Tuesday, March 20, 2012

Texas Approves HIE Plans

In March, the Texas Health and Human Services Commission (HHSC) and the Texas Health Services Authority (THSA) approved several Business and Operational (B&O) HIE plans located in several regions in the state. These approvals include the Rio Grande Valley HIE (RGV HIE), Southeast Texas Health System (SETHS), the Rio One Health Network, and FirstNet Exchange.

The Rio Grande Valley (RGV) healthcare industry is currently experiencing unprecedented changes and uncertainty due to healthcare reform, the Texas Managed Medicaid rollout will require changes, plus financial pressures are coming from hospitals and physicians to either upgrade or purchase EHR systems to meet Meaningful Use requirements.

The RGV consists of 24 hospitals with 14 of the hospitals adopting IT, four federally funded health centers, and slightly over 1,000 primary care physicians to care for a population of 1.4 million. This population grows at least 10 percent each year when adding the “Winter Texans” and does not include the constant heavy influx of patients from Mexico.

The Valley also faces major health disparities in a population that is among the poorest in the U.S. and is medically underserved. As a result, there are serious medical challenges in the valley. For example, the rate of diabetes in the U.S is about 8 to 9 percent of the adult population but in the Valley, the rate is over 20 percent which can lead to heart disease, renal disease, blindness, and overall disabilities.

The RGV HIE’s Business and Operation Plan addresses the major components for the HIE’s operations including governance, HIE technical model, HIE core services, and the plan for sustainability. The Plan also provides details on RGV HIE’s technology capabilities, implementation approach, and the timeline.

The SETHS is a non-profit corporation equally owned by 9 hospitals whose purpose is to collaborate to create economies of scale and scope in the delivery of healthcare. During the planning phase, objectives were to complete an environmental scan to identify the baseline of work, to identify a supportable and sustainable technology solution, and to determine the business model to use to support technology solutions.

The membership of SETHS predominantly represents smaller healthcare organizations that in many cases provide care to rural populations in southeast Texas. This means that the technical architecture needs to be developed in certain ways.

First, the architecture needed to be implemented using open source technologies not requiring extensive capital investments. Additionally, the architecture does not assume that all HIE participants have uniform or large-scale IT infrastructure available.

This means that as with most HIEs, the members of SETHS have chosen a variety of technologies to store electronic health data. Instead of forcing them to upgrade their systems to support a uniform information exchange capability, it is permissible to retrieve health data wherever the information is available.

The Rio One Network is a non-profit corporation established to develop a HIE organization in Hidalgo and Starr counties in compliance with state and federal standards. The network’s goal is to create a regional network of physicians, hospitals, pharmacies, and laboratories intent on exchanging health information.

The HIE is collaborating with the Hidalgo County Health Department to provide resources such as immunizations registries and other public health surveillance systems. The plan is to link with the network technology currently in use at the county government that is helping the enrolled indigent care population.

Members of the community and healthcare providers have been meeting to discuss the importance of developing a “Local Health Information Exchange” in the region. Not only have the features and benefits of a local HIE been discussed, but discussions on the software connectivity process, federal and state requirements for an HIE, grant requirements, and sustainability for the program have also been taking place.

The Rio One Network is actively identifying all pharmacies and laboratories that want to participate in the network. They are identifying the pharmacies and laboratories participating in e-prescribing and laboratories that are presently delivering results electronically.

Meetings have been held with the Independent Pharmacies Association to engage more pharmacists to participate in the local HIE plus independent laboratories have been approached in an effort to have them also participate. Ongoing discussions are being held with laboratory directors, managers, and their personnel.

To insure that active input is maintained, both the pharmacy and laboratory industry have representatives on the Rio One Board of Directors. The Board and Cerner are working with individual pharmacies and laboratories to insure a smooth transition to the Network in 2012.

FirstNet Exchange was formed in 1996 by the East Texas Medical Center (ETMC) Regional Healthcare System as a regional HIE. It started by connecting ETMC hospitals and physicians, but grew to provide a data exchange for numerous East Texas providers.

Today, the Exchange includes 15 hospitals and over 600 physicians and spans 21 counties with data on over one million patients. In the long term, the plans are to use the THSA local HIE Grant program funds to develop and implement a clinical information exchange to meet requirements in 37 counties of East Texas and then to integrate the exchange into the HIE platform.

FirstNet Exchange is working with their partners to provide connectivity services. In cases where current partners cannot offer connectivity services, the Exchange will identify other telecommunications companies or cable/cellular providers able to help develop a viable option.

For more information, go to www.thsa.org.