Tuesday, May 25, 2010

Tennessee’s State of the Union for Health Information Exchange (HIE) Collaboration

Tennessee’s State of the Union for Health Information Exchange (HIE)

With each passing decade, health care has consumed a larger share of gross domestic product (GDP) and Federal budgets. The Centers for Medicare and Medicaid Services (CMS) is estimating that the healthcare sector’s share of GDP made its biggest one-year jump ever, going to 17.3 % in 2009 from 16.2 in 2008. The financial burden of the ever increasing ratio of total out-of-pocket spending for health care services and premiums to total family income—continues to increase nationally. As a result of this trend, more people have been exposed to high costs and lack essential services.

In pilot programs across the US, it has been demonstrated that the use of electronic health records (EHRs) can significantly reduce the cost of health care while improving the quality. The American Recovery and Reinvestment Act of 2009 (ARRA) authorizes CMS to provide reimbursement incentives for eligible professionals and hospitals who are successful in adopting and becoming “meaningful users” of certified EHR technology. CMS’ goal is for the definition of meaningful use to be consistent with applicable provisions of Medicare and Medicaid law while continually advancing the stages for contributions certified EHR technology can make to improving health care quality, efficiency, and patient safety. For stage 1, which begins in 2011, CMS proposes objectives for physicians and hospitals to meet to be deemed meaningful EHR users. Stages 2 and 3 will expand the list in 2013 and 2015. Hospitals and physicians failing to adopt EHRs and meet the objectives by 2015 will face penalties.

One future requirement to achieve meaning use is to participate in an HIE. The Knoxville region has operated an HIE infrastructure since June 2004 among the area hospitals known as Innovation Valley Health Information Network (IVHIN). In June 2009 the board of IVHIN approved a collaborative initiative with CareSpark, another HIE based in the Tri-cities for health improvement for East Tennessee. Progress to date for the collaborative community known as CareSparkKnoxville region includes the following:

• Achieved the goal of full commitment of area hospitals and certain large physician practices to improve internal infrastructures and adopt systems to collectively connect to a secure utility for health information exchange.
• CareSpark hired Leigh Sterling as the Knoxville region coordinator for its 17 counties.
• Outreach has begun regarding the available CareSpark offering for HIE between hospitals, physician practices, health plans and public health departments. CareSpark currently serves almost 400,000 patients and 250 clinicians in the Tri-Cities region. IVHin and CareSpark are now aligning efforts and collaborating to share infrastructure for technical services, governance and policy, and business operations to enable HIE.

In addition, the state of Tennessee formed the Health Information Partnership for Tennessee (HIP TN) as a non-profit organization in the summer of 2009 with the purpose of “improving the health of people served in Tennessee using a public-private framework to coordinate and empower the sharing of appropriate health information through local and regional HIEs, as well as in areas not yet covered by exchange thereby improving quality, coordination of care, cost efficiency and public health. HIP TN is responsible for selecting and managing the infrastructure and services to support statewide HIE." The HIP-TN organization in partnership with the state of TN’s office of eHealth are working together to determine incentive program deployment strategies. HIP TN brings together Tennessee’s local, regional and state electronic health information initiatives and resources to form a collaborative partnership and framework.

With dozens of different vendors to choose from and the fast paced requirements beginning in 2011 for meaningful use, providers will need assistance with getting connected to an HIE, acquiring and implementing EHRs and other associated information systems. These systems often can't easily talk to each other; therefore, the use of qualified intermediaries will be required to support providers through the deployment of EHR technology in a meaningful way to qualify for incentives. These intermediaries will coordinate with the Regional Extension Center (REC) activities underway within TN and will increase successful adoption of EHRs by providing community-wide technical assistance and facilitating group purchasing. This coupled with the coordinated HIE efforts of HIP TN will ensure the requirements and capabilities for meaningful use can be consistently met as funding will be coordinated between programs to ensure consistency in application of rules and to maximize impact.

Serendipity Health, LLC will act as one of the intermediaries working with CareSpark, IVHIN, HIP-TN and others at the TN state office of eHealth to help area providers and hospitals understand and qualify for federal EHR incentive money while improving the health care in East TN. If your organization is interested in finding out more about deploying connected health care, please contact us at info@serendipityhealth.net to learn more about how your organization can qualify for incentives and help optimize health care for all.