HIE as a Force for 'Megachange' in Healthcare Transformation

State and federal leaders discussed the challenges they face when coupling federal health information exchange (HIE) methods like the Direct Project with statewide efforts for more robust HIE, during a discussion June 19 at the State Healthcare IT Connect Summit in Dulles, Va.

“Someone said to me ‘the best HIE is invisible,’” said Lee Stevens, program manager, State Health Information Exchange, ONC, one of the participants of the “Health Information Exchange as a Force for Megachange in Healthcare Transformation” panel at the summit.

Stevens added that the term HIE has been evolving over time to represent the verb, the transport of health information, rather than the noun representing central repositories for health data like the regional health information organizations (RHIOs) of yesteryear. He said that throughout the nation providers are slowly gaining awareness and adopting HIE, but there is much work to be done to promote consumer mediated exchange to enable people to become better customers of the healthcare system and an integral part of their own care through the maintenance of personal health records (PHRs).

“We have to have data liquidity, and that really is transforming paper-based records into electronic data to be exchanged,” said Stevens. He added that the three critical areas that would impact data liquidity was e-prescribing, lab interoperability, and clinical care summary exchange.

Arizona’s State HIT Coordinator Lorie Mayer said her state has struggled with many things in the area of HIE, including the federal direction. She said it was difficult moving forward after Arizona’s Medicare Transformation Grant ran out in 2009. The grant had allowed the Phoenix metropolitan area to develop and implement a web-based HIE utility, the Arizona Medical Information Exchange (AMIE), which brought Medicare providers from three major health systems and several health plans onboard to access patient data. Mayer said this effort proved that HIE could work in Arizona and stakeholders could work through the privacy and security issues, as well as other challenges.

At the same time, stakeholders in Tucson were creating the Southern Arizona Health Information Exchange (SAHIE). Payers, however, only wanted to pay for infrastructure for one exchange, and other stakeholders agreed that multiple governance bodies and RHIOs would not be effective. So, the two exchanges, AMIE and SAHIE, were combined in 2010 to form the Health Information Network of Arizona, which now serves 70 percent of Arizona's patients.

Part of this challenge of having multiple governance bodies, is the fact that Arizona itself has five different organizations overall that support meaningful use. This includes the Arizona Governor's Office of Economic Recovery (the state HIE grantee organization), the State Medicaid office (which administers the EHR incentive program), the Arizona Department of Public Health, the Arizona Health e-Connection (the state regional extension center), and the Health Information Network of Arizona (the state HIE organization). “It’s a five-ring challenge to make sure that we are all aligned and supporting the ultimate goal of meaningful use of EHR adoption,” Mayer said.

Mayer said that the Arizona Medicaid program is offering incentives over the next three years to offset costs for providers to join the Health Information Network of Arizona, and the focus will be adding high volume Medicaid providers like hospitals and Federally Qualified Health Centers (FQHCs) to create more stakeholder value. Currently, 22 are organizations participating.

Michigan’s HIE approach has been to tackle immunization records, a low hanging fruit, said Jim Hogan, information officer, Michigan Department of Technology, Management & Budget (DTMB). Currently, Michigan Health Connect, the state HIE organization, is receiving structured data in a consistent format so that public health can analyze immunization trends. Hogan says Michigan Health Connect also plans to implement a master patient index (MPI), so that as more health systems are connected, various records can be associated to the appropriate individual. He said the challenge now is to get more providers using the immunization registry.

Integrating Direct into State Efforts
Launched in March 2010 as a part of the Nationwide Health Information Network, one reason the Direct Project was introduced was to give every provider a chance to meet meaningful use, Stevens said. Many rural practices and hospitals, he said, have challenges with Internet connectivity, so introducing a standards-based way for participants to send authenticated, encrypted health information directly to trusted recipients over the Internet would be beneficial to these providers. Direct also gave these providers, who didn’t want to “jump in with both feet,” a basic way to exchange health information, Stevens said.  

The Arizona Governor's Office of Economic Recovery had to stop and reassess its strategy once the ONC introduced Direct, Mayer said. The challenges there have been around being organized and not having enough time to provide education and outreach to healthcare organizations about Direct and what Mayer calls more “robust HIE.” She is uncertain what the future of Direct will be as the industry moves toward more robust means of HIE. She doesn’t believe Direct will get her state prepared for quality reporting and analysis, but be a tool that can meet certain providers where they are now.