Kentucky sets stage for role as health IT test bed

Hoping to become a national leader in e-health, Kentucky announced plan on January 15 to create a statewide health information exchange, part of a strategy to turn itself into a national lab for determining the value of health IT to the public.

“We don’t change a thing that we do in health care unless we have evidence that works, and in changing the health care delivery system, we don’t really have evidence that it gives us any return on investment or that it improves health outcomes,” said Lt. Gov Dan Mongiardo in an interview with Government Health IT.

“And it needs to be researched to prove effectiveness, just like we research how we treat diabetes or any other ailment,” he added.

That need was underscored last year in a Congressional Budget Office report. The authors stated that they could not entirely justify spending federal dollars on information technology in health care because they lacked formal proof that health IT saved money or improved health outcomes.

Mongiardo said that Kentucky is the perfect test bed for researching the health IT value proposition.

With 4 million residents served by 126 hospitals and 7,000 physicians and only two major insurance companies doing business, the commonwealth’s health care environment is small enough to be manageable yet medically complex enough to be relevant.

Kentucky also counts over 710,000 Medicaid recipients, and ranks in the top 5 states in the percentage of residents battling chronic diseases, with especially high rates of cancer, diabetes, cardiovascular disease and obesity.

In moving forward with its health IT initiative, Kentucky released an RFP for development of an HIE infrastructure, which will include a master patient index, a records locater service, single sign-on and authentication, clinical decision support and disease management tools, as well as support for e-prescribing.

The commonwealth’s e-Health Network Board will design the new HIE with help from the University of Kentucky and the University of Louisville, which formed a collaboration in 2005 to provide research consulting on the project.

The winning vendor will be asked to provide electronic medical records for selected physicians; connections to the Kentucky Medicaid enterprise was well as private payers; and access for researchers to relevant data within the HIE.

The vendor will likely be chosen by late February. Mongiardo said he expects information to begin flowing between a few facilities before the summer and to have many of the hospitals throughout the state connected by early 2010.

An existing Medicaid Transformation Grant of nearly $5 million, originally awarded to create a smaller, less complex statewide health information Web portal, will be used to help pay for the HIE..

Mongiardo said the state is still pursuing funding for the project, but he said he expects private and public sector sources will find the plan compelling enough to back it. “No one is doing the research piece of this, but that is just really critical if people are going to begin investing more heavily in health IT,” he said.

Mongiardo said data from the Kentucky HIE would be de-identified for research purposes or Kentucky residents could volunteer to participate in health IT clinical trials. “The more medical records we have that are digital and the more providers we have that are digitized, the faster we can get to real research findings.”

Northern Kentucky University, which is currently building a new health informatics center, will provide research on the ROI provided by health IT, while the University of Kentucky and the University of Louisville will conduct research into the impact of health IT on health outcomes.