The State Level Health Information Exchange Consensus Project

1
The State Level Health Information Exchange
Consensus Project

• NHIN-HISPC-SLHIE Joint Conference
• May 1, 2008

2
Project Overview

• Launched in 2006
• Targeting organized state-level HIE efforts (not
  to be confused with state government)
• Field research and analysis (9-15 statewide
  initiatives)
• Governance
• Financial and operational characteristics,
• Health information exchange policies and
  practices, and
• Short and long-term priorities for implementation
  and sustainability
• Annual consensus conference to refine guidance
• State-level resources State Level Health
  Information Exchange Initiative Development
  Workbook, programs, presentations
• Input to national HIE strategies, projects
• Series of reports, www.Staterhio.org

3
2007 Project Team and Organization

• Staff
• Lynn Dierker, RN, Project director, Board of
  Directors, Colorado Regional Health Information
  Organization (CORHIO)
• FORE/AHIMA
• Research Consultants
• Lammot du Pont, William Bernstein, Manatt Health
  Solutions
• Don Mon, VP Practice Leadership, AHIMA
• Steering Committee (and other state-level HIE
  contacts)
• Project Partners
• National Council of State Legislators
• eHealth Initiative
• HIMSS
• ONC
• Liaisons to other agencies (AHRQ) and projects
• NGA State eHealth Alliance
• RTI HISPC

4
Steering Committee

• Laura L. Adams, President and CEO, Rhode Island
  Quality Institute, Providence, RI
• Antoine Agassi, Director and Chair of the
  Tennessee eHealth Council, Nashville, TN
• Rachel Block, Executive Director, New York
  eHealth Collaborative, New York, NY
• Ray Campbell, Esq., MPA, CEO, Massachusetts
  Health Data Consortium, Waltham, MA,
• Devore Culver, Executive Director, HealthInfoNet,
  Manchester, ME
• Lynn Dierker,RN,Senior Advisor, Colorado Regional
  Health Information Organization, Denver, CO
• Don Holmquest, MD, PhD, JD, CEO, CalRHIO, San
  Francisco, CA
• Beth Nagel, Health Information Manager, Dept of
  Community Health, Michigan Health Information
  Network, Lansing, MI
• Marc Overhage, MD, PhD, FACP, FACMI, CEO, Indiana
  Health Information Exchange, Inc.Indianapolis,
  IN
• Gina Perez, Executive Director, Delaware Health
  Information Network, Lewes, DE
• Jan Root, PhD, Executive Director, Utah Health
  Information Network, Murray, UT
• Christopher Sullivan, PhD, Florida Office of
  Health Information Technology, Florida Health
  Information Network, Tallahassee, FL
• Roxane Townsend, MD, Asst. VP, LSU Health
  Systems, Baton Rouge, LA
• Steering Committee Chair
• New in 2008

5
Targeting Major State-Level Issues

• Resources Financing strategies
• Sources of start-up capital
• Financial models for long term sustainability
  including support for state-level HIE roles
• Federal/state-level coordination
• Roadmap for how state-level HIE relates to
  federal programs
• Coordinating body to lead/structure collaboration
• HIE Roles for state governments
• Clarity about effective state government HIE
  roles, organization
• Stakeholder engagement
• Private payers from passive/competitive to fully
  engaged
• Medicaid and Medicare to fully leverage influence
  
• Accelerating HIE development
• Collaboration among states
• Finding easily replicable early wins

6
Project Findings March 2008

• Continued expansion and evolution in state-level
  HIE efforts
• 75 of states have established state-level HIE
  initiatives/governance entities
• Advanced state-level efforts poised to begin data
  exchange
• Health care reform, privacy rights and
  confidentiality protections are drivers

7
State level HIEAn Evolving Landscape
8
Identifying Trends and Models Across States

• Migration to two distinct and key organizational
  roles at the state level
• Governance convening, coordination
• Technical operations owned and/or managed
• State-level HIE governance role is primary
• Ensure that HIE develops as a public good (beyond
  silos, corporate interests)
• Serves all statewide stakeholders and data needs
• Reduces technology investments and other costs
  for all participants
• Mechanism for coordination of HIE policies and
  practices
• State level HIE governance entity is a
  public-private partnership entity
• Role between state government and the health
  sector and industry
• Involves state government, but independent of
  state government
• State governments play important roles
• Designating authority to a state level HIE
  governance entity
• Providing resources start up and ongoing
• Leveraging public programs, policy levers to
  create incentives for HIE
• Statewide technical approaches can vary and will
  likely evolve
• Size, market characteristics, resources,
• Stages of development

9
Key Issues

• Governance and accountability
• Policy implications for public-private
  state-level and national level HIE governance
• A common framework needed for HIE roles and
  accountabilities
• Coordinated HIE policies and practices
• Effectiveness of privacy policy linked to
  consistent operational/technical data sharing
  policies and practices
• State-level HIE governance entity provides key
  coordination role
• Value for stakeholders and sustainability
• Recognize where and how value accrues across
  levels
• Recognize realistic phases of development
• Start-up capital investments to achieve capacity
  beyond limited provider markets, support multiple
  HIE services
• Channel initial and ongoing state and federal
  funding
• Structure national incentives (e.g.
  reimbursement, participation in NHIN, federal
  programs) to drive stakeholder participation

10
2008 SLHIE Project Priorities

• Develop an implementation framework
• Governance functions, accountability
  criteria/mechanisms
• Coordinated policies and practices for effective
  data sharing and information use
• Financing strategies, business models and
  developmental pathways
• Support state-level HIE implementation efforts
• Consensus for best practices
• Information/resources
• Influence nationwide HIE implementation
• Voice for state-level HIE perspectives in policy
  development
• Representation in AHIC design and implementation,
  NHIN development

11
2008 Project Scope of Work

• Ongoing research
• Models, guidance for consistent HIE policies and
  practices
• State-level value propositions and sustainability
  models
• Inventory emerging resources to inform HIE
  financial sustainability research and development
• Map and monitor state-level HIE development
  trajectories
• Identify state level HIE value models,
  development and evolution, impact
• Consensus development
• Potential criteria for credentialling HIE
  organizations
• State-level HIE Forum
• Facilitate development of state-level HIE
  governance, accountability mechanisms
• Organize state-level interests, prototype for
  representation as part of permanent AHIC