State HIEs, analytics in a post HITECH world
In a post HITECH world, states are shifting from health IT adoption to data sharing and analytics. The primary goal of National Coordinator for Health IT Karen DeSalvo, MD, MPH, MSc, is “meaningful interoperability” by 2017, and states are just beginning to explore data integration and the challenges that come with it.
“It’s all very nascent, we’re at the beginning stages of this work,” said Hunt Blair, principal adviser of health-IT enabled care transformation in the Office of the National Coordinator for Health IT, speaking at the 2014 State Health IT Connect Summit on April 2. “What we’re trying to do is equivalent to a lunar mission or the Manhattan project. It’s not something we can do from the top down, it has to be bottom up and top down so we meet in the middle.”
Transformation is happening right in front of everyone’s eyes. And this means more than just health IT adoption, he said. “Technology is the least of it. It’s the relationships, it’s the various different players in the complex healthcare ecosystem finding new ways to come together. Historically, these systems have not been talking to each other.”
State health information exchanges (HIEs) increasingly are interested in more than just EHR data. “It’s about mashing up information from EHRs, state systems, public health systems, Medicaid and other state agencies.” Health IT transformation is taking off at the state level, said Karen Murphy, director of the state innovation model initiative at the Center for Medicare and Medicaid Innovation (CMMI).
About one year ago, CMMI began leading a group of 25 State Innovation Model (SIM)-funded states in testing innovative and delivery models. “We’re testing state governments to accelerate healthcare transformation using payment and regulatory levers.” These states developed state healthcare innovation plans that focus on improving population health, transforming healthcare delivery and expanding value-based payment models, she said. This work involves bringing together providers, public health agencies and other federal agencies to come up with best practices to manage entire state populations, including the disenfranchised. “It’s a more holistic approach,” she said.
The push for state HIEs, which face sustainability challenges, may have come too soon. After having technical, sustainability and data-sharing problems with its HIE several years ago, the state of Tennessee turned to Direct protocol to facilitate information sharing. “Then a funny thing happened,” said George Beckett, state health IT coordinator in Tennessee. As they pursued reform under a SIM testing grant, the state’s three managed care organizations (MCOs) came together to consolidate their technology efforts so providers can use one portal to access patient information and ADT feeds, and use the same care coordination software. “We started putting pictures on the board, and it started to look like an HIE.” The MCOs realized that when federal funding runs out, the only way to make money is to save money. Also, they realized that providers will revolt if all MCOs use different packages, he said.
“We haven’t made solid decisions on this, but this is the group think at the moment,” Beckett said. “This is something that wouldn’t have happened six months ago, but now we’re getting there because of healthcare reform and the SIM grant.”