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“If you’ve seen one Medicaid program, you’ve seen one Medicaid program,” as the old adage goes. Much of healthcare is regional and local, and nowadays the same is true for health information exchanges.
Even before the HITECH Act, there were regional health information organizations, some HIEs spanning regions and some efforts at statewide HIEs — a fairly successful one being the Indiana HIE, created in 2004. The HITECH Act’s state cooperative agreement then set that trend apace across the country.
The HIE landscape today among the 50 states shows the diversity of the country’s medical needs, governance approaches and healthcare markets, with a mix of public, private and public-private organizations managing HIEs on regional and statewide levels.
At the Government Health IT Conference (June 11 and 12 in Washington D.C.), HIMSS and the National Association of State CIOs (NASCIO) are slated to present the findings from a survey of 26 states, showing a detailed portrait of state HIEs and HIE management.
The joint survey probed the workings of state IT broadly, asking state CIOs and agencies for details on their approaches to HIE, health insurance exchanges, Medicaid information systems and shared services, among other IT work.
While the survey polled just over half the states and isn’t statistical, the CIOs responding were from a diverse cross-section of the country and the range of those states’ initiatives do represent the diverse national government IT landscape, said Pam Matthews, HIMSS senior director of regional affairs, a registered nurse and a former CIO at American Healthcare Services.
Of those 26 states, according to the survey, 11 have state-managed HIEs and 15 have HIEs managed by
state-designated entities, about one-third of them registered as 501 c3 nonprofits.
Looking across the country, statewide HIEs can be seen offering a variety of services — quality metric reporting on how physicians are treating chronic conditions in Indiana, for instance, and legislative proposals in North Carolina to have the state HIE publish hospital prices for common procedure.
“The states determine their strategy based on their needs. That really showed up across many of these areas,” Matthews said. “Drilling down a bit to their stakeholders, mostly hospitals and primary care doctors, we can make a correlation to the EHR incentive program, but we can also see emerging stakeholders and participants — payers, third-party administrators, employers, consumer groups and providers like long-term care, post-acute, behavioral and mental health.”
Indeed, while long-term, post-acute and behavioral-mental health providers aren’t eligible for the meaningful use IT incentive program, there is a growing consensus among federal health officials that those providers’ role in a patient’s continuity of care is fairly crucial to fixing the fragmentation problems that HITECH and the Affordable Care Act try to address. So linking those providers to health systems and physicians is becoming a goal for increasingly more HIEs.
One example of that can be found at the Keystone Beacon Community, which tapped the central Pennsylvania HIE KeyHIE to develop a tool that allows any skilled nursing facility to share patient information with other providers — with or without an EHR — using a tool that turns a minimum data set patient record into a continuity of care document.
The Keystone Beacon has also been making inroads with patient engagement, which like HIE is also seen as a necessary component of health reform. Representatives from the Keystone and other Beacons will be sharing their experiences on the intersection of HIE and patient engagement at the Government Health IT Conference — about what’s worked so far and also what hasn’t.
Commentary: Vermont invests in HIE