Tony Gilman: Texas a National Leader in HIE Implementation
I am pleased to present to you the inaugural edition of HIETexas Connection, a quarterly newsletter published by the Texas Health Services Authority to keep you up-to-date on local, state and federal health information exchange (HIE) progress and initiatives.
With the approval of the State HIE Plan by the Office of the National Coordinator for Health Information Technology (ONC) in 2010, the THSA, in partnership with the Texas Health and Human Services Commission (HHSC), is building the HIE infrastructure necessary to support a modern, electronically enabled health care system in Texas. Through greater use of technology, Texas providers will be able to deliver higher-quality, more efficient care. Having the right information at the right time supports better care; reduces the need for duplicative tests; avoids adverse drug interactions; and improves care coordination, patient relations and satisfaction.
In these early stages, I’m pleased to report that Texas is a national leader in HIE implementation. Through the first calendar quarter of 2013, Texas ranks second among states in the number of enabled HIE users, with 26,268 clinical and administrative staff enabled for query-based exchange. Through a query-based exchange, providers can query a network to find clinical data produced by other providers, enabling HIE use cases such as checking for the presence of lab results before performing lab tests or querying for medical history for patients arriving in the emergency department.
With 581 organizations enabled for query-based exchange, Texas ranks third among all states. Texas has 357 ambulatory entities and 56 acute care hospitals actively participating in query-based exchange.
The THSA, in partnership with HHSC, is working to ensure the private and secure electronic exchange of health information at the community level, and across Texas, through the execution of three key strategies:
- Implementation of a Local HIE Grant Program administered by HHSC with support from THSA to partially fund the planning, development and operations of local and regional HIE networks;
- Facilitation of “lite” HIE capabilities in rural “white space” counties not served by local HIEs through the provision of connectivity services by Health Information Service Providers; and
- Development of general state-level operations administered jointly by the THSA and HHSC, including a transparent and collaborative governance structure to support coordinated implementation of HIE in Texas, development of policies and guidelines, and provision of statewide services to support HIE-to-HIE connectivity and connectivity with the rest of the nation.
Local HIE Grant Program
Texas is supporting the expansion and development of 12 community-based HIE networks in Texas. These 12 HIEs, which received grants from HHSC in 2011, cover all major urban areas in Texas and have committed to connecting 85 percent of the 53,000 physicians and 600 hospitals in Texas. The operational status of each HIE differs, but all have selected an HIE technology partner, enabling them to move forward in (or toward) implementation of query-based data exchange services. Eleven HIEs are now offering Direct Secure Messaging, an encrypted email system that facilitates the exchange of protected health information between two HIPAA-compliant clinical providers. Four of the 12 HIEs are considered live, including Greater Houston Healthconnect, Health Care Access San Antonio, Integrated Care Collaboration (Austin/Central Texas), and North Texas Accountable Healthcare Partnership (Dallas-Fort Worth Metroplex).
Serving “White Space”
In areas of Texas not supported by a local HIE (primarily counties in rural West Texas), the THSA contracts with four Health Information Service Providers (HISPs) to provide a simple and low-cost HIE connectivity option that utilizes Direct Secure Messaging. Utilizing this option, providers can actively send clinical information to other providers, enabling particular HIE use cases such as delivery of laboratory results from the lab to the ordering provider or delivery of a clinical summary upon referral to a specialist or hospital.
Through a voucher-style program, Texas is offsetting initial costs for physicians and hospitals in the White Space to connect to HISPs. As a result of this program, all Texas providers have at least one method of achieving the HIE elements of federal “meaningful use” requirements.
State-level Shared Services
This year, the THSA is implementing a basic layer of shared technical services to support HIE-to-HIE connectivity within Texas and with other states and federal agencies, such as the Veteran’s Administration and Social Security Administration. In April, the THSA contracted with InterSystems to build out the state’s shared services, also known as “HIETexas.”
In the future, the THSA plans to connect to other state-level data sources such as Medicaid, the immunization and cancer registries maintained by the Texas Department of State Health Services, and the state’s Prescription Drug Monitoring Program for controlled substances.
In the coming months, you will hear more about the THSA’s HIE certification process for Texas. Through this process, providers and consumers can be confident that certified HIEs have adhered to applicable state and federal privacy, security and interoperability standards, and support federal “meaningful use” requirements.
I hope you enjoy this quarter’s newsletter, and I encourage you to get involved at the state or local level in connecting Texans through HIETexas and local HIEs to support higher-quality and more efficient care in Texas.