State-Level Efforts to Advance Health Information Exchange

Update from the SLHIE Consensus Project

HIMSS RHIO RoundtableMay 15, 2008

Lynn Dierker, RN

Agenda

• Background – the project and its context• Key findings – state-level development• Issues and priorities – implications for state-

level and national efforts• Moving forward – project focus and

activities

Project Overview• Launched in 2006 • Targeting organized state-level HIE efforts (not to be

confused with state government)• Field research and analysis (9-15 statewide initiatives)

• Governance • Financial and operational characteristics, • Health information exchange policies and practices, and• Short and long-term priorities for implementation and sustainability

• Annual consensus conference to refine guidance• State-level resources: State Level Health Information

Exchange Initiative Development Workbook, programs, presentations

• Input to national HIE strategies, projects • Series of reports, www.Staterhio.org

2007 Project Team and Organization• Staff

• Lynn Dierker, RN, Project director, Board of Directors, Colorado Regional Health Information Organization (CORHIO)

• FORE/AHIMA

• Research Consultants• Lammot du Pont, William Bernstein, Manatt Health Solutions• Don Mon, VP Practice Leadership, AHIMA

• Steering Committee (and other state-level HIE contacts)• Project Partners

• National Council of State Legislators• eHealth Initiative• HIMSS

• ONC• Liaisons to other agencies (AHRQ) and projects

• NGA State eHealth Alliance• RTI HISPC

Steering Committee• Laura L. Adams, President and CEO, Rhode Island Quality Institute, Providence, RI• Antoine Agassi, Director and Chair of the Tennessee eHealth Council, Nashville, TN• Rachel Block, Executive Director, New York eHealth Collaborative, New York, NY• **Ray Campbell, Esq., MPA, CEO, Massachusetts Health Data Consortium, Waltham,

MA, • Devore Culver, Executive Director, HealthInfoNet, Manchester, ME• Lynn Dierker,RN,Senior Advisor, Colorado Regional Health Information Organization,

Denver, CO• Don Holmquest, MD, PhD, JD, CEO, CalRHIO, San Francisco, CA• *Beth Nagel, Health Information Manager, Dept of Community Health, Michigan Health

Information Network, Lansing, MI• Marc Overhage, MD, PhD, FACP, FACMI, CEO, Indiana Health Information

Exchange, Inc.;Indianapolis, IN• *Gina Perez, Executive Director, Delaware Health Information Network, Lewes, DE• Jan Root, PhD, Executive Director, Utah Health Information Network, Murray, UT• Christopher Sullivan, PhD, Florida Office of Health Information Technology, Florida

Health Information Network, Tallahassee, FL• Roxane Townsend, MD, Asst. VP, LSU Health Systems, Baton Rouge, LA

**Steering Committee Chair* New in 2008

Observations and Themes 2006 and Continuing

www.staterhio.org

• Key state-level distinctions• Organizational functions, roles• On the ground issues in implementation

• Resources –Financing strategies• Sources of start-up capital • Financial models for long term sustainability including support for state-level HIE roles

• Federal/state-level coordination• Roadmap for how state-level HIE relates to federal programs• Coordinating body to lead/structure collaboration

• HIE Roles for state governments• Clarity about effective state government HIE roles, organization

• Stakeholder engagement• Private payers from passive/competitive to fully engaged• Medicaid and Medicare to fully leverage influence

• Accelerating HIE development• Collaboration among states• Finding easily replicable early wins

Project Findings – March 2008

• Continued expansion and evolution in state- level HIE efforts– 75% of states have established state-level HIE

initiatives/governance entities– Advanced state-level efforts poised to begin

data exchange– Health care reform, privacy rights and

confidentiality protections are drivers

State level HIE An Evolving Landscape

4. Operating

3. Early Implementation

2. Foundational

1. Early Planning

(RI)

(DE)

(CT)

State/Regional Contracts (6)

Medicaid Transformation Grants – HIE/EHR focus (15)

NHIN Trial Implementation (9)

Key Findings March 2008• Migration to two distinct and key organizational

HIE roles at the state level – Governance:

• Neutral convening: Structure for engaging stakeholders in statewide mission to build HIE for healthcare quality, cost- effectiveness

• Coordination: Mechanism to facilitate collaboration across diverse interests

– Development and implementation of a statewide HIE roadmap – Consensus-based HIE data sharing policies and practices to

ensure confidentiality protections– Facilitate lowest cost HIE development serving statewide

stakeholders

– Technical operations: • State-level technical functions (owned and/or managed) to

facilitate statewide HIE• Variable technical models, approaches

Findings - Trends Across States• State-level HIE governance role is primary

• Ensure that HIE develops as a public good (beyond silos, corporate interests)• Serves all statewide stakeholders and data needs• Reduces technology investments and other costs for all participants

• State level HIE governance entity is a public-private partnership entity

• Sits between state government and the health sector and industry• Involves state government, but independent of state government• Addresses public and private sector interests, blends investments• Mechanism for coordination of HIE policies and practices

• State governments play important roles• Designating authority to a state level HIE governance entity • Providing resources: start up and ongoing• Leveraging public programs, policy levers to create incentives for HIE

• Statewide technical approaches can vary and will likely evolve• Size, market characteristics, resources, • Stages of development

Organizational Models Developmental Pathways

HIE Infrastructure Working Model Scale and Sustainability

Project Observations March 2008 Findings

• Organizational models for SLHIE governance– Examples of $$ and staff to support statewide HIE

leadership– Small number of HIE with sustainable HIE operations

based on transactional efficiencies (IN, EHEN, UHIN)

• Progress in development– States poised to begin exchange

• Continued quest for long range sustainability models

Project Research Seeking Statewide Strategies

• Evidence of certain self-sustaining HIE services

• Preoccupation with the need for start up capital

• Heavy reliance on grants, state and federal funds

• Need to address underlying sustainability issues and factors

States Illustrate Variety

• No one roadmap– RI: established mission based on community-wide

quality improvement; robust stakeholder engagement enabled explicit discussion about principles underlying business models

– CO: AHRQ SRD committed early to federated clinical data exchange as technical approach

– MA: influence of health care/academic environment (and $$ from BCBS)

– IN: Age and maturity, expertise, and Regenstrief

Key Issues

• The value proposition for public good functions– Ensuring that HEI develops beyond siloed corporate

interests to serve all statewide stakeholders and their data needs

– Facilitating new levels of collaboration vs competition to realize data sharing

– Serving public policy interest and consumer protection concerns by facilitating consistent reliable HIE practices

• Federal and state-level HIE linked to an agenda to transform health care

•Urgency–Mounting pressure from corporate health IT interests–Resistance to full participation from key players

•Need for a multi-level value proposition and business models across the continuum of local, state, national levels–Guidance for states–Criteria and measures to track progress–Links to AHIC use cases/NHIN core services

•Growing consensus for blended public-private financing strategy–Continued investments at provider level–Define contributions from public programs, public beneficiaries

Value Proposition for SLHIE Recommendations

Statewide HIE Mission Emerging Sustainability Issues

• Linking the quality and HIE agendas• Ultimate importance of secondary data

• Need for restructured incentives• Creating a market for information

• Channeling resources and support for the functions of the SLHIE governance entity

• Importance of state government empowerment for single source of SLHIE

HIE Implementation Key Issues

• Governance and accountability• Policy implications for public-private state-level and national level

HIE governance• A common framework needed for HIE roles and accountabilities

• Coordinated HIE policies and practices• Effectiveness of privacy policy linked to consistent

operational/technical data sharing policies and practices• State-level HIE governance entity provides key coordination role

• Value for stakeholders and sustainability• Recognize where and how value accrues across levels• Recognize realistic phases of development• Start-up capital investments to achieve capacity beyond limited

provider markets, support multiple HIE services • Channel initial and ongoing state and federal funding • Structure national incentives (e.g. reimbursement, participation in

NHIN, federal programs) to drive stakeholder participation

2008 SLHIE Project Priorities1. Develop an implementation framework

• Governance functions, accountability criteria/mechanisms• Coordinated policies and practices for effective data sharing and

information use• Financing strategies, business models and developmental pathways

2. Support state-level HIE implementation efforts• Consensus for best practices• Information/resources

3. Influence nationwide HIE implementation• Voice for state-level HIE perspectives in policy development• Representation in AHIC design and implementation, NHIN

development

2008 Project Scope of Work• Ongoing research

– Models, guidance for consistent HIE policies and practices– State-level value propositions and sustainability models

• Inventory emerging resources to inform HIE financial sustainability research and development

• Map and monitor state-level HIE development trajectories• Identify state level HIE value models, development and evolution,

impact

• Consensus development– Viability of accreditation and/or other accountability mechanisms– Potential criteria for credentialling HIE organizations

• State-level HIE Forum– Facilitate development of state-level HIE governance, accountability

mechanisms– Organize state-level interests, prototype for representation as part of

permanent AHIC

Genesis of the Forum

• Growing number of state-level HIE efforts seeking to incorporate Project recommendations.

• Pivotal time when state-level HIE perspectives should inform the design and implementation of AHIC and NHIN.

• Desire to build on experience of the Project’s Steering Committee – Further inform Project’s research and analysis efforts– Broaden engagement, organize state-level HIE shared

interests, ensure strong voice

SLHIE Leadership Forum Goals

• Advance implementation of state-level HIE governance functions and organizational roles

• Development/coordination of HIE policies and accountability mechanisms

• Advance state-level value propositions, financing models and pathways to sustainability

• Develop working model for formal state-level HIE representation and participation in AHIC governance.

Further Information

Lynn Dierker, RNProject Director

SLHIE Consensus ProjectLynn.dierker@ahima.org

www.staterhio.org