Wednesday, June 17, 2009

Nebraska Implementing HIE

The Nebraska Health Information Initiative (NeHII) is currently communicating with many providers to connect them to the NeHII platform. Currently, the NEHII pilot program is evaluating the technical and functional capabilities of the HIE system with a limited number of participants. Today, there are 50 physicians and staff members using the Virtual Health Record and an additional 46 physicians asking to participate.

NeHII uses a hybrid federated model allowing for information to be stored on multiple databases on the back end. This model allows for better data storage and improved performance. Over the next few years, the HIE will be rolled out across the state and will ultimately become part of the Nationwide health Information Network.

The eHealth Council was created by the Nebraska Information Technology Commission (NTIC) to discuss eHealth initiatives in the state. The Council held a meeting in May 2009 on the strategies needed to support the development and expansion of HIEs.

One of the strategies is to support efforts to obtain HIE funding. This effort will be helped by working with other stakeholders to publicize health IT success stories within the state and to inform all stakeholders of the benefits of health IT.

The Legal Work Group of the Nebraska HISPC has reviewed Nebraska’s health information disclosure laws to identify laws that are more stringent than HIPAA. The result was that they found that the Nebraska Rev. Stat. 71-8403 stipulates that authorizations for release of medical records are valid for a maximum period of 180 days. The group recommended deleting the 180 day limit. HIPAA requirements would then apply allowing patients to state an expiration date or expiration event.

The Council’s e-Prescribing Work Group also identified a potential barrier to e-prescribing in a Nebraska statute that requires pharmacists to keep paper copies of prescriptions. A change to this statute would enable pharmacists to keep copies of prescriptions in a readily retrievable format.

The goal for the e-prescribing work group is to identify the barriers to e-prescribing and study the start-up and sustainability costs and resources to support the essential needs of pharmacies. Costs include transaction, software, and other optional fees.

Other problems hindering e-prescribing include changes in workflow which can temporarily reduce productivity for some, not being able to transmit prescriptions for controlled substances electronically, lack of training on the system, and prior negative experiences with the e-prescribing process.

The state also supports the development of interconnections among HIEs in the state and across borders. The idea is to determine the requirements for connections among exchanges and to explore options including connecting through NeHII or through NHIN’s open source Connect Software. There are plans to issue an RFP in the future.

The Council is going to work with the HIEs to map the adoption of standards to enable the integration of data from disparate sources into electronic medical records. The migration to HL7 version 3 has been identified as a potential strategy.

Other eHealth initiatives currently underway in Nebraska include:
  • The Nebraska Statewide Telehealth Network (NSTN) is going to connect nearly all of the state’s hospitals and public health departments particularly in rural Nebraska
  • The Western Nebraska HIE, has completed a plan and is beginning to implement a regional HIE
  • The Southeast Nebraska Behavioral Health Information Network is implementing the country’s first behavioral HIE
  • The Southeast Nebraska HIE now connects five rural health clinics, a home health agency, a nursing home, an assisted living facility, several EMS units, two pharmacies, and the St. Elizabeth Regional Health System in Lincoln