Apgar and Associates LLC

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The expanded use of health information technology (HIT) has become somewhat of a money maker for states and has been cited as key to successful healthcare reform. Many states have formed either legislatively created or Governor’s Office created HIT planning and oversight bodies. All are vying for stimulus dollars to develop state level HIT strategic plans and tap into dollars to pay for HIT expansion within (and hopefully between) states. Oregon is no different. Initially HIT planning was the purview of the Oregon Health Information Infrastructure Advisory Committee (HIIAC), of which I was a member, created by executive order. The input from the Oregon HIIAC was incorporated in a broader healthcare reform report with recommendations presented to the Oregon Legislative Assembly for consideration during the 2009 legislative session. One of the HIIAC recommendations was to created a HIT oversight and planning body push expanded use of HIT in Oregon. The recommendation was to create an independent HIT oversight and planning body, what later came to be named the Oregon Health Information Technology Oversight Council. During the course of the session the bill that was introduced to form this independent body was folded into Oregon’s version of healthcare reform and the HITOC was subsumed under the to be created Oregon Health Authority rather than to remain as an independent oversight body. It makes sense for states to form independent bodies, whether public, private or a combination of, to move forward the expanded use of HIT within and between states. In Oregon, though, that independent body now must answer to a higher authority and lost the autonomy to act primarily as a catalyst to increase HIT use and take advantage of associated efficiencies and increases in quality care. That being said, we have what we have and, as with many other states, need to use whatever vehicle is available to hopefully help the healthcare industry move into the 21st century. In this blog I included my latest testimony to the HITOC. It serves as an example of issues many states are facing and limitations to existing efforts. I believe many of the following recommendations and the details behind those recommendations are applicable not just in Oregon, but across state lines. States are all in varying stages of preparation for the new world of expanded use of HIT and the expansion of what I would call real electronic health information exchange (versus point-to-point or organization to organization communication only). For your interest, pleasure and edification, I present to you the latest in my attempts to influence positively the march into the 21st century. Hopefully it can assist other states besides Oregon as differing bodies wrestle with what can be complicated and politically charged endeavors related to HIT expansion. Summary of Recommendations: -Clearly define stakeholders (similar to the method used by the State of Oregon as part of the Health Information Security and Privacy Collaboration (HISPC) project). -Clearly define how all identified stakeholders will be afforded an opportunity to provide input as the HIT strategic plan is developed by the HITOC. -Review and re-examine entities or collaboratives that were previously categorized as Oregon health information exchanges (HIE) to determine which are truly HIEs versus point-to-point (organization to organization communication) data exchanges. -Review and revise electronic health record (EHR) statistics to differentiate between purchased or implemented EHRs versus actual EHR utilization. -Revise dollar figures related to EHR implementation incentive dollars that will flow into Oregon to reflect the likely inflow of funds versus the “best case scenario.” -Include plans to incentivize adoption of EHR/electronic medical records (EMR), especially by small to medium sized practices given the fact that the “stick” associated with stimulus package incentives will have minimal impact in moving these providers to adopt HIT combined with the lack of capital to make the necessary investment that precludes taking advantage of federal incentives. -Review regulatory requirements related to the privacy and security of individually identifiable health information (state and federal). This applies to intra and inter-state HIE. -Offer educational opportunities in conjunction with the Office for Civil Rights (OCR) regarding how consumers’ health information is used and their rights/control over the exchange of their identifiable health information. -Make an effort to take more of a consumer versus provider centric approach to expanded use of HIT in Oregon. -Reconsider adding “privacy” to the HITOC guiding principles. -Base the Oregon health information exchange (HIE) or health information exchange organization (HIEO; also called a regional health information organization (RHIO)) on a successful HIEO/RHIO model versus the unsuccessful Portland model. -Consider alternative models other than the Oregon Department of Human Services (DHS) Division of Medical Assistance Program’s (DMAP) Health Record Bank (HRB) project when developing plans to engage consumers through the use of personal health records (PHR) given current privacy, security and regulatory issues associated with the HRB project that remain unaddressed by DMAP. -Review and incorporate new privacy and security requirements included in the American Recovery and Reinvestment Act (ARRA) when developing especially the detailed portion of Oregon’s HIT strategic plan.

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