An equation for success: State HIEs and their accelerating effect on health IT adoption
Published: September 16, 2013
The 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act gave the Department of Health and Human Services (HHS) approximately $26 billion to promote the adoption and meaningful use of health information technology (IT). Prior to this legislation, the medical field experienced challenges with accessing and updating patient records that were primarily paper-based. The push for moving away from a paper-based system to a computerized one was further expedited by tragic events like Hurricane Katrina, where nearly 400,000 medical records were lost due to flooding.
To encourage the adoption of health IT, CMS launched the Medicare and Medicaid Electronic Health Records (EHR) incentive programs. The programs, which began in January 2011, provides incentive payments to eligible professionals (EPs) and hospitals as they adopt, implement, upgrade or demonstrate meaningful use of certified EHR technology. The main goal of the incentive programs is not just to increase EHR adoption, but to support the meaningful use of the EHR technology by improving efficiencies in health care delivery.
Meaningful use refers to the ways in which technologies are utilized. CMS defines meaningful use of EHRs to include complete and accurate information used within the systems. In other words, providers should know more about their patients’ health history before they walk into the examination room. There should also be better access to and sharing of information among doctors’ offices, hospitals and other health systems in order to improve coordination of care.
Patient empowerment refers to EHRs being able to help patients take a more active role in their health, such as being able to receive electronic copies of their medical records and share health information securely over the Internet.
In 2010, the Office of the National Coordinator (ONC) launched the State Health Information Exchange (HIE) Cooperative Agreement Program. Under the initiative, $548 million was allotted to states to assist in the modernization of how patient health data is stored and shared. The goal of the program was to develop and enhance HIE services across the U.S. and create a “coordinated system” for states to operate under a common set of principles.
Many states, with the exception of Nevada, have already procured their statewide HIE themselves or through a separate entity. Therefore, there are not many opportunities that exist for vendors to build out statewide HIE systems. Still, states are procuring for other HIE-related services and technologies, though they are more along the lines of helping hospitals and other health care providers get on board with health IT in general (e.g. EMRs/EHRs).
As mentioned, Nevada is one state that has recently released a solicitation for a statewide HIE. In 2012, the state underwent a health information technology assessment, in which it was found that about three-fourths of Nevada’s providers have or will have an EHR implemented by 2015.
Nevada’s goal was to provide HIE capability for all providers wherever needed in the state, including the facilitation of early connectivity through the use of DIRECT services. The state created an HIE board of directors to oversee the planning and procurement of the statewide HIE services, and an RFP was released on July 3, 2013. The resulting contract will be for about $2.3 million, with an initial term of three years. The state also has plans to request consultative/project management services relating to the statewide HIE, though the release date for that procurement is not available at this time.
Most of the states that already have an HIE vendor are unable to confirm the direction they will take once the contract with their statewide HIE vendor expires. This is mostly due to the contract either having an expiration date that is considerably far out, or the state being unsure what direction their designated entity will be taking. That said, there are still some procurements being released at the city and county level for services such as patient portals, EMRs and other health information-related systems. For instance, San Diego County released a request for information (RFI) back in December 2012 to obtain feedback on integrated health and human services exchanges. The goal of the project was to enhance access, quality, outcome and cost-effectiveness of the county’s health and human services agency programs. The project involves moving from large legacy systems to more agile, flexible and interoperable enterprise-based infrastructure. An RFP for these services was released in June 2013, and proposals were due at the end of August. The initial contract term covers the system design, acquisition/development, integration and implementation. A two-year warranty period will follow, with an optional (at the county’s sole discretion) annual maintenance period or multi-year extended warranty period. The county is still reviewing proposals at this time.
Health IT as a whole has been increasing rapidly in the U.S., and it is largely due to federal initiatives such as the state HIE Cooperative Agreement Program and EHR incentive programs that have provided a considerable amount of funding to states and health providers. Though most states have already selected contractors to build out their statewide HIEs, vendors can still expect to see more health-IT related opportunities released by states and localities in the future.