On a frosty Jan. 31 in Minnesota, a task force met to continue its work of reaching consensus on recommendations to the state e-Health advisory committee on how to improve health information exchange in the state. One topic under consideration is the development of centralized services, including a provider directory, patient-matching solution and a routing mechanism between health information organizations (HIOs).
Minnesota has had great success in EHR and e-prescribing adoption, but it chose initially not to create a state-designated HIE body and instead decided to certify private HIOs. That led to some gaps in coverage. An earlier Minnesota Department of Health (MDH) study ordered by the Legislature recommended moving to a “connected networks” approach that would provide essential HIE services to all stakeholders statewide and to align with and build upon national HIE initiatives and networks.
The task force must make its recommendations by May 2019. One key issue it is grappling with is how to expand exchange of clinical information to support care transitions between organizations that use Epic and those that do not. In Minnesota 51 percent of clinics use Epic. Those 641 clinics dwarf the second-highest number, which is eClinicalWorks at 112 or 9 percent. No other provider has more than 5 percent. (Fifty-eight percent of primary care doctors use Epic.)
One challenge the task force is working through is how to define “nodes” on the network and delineate their roles and responsibilities, and how much oversight there would be.
Large health systems could become nodes on the Minnesota network themselves if they are connected to the national eHealth Exchange network or they could participate with another HIO in the state. As this topic was discussed, several task force members raised the question of how the forthcoming TEFCA (Trusted Exchange Framework and Common Agreement) guidelines might impact health system decisions about whether they want to participate as nodes and meet all the state certification requirements including participating in all centralized services and maintaining and updating consent management for patients.
Jennifer Fritz, director of the Office of Health Information Technology for the Minnesota Department of Health at Minnesota, noted that among the group’s goals were ensuring full participation in Minnesota’s connected networks and ensuring that there is at least one viable HIO to fill connectivity gaps for smaller, independent providers, long-term and post-acute care settings and behavioral health providers.
Looking to other states for examples, the task force has noted that payer incentives or requirements for participation have worked. For instance,Blue Cross Blue Shield of Michigan, the largest payer in that state, had success with this option, resulting in much higher HIE participation rates
Earlier work on identifying valuable centralized services to offer identified at least three:
• Healthcare (provider) directory: This would ensure that information is sent to the correct/appropriate provider using that provider’s preferred transport/ delivery method and workflow. May be used for referrals, transitions of care, and event alerting. Other state agencies and payers may contribute information to this directory for use cases such as provider credentialing/privileging, health plan enrollment and provider relationship, prior authorization, provider/payer quality reporting, and provider accessibility, as determined by the governing body. The HL7 standards validated for the healthcare directory would be used.
• Patient directory or other patient matching tool/solution: This central directory would contain information on the location of an individual’s health information and identify to whom specific transactions should be sent, if applicable (e.g., alerts to a specific care coordinator).
• Routing mechanism: Nodes and other stakeholders would use this centralized service to help route health information correctly to the appropriate receiving entity. Algorithms may be used to determine when, to which stakeholder, and what information is to be shared based on specific requirements and individual HIE consent. The initial use cases may be related to public health reporting (i.e., immunizations, electronic lab reporting, and newborn screening) and sharing ADTs of Medicaid patients with the Minnesota Department of Human Services.
The task force also is charged with developing a plan for five-year interim governance, authority, and financing with the goal of optimal HIE. It will also come up with recommended policy updates to Minnesota’s HIE Oversight Law.
The goal is to develop a final set of recommendations by May and put it out for public comment in early summer.