Texas HIEs rate high on governance, interoperability but lag on patient engagement

By sharing services and committing to transparent governance, health information exchange (HIE) organizations in Texas are well on their way to sustainability and generally closer to interoperability than their counterparts in other states, a new survey suggests. However, HIEs in the state and nationally still lag when it comes to patient engagement.

All 10 local HIEs in Texas that received HITECH Act grant funding from the Office of the National Coordinator for Health IT (ONC) have begun pilot-testing data, according to the survey, released by the eHealth Initiative (eHI), and six are fully operational. Notably, eight of the 10 are generating revenue through membership and usage fees.

This is important for long-term sustainability, and puts Texas ahead of much of the rest of the country.

“Sustainability quickly emerged as the No. 1 issue for data exchange over the last 10 years. HIE organizations have struggled with defining value to stakeholders, who may not understand the value of sharing information with potential competitors. However, the emergence of coordinated value-based care models such as the accountable care organization have likely helped in this regard, as has the overall proliferation of electronic health records,” the report said.

ONC-funded entities make up half of the HIEs in Texas, according to the Texas Health Services Authority, a state-sanctioned nonprofit that coordinates HIE implementation there. Among the entire group of 20, 15 have defined strategic and operational plans, which the eHI said “demonstrate[s] a commitment to governance.”

A key governance issue is protection of patient data. On that front, HIEs in Texas are doing well; 18 have formal privacy and security policies at least as strong as HIPAA, and six organizations go beyond HIPAA, according to the report. None of the 20 has faced a security breach, eHI said.

Operationally, the challenges have been myriad, notably with interoperability of health information.

“Providers, hospitals and health systems have adopted a dizzying array of different health IT and EHR solutions without an existing national framework for technical standards and specifications governing how those systems handle data. As a result, proprietary solutions all too frequently require custom interfaces to enable them to communicate with other systems,” the report said.

However, Texas has a better handle on this problem than most because healthcare entities in the Lone Star State tend to use fewer IT vendors than the national average. “Nationally, 37 percent of HIEs responding to eHI’s survey reported constructing between 11 and 25 interfaces with disparate EHR systems. By comparison, only two Texas HIEs have interfaced with more than 10,” eHI reported.

Like other states, Texas is not doing a whole lot in terms of patient engagement via HIEs. Just four of the 20 entities surveyed said their patients were able to access personal data, near the national average of 21 percent. Eight currently do not even have plans to offer patient access in the future.

For more, download the eHI report.