HIE Profile: Nevada HIE Is Cleared for Takeoff

In late spring, the state of Nevada’s State Health Information Technology Strategic and Operational Plan was approved by the Office of the National Coordinator for Health IT. The Nevada Legislature then passed the necessary legislation to establish Nevada’s statewide HIE. But there’s no time to stop to toast this achievement: State Health IT Coordinator Lynn G. O’Mara, MBA, is busy plotting the trajectory of Nevada’s statewide HIE as it prepares to launch.

Q: What is the top priority for the plan as it moves forward?

O’Mara: It’s what’s approved in our state health IT plan and also what terms and conditions are included in our ARRA HITECH State HIE Cooperative Agreement. The most important thing to do is to get our governing entity and board established. Concurrently, we have to put in place a portal for connecting to the Nationwide Health Information Network (NwHIN). Until we have the robust HIE statewide system in place, providers who are eligible for EHR financial incentives from Medicaid and meet Stage 1 of meaningful use can at least do it through NwHIN Direct.

Then, by the end of the calendar year, using the Direct Project, we need to have e-prescribing available, as well as structured lab data exchange and also the continuity of care (CCD) documents.

Q: Who will the governing board include?

O’Mara: We have some flexibility in the legislation in getting this established. We may have one in place to get things started until regulations can be passed. However, we still have HITECH requirements as well as the terms and conditions of our cooperative agreement to meet—we have to be sure we have the required and right stakeholders at the table.
 

Q: In addition to providers, payors and state agencies, will patients have a role in planning the HIE?

O’Mara: Within legislation that was passed in Senate Bill 43, there is an important provision: that patients can choose whether or not their information is sent electronically and used in an HIE. The intent of the legislation is that the patient has a choice about this. It’s an informed patient consent. The state Health IT Authority is empowered to promulgate the regulations to support this. It means Nevadans will be at the table helping us with development, and they’ll have a voice in what’s being done, as required by Nevada’s administrative rulemaking process.

Q: Will the board have a large rural component?

O’Mara: We want to be sure that care in rural areas is not overlooked. We know who to bring to the table to ensure that doesn’t happen. Not only will we have the Nevada Hospital Association be represented, but also one of their members—the Nevada Rural Hospital Partners. We’ll be looking for representatives from small physician offices as well as large practices.

We have three population centers: One county has two-thirds of our population, another significant group resides between two other counties. The rest are in our rural and frontier areas, where people have limited access to care, often having to travel to get their healthcare. Even within our urban areas, we may have underserved populations and health professional shortage areas.

Q: What is the timeline for the HIE rollout?

O’Mara: A lot of it is established by  the HITECH Act itself and by the terms and conditions in our state HIT plan. By the end of the calendar year, we will have to have NwHIN Direct secure messaging in place, along with e-prescribing, exchange of structured lab data and exchange of CCDs.

We’ll have a more robust system in place by early 2013 or so. The cooperative agreement ends in February 2014, and at that time, everything must be up and running completely statewide. The majority—75 to 80 percent—of physicians do expect, by sometime in 2015, to at least have implemented and started to use EHRs. While the Eligible Providers will adopt sooner versus later because they’ve got financial incentives, our other providers like the concept of EHRs and HIE, and they understand the value to their patients and practice. It will depend somewhat on our economic situation. It’s a big investment for the providers, and when they can adopt EHRs will depend on their fiscal health.

Q: Will state government take a hands-on role in Nevada’s HIE?

O’Mara: When we did our statewide assessment, our stakeholders said “we want the state to be the regulator, the enforcer.” The legislation established the director of the state Department of Health and Human Services as the state health IT authority. That individual is empowered to promulgate regulations that are necessary regarding health IT, such as the electronic exchange of information and utilization of EHRs.

We’re also the coordinators [who are] facilitating the integration of health IT throughout the state, making sure everything all works together. This is much bigger than putting a bunch of EHR systems out there and having them talk to each other for information exchange. There’s a whole economic and workforce development piece that has to support this. That has to be addressed as well. There are state agencies that will be involved in a number of roles. To have this be effective and accomplish things like improving the quality of care, improving efficiency, decreasing costs, and reducing medical errors, we  have to make sure it gets coordinated in the statewide system of healthcare.

Q: How will you coordinate health IT functions?

O’Mara: We’re going to set up a governing entity as a nonprofit, as authorized by the legislation, to establish policies and procedures that work with the state HIT authority on regulations and statutes … They’ll be setting up the policies and procedures on how HIE will be accomplished in the state and how [existing] HIEs will work together as part of the statewide system. We’ll establish certification requirements and regulations, and probably work with them to [certify] HIEs that want to be part of the statewide system.

We’ll have as many HIEs as we think we need to support the needs of the state for information exchange. We believe we’ve achieved a good balance in legislation, enough to ensure things like security and privacy of information, meeting HITECH requirements, federal law and mandates, while at the same time allowing the market forces to drive the HIEs we have, what they’re doing and how they operate together.

Q: Where do you see the benefits of the HIE?

O’Mara: While the value of HIEs and EHRs is pretty much accepted, for Nevada with its fragile economy, this also could have an important positive impact. Not only can we improve the quality of care and offer more efficient care and greater access for our residents, we also can  help the economy a bit because we’re going to need a lot of health IT professionals to maintain these systems. There’s opportunity for small businesses as well as workforce development that can help Nevada as we recover from the current economic situation.