Sunday, September 11, 2011

Alaska's Vision for Healthcare

The Alaska Health Care Commission has recommended that a five year road map to transform Alaska’s health system be developed to make high quality healthcare more available, accessible, and affordable for all Alaskans. The goal is to transform Alaska’s health system and develop the vision for the future of healthcare in the state.

The goals are to strengthen the health information infrastructure in terms of EHRs , develop the state’s HIE, further develop the health workforce by tracking the Alaska Health Workforce Coalition’s planning activities, and to further advance telemedicine adoption in the state.

Alaska’s present and future telemedicine activities will be highlighted by Stewart Ferguson, PhD, President-Elect ATA and Chief Information Officer for the Alaska Native Tribal Health Consortium along with many other leaders at the ATA Forum 2011 to be held in Anchorage Alaska September 19-21, 2011.

The other goals for the state are to support the development of patient-centered medical homes, identify long term care system and trauma system issues, study payment reform strategies in terms of price and quality transparency, provide for price bundling by episode of care or diagnosis, and examine the multi-payer approach.

The state health IT plan was formally approved by ONC on June 9, 2011 and HIE pilot sites are performing live data transfers with Fairbanks Memorial Hospital and Tanana Valley Clinic.

Today, the state has access to a number of health-related data sources related to claims and clinical data, public health surveillance data, population and other data, but there are still some gaps in the area of health workforce data, all-payer claims data, HAI data, syndromic surveillance data, and gaps in broadband in rural areas.

Alaska’s Hospital Discharge Database (HDD) has been maintained since 2001. Since its inception, the HDD has been maintained by the Hospital Industry Data Institute, Inc (HIDI) a subsidiary of the Missouri Hospital Association.

Currently, 27 hospital facilities participate in the database that includes mostly large hospitals but several facilities such as two military hospitals, two mental health hospitals, six regional tribal health system hospitals, and the long-term acute care hospital do not participate.

The discharge data is submitted to the clearinghouse maintained by HIDI on a quarterly basis with smaller hospitals reporting on an annual basis. Hospital billing departments transmit encrypted data to HIDI via a secure network. Unlike some other states, Alaska’s HDD system does not make de-identified data sets available for public use.

Alaska’s HDD system initially gathered inpatient data only but in 2007, outpatient and emergency department databases were added. However, a database for ambulatory surgery is not included in Alaska’s system.

There are challenges since only a portion of the state’s hospitals participate in the HDD system, incomplete data is a problem, and the data in the system is underutilized. Alaska is trying to increase facility participation in the database and also improve the use of HDD data.

The state is also encouraging patients to implement the use of “myAlaska” and personal health records. “myAlaska” is a web service operated by the state to provide single sign-on for multiple state services and provide a framework for electronic signatures for state forms or transactions.

As for e-prescribing, a portal is being implemented for Medicaid prior to the implementation of the new MMIS called the Alaska Medicaid Health Enterprise. The e-prescribing solution is called “CyberAccess” which is a stand-alone portal to deliver basic core functionality with additional Alaska specific customizations.

The primary users of “CyberAccess” will be providers, fiscal agent personnel, and state personnel. The portal is close to implementation but the near term plan is to roll out “Cyber Access” first to the primary care community.