Bill Russell, a geriatrician and vice president of clinical information for Erickson Living Management in Silver Spring, Md., looks forward to being able to get hospital information on his nursing home patients through a state-sponsored health information exchange (HIE) known as CRISP. Among other things, the HIE will help the hospital and ER physicians who care for his patients by giving them access to outpatient records.
Russell acknowledges that it will be difficult for physicians to assimilate all the new patient data that they will eventually get through HIEs. "If they're going to be drinking from a fire hose of information, it's a tremendous amount of extra work for doctors to process all of that information," he points out.
Still, he believes that if the outside data is properly structured and filtered and can be accessed through an EHR, it "can enrich your decision-making process."
Today, there are only 73 operational, multi-stakeholder HIEs throughout the country, according to the eHealth Initiative, an organization that tracks these exchanges. But the number is expected to grow rapidly in the next few years, partly because of the $564 million in federal funds that are starting to flow to the states to accelerate the formation and expansion of HIEs.
Authorized by the American Recovery and Reinvestment Act of 2009, the money designated for HIE is intended to increase the interoperability of health IT systems, including electronic health records, and to support providers in their efforts to show "meaningful use" so they can obtain government incentives. Most states are funneling these stimulus funds to private, nonprofit organizations called "state-designated entities," or SDEs, which are responsible for administering HIE. In Maryland, for example, the SDE is CRISP.
While $564 million sounds like a lot of money, it isn't when you're talking about HIEs in 56 states and territories, including the District of Columbia. But many states will build on existing HIEs, and some are getting money from other sources. For example, both the New York and Massachusetts legislatures have appropriated funds for HIE development; Vermont is assessing health plans for a percentage of claims; and Maryland is getting extra HIE funding indirectly from payers through the state's hospital rate-setting mechanism.
The federal government's emphasis on information exchanges also is having a spillover effect in the private sector, notes Jennifer Covich, CEO of the eHealth Initiative. "People recognize that HIE is for real now, and the federal government is supporting it, so there's a lot of action in the industry and a ramp-up for the implementation phase."
What all of this means is that you may soon have access to an information exchange that goes beyond your local hospital system. If you have an EHR, this HIE will help you gain access to hospital, lab, and imaging data on your patients without spending big bucks on interfaces, and it will make it easier for you to show meaningful use. If you haven't made the EHR plunge yet, you should still be able to view patient care summaries and other clinical data on a Web portal.
As Russell indicates, there are plusses and minuses to this new world of information access. But it's the world we're entering, so here's some background about federally funded state HIEs and what to expect from them.
The goals of state HIEs
So far, only a dozen states have actually received HIE funds from the federal Office of the National Coordinator for Health IT (ONC). But at the latest count, ONC had approved the HIE plans of 35 states. Among other things, the government wants all state HIEs to help healthcare providers receive structured lab results online, prescribe electronically, and exchange care summaries in 2011. The state-designated entities are also supposed to devise strategies to fill in gaps in the ability of providers to show meaningful use. And they must create strategies for public health reporting and quality reporting to the Centers for Medicare and Medicaid Services (CMS).
The states are taking a wide variety of approaches to achieving these goals, and some are much further ahead than others, notes Mickey Tripathi, president of the Massachusetts eHealth Collaborative (MAeHC). States that already have regional or local HIEs will build on those, while other states will use the federal grants as seed money to launch HIEs.
New Hampshire, for instance, is eligible for only $5.5 million from ONC, Tripathi notes. But the state has several hospital-based HIEs that cover 75 percent of its ambulatory-care physicians. So in the grant application that MAeHC helped write for New Hampshire, the focus is on creating a "network of networks" that will help the existing HIEs fill in gaps and make their services available to all of the physicians in the area. In addition, the New Hampshire HIE will need to figure out how to link together practices and hospitals in regions where there are no networks.
Initial emphasis on hospital data
The biggest question about the viability of the state HIE approach is whether it will help states to provide or augment the local connectivity required to improve the quality of care and lower costs. Mark Anderson, a veteran health IT consultant based in Montgomery, Texas, is skeptical.