fulfilling CCHIT's contract with the federal government.
Leavitt stresses that while HIEs are developing independently in different regions of the country, a key national goal is for them to be able to exchange information with each other. “We want health information to be portable, so when you're traveling to Florida, the health information extends across networks,” he says. “The networks have to be interoperable and that means an adherence to standards.”
On CCHIT's roadmap for future measurement are portal services and providing data for public health entities and quality measures, says Virginia Riehl, healthcare management consultant and strategic leader of CCHIT's HIE Work Group. “These services are just now evolving, so we anticipate adding them later,” she says.
“The greatest challenge to our workgroup was that we were targeting something that was undergoing rapid evolution, so the circumstances changed from when we started 15 months ago,” Riehl says. “We often had to go back and rework criteria and do reality checks.”
Riehl says a pilot project with four HIEs went well. “None of them reported that the process was too complicated, too much work, or that they couldn't do it,” she says. “There were testing procedures that had to be refined. We had to make sure we had an option for Linux environments, for instance.”
Leavitt estimates that in the first year, somewhere between 10 and 20 HIEs will apply for certification. “There are 130 HIEs in the country, but when you get down to those actually operating, the number is more like 30,” he says. “So, just as with the electronic health records, if we can get half in the first year, that is good progress.”
According to Leavitt, CCHIT has $200,000 available in a scholarship fund to help nonprofit HIEs with revenue of less than $6 million pay part of the certification fees.
Dierker says many HIE leaders will need to see a business case before pursuing certification. “The real proof will come when you can answer the question, ‘What value do you get from certification, and in who's eyes?’”
Accrediting RHIOs in New York
The state has invested more than $200 million in its nine RHIOs and is working to stitch them together into the Statewide Health Information Network for New York (SHIN-NY). Because the RHIOs have received substantial public funding and play a key role in governance, state health leaders see transparency and accountability as key to long-term success.
RHIO leaders are meeting regularly to craft a state-level policy framework. Once that work is done, the RHIOs will be responsible for implementing those policies locally. “The question is what's the best way to make sure they are implementing them,” says Lori Evans, deputy director of the New York State Department of Health and head of the Office of Health Information Technology Transformation. “We think it makes sense to separate the governance and policy issues from the technical,” which CCHIT can handle, she adds.
New York would most likely turn to a third party to handle accreditation. Officials have spoken with representatives of EHNAC, The Joint Commission, the National Committee for Quality Assurance and the Utilization Review Accreditation Commission. Evans says accreditation bodies expressed confidence that the standards New York is in the process of creating could be measured. Evans estimates it would take 18 to 24 months to get started.
Evans admits that RHIO leaders are concerned about the costs associated with accreditation, “but they understand that we need to have a plan for enforcing accountability. This area will be regulated,” she says. “The sheriff will come to town. This way we have a little more control over our own destiny.” — D.R.