As 2013 draws to a close, only a few months of funding remains available through the State Health Information Exchange Cooperative Agreement Program – the federal grant program established by the Affordable Care Act to help states build capacity for exchanging health information electronically. Following is an overview of current progress on health information exchange in Texas as we approach this critical milestone.
Regional Exchanges. In Texas, efforts to promote the exchange of health information started at the local level, with communities and policy makers working to form 12 regional Health Information Exchanges (HIEs) funded by a federal grant program that began in March 2010 and will wind down in March of 2014. Of the 12 regional HIEs in Texas, 10 are fully operational, and the majority possess a sustainable business model and a strong technology partner. The HIEs will communicate with a "network-of-networks" model, referred to as "HIETexas" and facilitated by the Texas Health Services Authority (THSA). The THSA is tasked with developing the statewide infrastructure to support connectivity between the regional HIEs in Texas and with other states and federal agencies via the national eHealth Exchange. HIETexas will also connect HIEs to state health data sources, such as registries at the Department of State Health Services.1
With the federal grant money running out, the time has come for the HIEs to become self-sustaining. Hospitals are key partners in the HIEs' sustainability plans, as are other providers, physicians, businesses, pharmacies, labs, patients, payers, government funding, and philanthropy. The THSA is providing shared services to assist HIEs with providing secure, confidential, and accurate information that will help the entities recruit, serve, and maintain users. THSA has developed and implemented a data use/trust agreement that helps to alleviate concerns about competing entity users by limiting the permitted uses of data and prohibiting marketing. Interoperability is still a challenge due to varying bandwidth around the state and EHR and HIE products that don't always interface properly. In addition, technology solutions to address patient privacy concerns are still lacking; automated limitations on sharing sensitive information contained in EHRs pertaining to sexual assault, domestic violence, family planning, mental health, substance abuse, minors, and other issues are still under development.2
Agency Activity. Two initiatives are underway at the Departmentof State Health Services (DSHS) to improve and expand health information exchange in Texas: the HIE Feasibility Business Cases Initiative and the DSHS Public Health Gateway. The first will involve a cross-agency workgroup to develop business use cases and technology solutions to improve public health reporting by HIEs. The second is working to develop capacity for data exchange on a platform that meets the Medicare and Medicaid EHR Incentive Payment Program requirements so that data reporting may be more timely and accurate. DSHS is focusing on the following areas: immunization, electronic lab reporting, cancer registry, syndromic surveillance, behavioral health, HIV/STD and HIV program, and lab.3
Medicaid Implementation. The Texas Legislature established the Medicaid/CHIP Health Information Exchange (HIE) Advisory Committee at the Texas Health and Human Services Commission (HHSC) to oversee the development of an electronic HIE system to improve the quality, safety, and efficiency of healthcare services provided by the State's Medicaid and CHIP programs. HHSC has worked closely with THSA and a broad array of public interest and advocacy groups to promote state policy with regard to the application of HIT in Medicaid and CHIP. Currently, the state Medicaid/CHIP provider portal — Medicaid Eligibility and Health Information Services (MEHIS) — affords authorized providers with access to three years of immunization history, Texas Health Steps, and visit history. The Advisory Committee continues to work on business rules that will govern the authorization required to report to and access additional information from the system. The "Medicaid Clinical Gateway" is slated to provide claims-based data to providers and accept clinical data on Medicaid clients via the THSA state-layer connectivity in the near future.4
Regulatory Challenges. As public and private partners work to improve the sharing of health data between providers and state health agencies, a number of regulatory hurdles have been identified. For example, THSA recommends giving healthcare providers clear authority to use an HIE to report to and access information in certain DSHS registries, including communicable disease registries, cancer registries, and immunization registries. While some providers have already taken part in this type of exchange, clear authority may help promote even more sharing. In addition, HIE and healthcare providers have requested liability protection when exchanging information through an HIE. It has also been pointed out by the THSA that the confidentiality protections afforded to government program IT security systems should be extended to IT security systems in general, or at a minimum, specifically include confidentiality protection to security systems that are audited by an agency that is subject to the Public Information Act. These issues are likely to be subjects of the Sunset Advisory Commission's upcoming review of the THSA and may result in recommendations to be considered by the 2015 Legislature.5
Footnotes
1. http://hietexas.org/fall-2013
2. Ibid.
3. http://www.dshs.state.tx.us/hit
4. http://www.hhsc.state.tx.us/about_hhsc/AdvisoryCommittees/HIE/ac-meeting-071813.pdf
5. http://www.sunset.state.tx.us/84th/hsa/ser_hsa.pdf
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