State HIE Organizations Shift Gears as ONC Funding Dries Up

Feb. 12, 2014
From Pennsylvania to California, state-designated entities are handing off responsibilities to HIE associations and seeking new sources of funding for uncompleted projects.

Two recent Healthcare Informatics news items serve as a reminder that the state-designated organizations charged with overseeing health information exchange development and EHR implementations are shifting gears as federal funding winds down. The first was a story about the Kansas Regional Extension Center (REC) getting a one-year extension to spend its $9.5 million grant. The Kansas REC still has more than $2 million in funds from the initial grant, and ONC has given the REC another year, until Feb. 7, 2015, to help primary care physicians set up EHR systems.

But entities involved in ONC’s HIE State Cooperative Agreement have not been as fortunate in getting extensions. Another recent HCI news item described how the Pennsylvania eHealth Partnership Authority has released nearly $500,000 in grant funding to five home health agencies to improve healthcare outcomes through the secure exchange of electronic health information. Pennsylvania had sought a no-cost extension to its HIE grant, but ONC turned it down.

I recently spoke to Alix Goss, executive director
 of the Pennsylvania eHealth Partnership Authority, about the challenges the Commonwealth has experienced in spending the $17.2 million in grant funds on its strategic priorities by the Feb. 7 deadline.

In November, Gaspere Geraci, M.D., chairman of the board of directors of the Pennsylvania eHealth Partnership Authority, wrote a letter to ONC seeking an extension, and stating that $2.5 million in grant funding was at risk. In January, ONC responded by denying Pennsylvania an extension and encouraging it to spend as much of the funding as it could by the first week in February.

Goss told me that health IT executives in Pennsylvania “saw the writing on the wall” that they probably were not going to get this extension, so they forged ahead on several fronts, including the grants to the home health agencies and public awareness campaigns around the state. So although the letter cited $2.5 million at jeopardy, the actual amount that didn’t get spent is closer to $500,000, she said.

However, one project that has been seen as essential to statewide HIE service, a Public Health Gateway (PHG), has not been completed. Geraci’s letter noted that the PHG “represents the largest part of the value proposition to several of the largest and most mature HIOs (health information organizations). It is unlikely that these organizations will connect to the state-level architecture if the PHG is not implemented. This in turn will reduce the value of the overall network-of-networks to all other HIOs, and ultimately to our patients,” he wrote.

The commonwealth is now seeking alternative sources of funding to continue work on the PHG. In partnership with the Department of Public Welfare, the Authority will seek a CMS Medicaid HIT Implementation grant. “We have not stopped working on it at all,” Goss stressed. “We have a pilot underway working with our vendor Truven Health Analytics.”

Meanwhile, across the country, the California State HIE Cooperative Agreement grant came to a close last week, and in a letter to stakeholders, Pam Lane, the state’s deputy secretary for HIE, said that the California Office of Health Information Integrity is turning toward better coordinating data exchange among state departments that manage patient information. In addition, CalOHII will continue to work on improving implementation of federal and state privacy laws. Lane said the California Association of HIEs would be providing leadership for many important HIE related activities in the state. That group’s board has named Rim Cothren CAHIE’s executive director. Cothren most recently served as the technical director for California Health eQuality (CHeQ), the state-designated entity, and is a long-time California and national leader in advancing HIE. The group’s plans for the next few months include on-boarding all pilot members to the California Trusted Exchange Network, forming the California Interoperability Committee, developing a business plan and revenue model, and recruiting all HIE-capable organizations in the state.

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