HIE Profile | Bluegrass State Coordination Drives HIE Success
The capabilities of the Kentucky Health Information Exchange (KHIE) started as an unfunded idea in 2005 when legislation created the Kentucky eHealth Network Board. The idea gained traction in February 2007 when the state received a $4.9 million Medicaid transformation grant to begin construction of a statewide HIE, a project that received a boost in 2009 when the Office of the National Coordinator for Health IT (ONC) provided an additional $9.75 million through the state HIE cooperative agreement. Since then, providers have been racing to join the KHIE faster than three-year old fillies on derby day.
When KHIE's Deputy Executive Director Polly Mullins-Bentley, RN, speaks with HIE coordinators from other states, they often tell her how difficult it is persuading providers to sign up, but that problem doesn't exist in Kentucky. "It's been a steady stream and we have not had a problem getting providers engaged."
Part of that success is due to a coordinated effort between KHIE, the governor's office, the Kentucky regional extension center (REC) and an outreach strategy modeled after a 19th century U.S. Department of Agriculture (USDA) program.
The University of Kentucky (UK) in Lexington, a land-grant university and academic medical center, houses the Kentucky REC. The unusual combination "made sense to us," says Carol L. Steltenkamp, MD, MBA, who is both the CMIO of UK Chandler Hospital and principal investigator for the Kentucky REC. "Our mission is similar to the mission of the land-grant university. We're using that same model to help providers leverage technology into better care for their patients."
The Kentucky REC has implementation specialists working throughout the state in five regions and KHIE also has five outreach specialists working throughout the state in similar regions.
KHIE's collaboration with the REC presents a "one-two punch," according to Steltenkamp.
"We have boots on the ground across the state," Mullins-Bentley says. "We don't have to recruit much because we work so closely with the REC that we just take referrals. We seldom do cold calls. Providers usually call us on their own or after speaking with the REC."
The executive order placed KHIE under the purview of the Kentucky Cabinet for Health and Family Services (CHFS), which means KHIE shares an office building with many of the state's public health agencies.
"There are other critical entities within the cabinet who help us," Mullins-Bentley says. "They're right down the hall from me and they're my new best friends."
She specifically referenced the Department for Medicaid Services and the state Department of Public Health, including the Kentucky State Laboratory. The Department of Medicaid was instrumental in a successful project to seed KHIE's patient records with Medicaid claims data, and she has worked with the state laboratory to make microbiology results available and to begin testing the exchange of newborn metabolic screenings.
Mullins-Bentley and Steltenkamp aren't just patting themselves on the back when they speak of the highly coordinated effort between Kentucky's healthcare entities to move health IT forward; last September, the Centers for Medicaid & Medicare Services (CMS) presented the Kentucky CHFS with the 2011 Public Health and Medicaid Award for Collaboration in Health IT.
Currently, 241 provider organizations are are live on the KHIE or have signed a data-sharing agreement, and 23 of the state's 30 critical access hospitals are in active status. "We have a presence in almost every county in Kentucky," Mullins-Bentley says.
Also, Kentucky's massive demographic landscape is considered. In 2010, more than 1.8 million of Kentucky's 4.3 million citizens lived in rural areas, according to data collected by the USDA.
"When you get into the Appalachian Mountains, that terrain is challenging," Steltenkamp says, referring to the REC's recruitment efforts. "You might only reach out to one or two providers within each workday. They're no less valuable, but they're more challenging to get to."
That's why the cooperative extension service model has worked, she adds, pointing out that implementation specialists actually live in those regions and aren't driving there from Louisville.
Mullins-Bentley agrees that the outreach conducted by the Kentucky REC has successfully drawn many providers to KHIE, but she also believes that money talks. Kentucky was the first state in the U.S. to reimburse providers for meeting the requirements of a Medicaid incentive program.
On Jan. 3 2011, the Medicaid EHR incentive program wrote a check to UK Chandler Hospital for $2.8 million, which was the first incentive check written in the nation. Since then, providers in only seven states have received more than the approximately $80 million total received by Kentucky providers through Medicaid and Medicare incentive programs, according to CMS.
"At the end of the year, Medicaid had paid out more than $66 million to 73 hospitals," Mullins-Bentley says. "We only have 100 acute-care hospitals in the state."
While KHIE has been able to show providers the money, that's not the only reason they're signing up, and rural providers may have more incentives to sign up with KHIE than their urban counterparts.
"We provide primary care in a rural, isolated area of eastern Kentucky and it's always been a challenge to obtain a patient's most current medical records in a timely fashion," says Karen S. Ditsch, CEO of Juniper Health in Beattyville. "KHIE will allow us to become more efficient with our limited manpower by providing us with timely, up-to-date, accurate information."
KHIE is currently piloting a laboratory results delivery program, a health IT vendor is working with approximately 15 providers to interface their EHRs with KHIE and metabolic screening results should be available through KHIE by this month, says Mullins-Bentley. "We're beginning to see the light at the end of the tunnel and it's only a matter of time before we really see the floodgates open," she says. "Until then, we've just got to keep on keeping on."
When KHIE's Deputy Executive Director Polly Mullins-Bentley, RN, speaks with HIE coordinators from other states, they often tell her how difficult it is persuading providers to sign up, but that problem doesn't exist in Kentucky. "It's been a steady stream and we have not had a problem getting providers engaged."
Part of that success is due to a coordinated effort between KHIE, the governor's office, the Kentucky regional extension center (REC) and an outreach strategy modeled after a 19th century U.S. Department of Agriculture (USDA) program.
REC alignment
Although not formalized until the passage of the Smith Lever Act in 1914, the USDA has been operating its cooperative extension service since the 1860s and since designated at least one university in each state a "land-grant" university. As healthcare providers are encouraged to use RECs as a resource for learning the best practices to implement health IT, farmers were encouraged to speak with USDA liaisons at land-grant universities to learn modern agricultural techniques.The University of Kentucky (UK) in Lexington, a land-grant university and academic medical center, houses the Kentucky REC. The unusual combination "made sense to us," says Carol L. Steltenkamp, MD, MBA, who is both the CMIO of UK Chandler Hospital and principal investigator for the Kentucky REC. "Our mission is similar to the mission of the land-grant university. We're using that same model to help providers leverage technology into better care for their patients."
The Kentucky REC has implementation specialists working throughout the state in five regions and KHIE also has five outreach specialists working throughout the state in similar regions.
KHIE's collaboration with the REC presents a "one-two punch," according to Steltenkamp.
"We have boots on the ground across the state," Mullins-Bentley says. "We don't have to recruit much because we work so closely with the REC that we just take referrals. We seldom do cold calls. Providers usually call us on their own or after speaking with the REC."
In the corner office
In 2009, Kentucky Governor Steve Beshear signed an executive order creating the Governor's Office of Electronic Health Information (GOEHI), which has provided leadership for the development of KHIE and has since been appointed the state-designated entity to receive funds through the state HIE cooperative agreement.The executive order placed KHIE under the purview of the Kentucky Cabinet for Health and Family Services (CHFS), which means KHIE shares an office building with many of the state's public health agencies.
"There are other critical entities within the cabinet who help us," Mullins-Bentley says. "They're right down the hall from me and they're my new best friends."
She specifically referenced the Department for Medicaid Services and the state Department of Public Health, including the Kentucky State Laboratory. The Department of Medicaid was instrumental in a successful project to seed KHIE's patient records with Medicaid claims data, and she has worked with the state laboratory to make microbiology results available and to begin testing the exchange of newborn metabolic screenings.
Mullins-Bentley and Steltenkamp aren't just patting themselves on the back when they speak of the highly coordinated effort between Kentucky's healthcare entities to move health IT forward; last September, the Centers for Medicaid & Medicare Services (CMS) presented the Kentucky CHFS with the 2011 Public Health and Medicaid Award for Collaboration in Health IT.
Kentucky providers
As of November 2011, the Kentucky REC was assisting more than 1,500 individual providers, 300 provider organizations, 95 percent of Kentucky's federally qualified health centers and 60 percent of Kentucky's rural hospitals, according to Steltenkamp.Currently, 241 provider organizations are are live on the KHIE or have signed a data-sharing agreement, and 23 of the state's 30 critical access hospitals are in active status. "We have a presence in almost every county in Kentucky," Mullins-Bentley says.
Also, Kentucky's massive demographic landscape is considered. In 2010, more than 1.8 million of Kentucky's 4.3 million citizens lived in rural areas, according to data collected by the USDA.
"When you get into the Appalachian Mountains, that terrain is challenging," Steltenkamp says, referring to the REC's recruitment efforts. "You might only reach out to one or two providers within each workday. They're no less valuable, but they're more challenging to get to."
That's why the cooperative extension service model has worked, she adds, pointing out that implementation specialists actually live in those regions and aren't driving there from Louisville.
Mullins-Bentley agrees that the outreach conducted by the Kentucky REC has successfully drawn many providers to KHIE, but she also believes that money talks. Kentucky was the first state in the U.S. to reimburse providers for meeting the requirements of a Medicaid incentive program.
On Jan. 3 2011, the Medicaid EHR incentive program wrote a check to UK Chandler Hospital for $2.8 million, which was the first incentive check written in the nation. Since then, providers in only seven states have received more than the approximately $80 million total received by Kentucky providers through Medicaid and Medicare incentive programs, according to CMS.
"At the end of the year, Medicaid had paid out more than $66 million to 73 hospitals," Mullins-Bentley says. "We only have 100 acute-care hospitals in the state."
While KHIE has been able to show providers the money, that's not the only reason they're signing up, and rural providers may have more incentives to sign up with KHIE than their urban counterparts.
"We provide primary care in a rural, isolated area of eastern Kentucky and it's always been a challenge to obtain a patient's most current medical records in a timely fashion," says Karen S. Ditsch, CEO of Juniper Health in Beattyville. "KHIE will allow us to become more efficient with our limited manpower by providing us with timely, up-to-date, accurate information."
Moving forward
While Kentucky may be known more for horseracing than health IT, that could change if KHIE continues to progress at its current rate.KHIE is currently piloting a laboratory results delivery program, a health IT vendor is working with approximately 15 providers to interface their EHRs with KHIE and metabolic screening results should be available through KHIE by this month, says Mullins-Bentley. "We're beginning to see the light at the end of the tunnel and it's only a matter of time before we really see the floodgates open," she says. "Until then, we've just got to keep on keeping on."