HCS 483 Discussion

In this thread we discuss the different types of HIE or Health Information Exchanges. In Support of this discussion, I am attaching an interesting FINAL Report on HIEs that was published in 2016, from a National Perspective. Note the challenges and issues that were described in this report in terms of technology, operations, and financing of health information exchanges. We know that every state in the US has approached the concept of health information exchange from their own perspective-there are regional exchanges, state level exchanges etc. Clary your state and look for the health information exchange is in the state where you live.What did you find? What type of exchange is it? How big is the exchange and what providers in your area are participating and/or not participating? 150-200 words
final_report_state_hie_march_2016.pdf

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EV ALU ATION OF THE ST ATE HIE
COOPERATIVE AGREEMENT PROGRAM
Final Report
MARCH 2016
PRESENTED TO:
Matthew Swain
The Office of the National Coordinator
for Health Information Technology
U.S. Department of Health and Human
Services
Washington, DC
Contract Number:
HHSP2337010T/OS33547
PRESENTED BY:
Prashila Dullabh
Shriram Parashuram
Lauren Hovey
Petry Ubri
Kathryn Fischer
NORC at the
University of Chicago
4350 East-West Highway
Suite 800
Bethesda, MD 20814
NORC | Evaluation of the State HIE Cooperative Agreement Program
Acknowledgements
The NORC project team would first like to acknowledge the large number of stakeholders who
contributed to this evaluation, including State Health IT Coordinators, State Designated Entity Directors,
HIE leadership, subject matter experts and many others who participated in interviews, discussions, and
case studies. We would like to thank Dr. Julia Adler-Milstein of the University of Michigan for her
ongoing involvement with the evaluation and her review and thoughtful feedback on this final report, Dr.
Ashish Jha of Harvard School of Public Health for his involvement in the early stages of the evaluation,
and Felicity Skidmore for her editorial support. We also gratefully acknowledge the contributions of our
ONC project team, Matthew Swain, Vaishali Patel, Talisha Searcy, Michael Furukawa, and Jawanna
Henry, as well as other ONC staff who provided thoughtful input and guidance throughout the project.
Throughout the duration of this five year evaluation, numerous NORC staff contributed to evaluation
activities. We acknowledge current and former NORC staff, including Adil Moiduddin, Christine Nye,
Sai Loganathan, Lindsay Virost, Catharine Q. Fromknecht, Ilana Dickman, Michael Latterner, Rebecca
Shore Catterson, Sarah Downie, Jean-Ezra Yeung, Terra Gore, Stephanie Hedquist, Samantha Zenlea,
Sarah Downie, Elizabeth Babalola, and Melissa Atlas. We also acknowledge the efforts of the National
Survey for Health Information Exchange survey team including Susan Schechter, Ken Copeland, Felicia
LeClere, Erin Tanenbaum, Rene Bautista, Michael Colichia, Brad Parsell, Lauren McNamara, and Susan
Hinkins.
Final Report | I
NORC | Evaluation of the State HIE Cooperative Agreement Program
Table of Contents
ACKNOWLEDGEMENTS ………………………………………………………………………………………………I
ABBREVIATIONS …………………………………………………………………………………………………… VIII
EXECUTIVE SUMMARY ………………………………………………………………………………………………1
I. Introduction and Context ……………………………………………………………………………………..1
Program and Evaluation Overview …………………………………………………………………..1
II. Methods …………………………………………………………………………………………………………..2
III. AIM 1: Characterize Approaches Taken to Enable HIE and How They Evolved …………. 2
What Approaches Did Grantees Take to Enable HIE Services? …………………………..2
What Was the Rationale for the Approach Chosen? …………………………………………..3
How Did Grantee Approaches Evolve over Time? ……………………………………………..3
IV. AIM 2: Characterize HIE Levels at Baseline and How They Changed over Time ……….. 3
What Were HIE Levels at Baseline and How Did They Progress over the
Program? ……………………………………………………………………………………………….3
V. AIM 3: Assess Overall Program Effectiveness ……………………………………………………….5
What Were the Factors (Contextual and Programmatic) that Influenced HIE
Progress?………………………………………………………………………………………….5
What Were the Overall Program Impacts? ………………………………………………………..5
VI. Lessons Learned: Key Drivers, Challenges, and Solutions ……………………………………..5
Lessons Learned ………………………………………………………………………………………….5
Challenges ………………………………………………………………………………………………….6
Sustainability ……………………………………………………………………………………………….6
VII. Policy Implications …………………………………………………………………………………………..6
State Role ……………………………………………………………………………………………………7
Federal Role ………………………………………………………………………………………………..7
Shared Needs and Responsibilities …………………………………………………………………7
Conclusions …………………………………………………………………………………………………………8
I. INTRODUCTION AND CONTEXT ……………………………………………………………………………….9
Chapter Summary …………………………………………………………………………………………………9
Overview of the State HIE Program and Related Federal Initiatives ……………………..9
Changes in Landscape: Progress since HITECH ……………………………………………….9
Introduction ………………………………………………………………………………………………………….9
Overview of the State HIE Program ……………………………………………………………………….10
Funding Opportunity Announcement and PIN Priorities ……………………………………. 10
ONC’s Programmatic Role……………………………………………………………………………11
State-Level Planning and Coordination …………………………………………………………..11
Program Evaluation …………………………………………………………………………………….11
Final Report | II
NORC | Evaluation of the State HIE Cooperative Agreement Program
HIE Overview……………………………………………………………………………………………..11
HITECH and EHR/HIE-Supportive Initiatives …………………………………………………..12
State HIE Program Evaluation ………………………………………………………………………………15
II. METHODS …………………………………………………………………………………………………………….16
Evaluation Aims, Research Questions, and Data Sources …………………………………………16
Qualitative Evaluation Activities …………………………………………………………………………….17
Content Analysis of Grantee-Reported Data ……………………………………………………17
Stakeholder Discussions………………………………………………………………………………17
Case Studies ……………………………………………………………………………………………..18
Analytic Approach for All Qualitative Activities …………………………………………………19
Quantitative Evaluation Activities …………………………………………………………………………..19
Typology ……………………………………………………………………………………………………19
Composite HIE Score ………………………………………………………………………………….19
Hypotheses Testing …………………………………………………………………………………….19
National Survey on HIE in Clinical Laboratories ……………………………………………….19
III. AIM 1: CHARACTERIZE APPROACHES TAKEN TO ENABLE HIE AND HOW THEY
EVOLVED OVER TIME ………………………………………………………………………………………………20
Chapter Summary ……………………………………………………………………………………………….20
What Approaches Did Grantees Take to Enable HIE Services? ………………………… 20
What Was the Rationale for the Approach Chosen? ………………………………………… 20
How Did These Approaches Evolve over the Duration of the Program? ……………… 20
Conclusions ……………………………………………………………………………………………….20
Introduction ………………………………………………………………………………………………………..21
What Approaches Did Grantees Take to Enable HIE Services?…………………………………. 21
Leadership and Organizational Structure ………………………………………………………..21
Technical Approach …………………………………………………………………………………….22
Legal and Policy Approaches ……………………………………………………………………….27
What Was the Rationale for the Approach Chosen? …………………………………………………31
Leadership and Organizational Structure ………………………………………………………..31
Technical Approach …………………………………………………………………………………….31
Legal and Policy Approach …………………………………………………………………………..32
How Did Approaches Evolve over the Duration of the Program? ……………………………….. 33
IV. AIM 2: CHARACTERIZE HIE LEVELS AT BASELINE AND HOW THEY CHANGED
OVER TIME ………………………………………………………………………………………………………………36
Chapter Summary ……………………………………………………………………………………………….36
What Were HIE Levels at Baseline and How Did They Progress over the
Program? ………………………………………………………………………………………..36
Conclusions ……………………………………………………………………………………………….36
Final Report | III
NORC | Evaluation of the State HIE Cooperative Agreement Program
Introduction and Methods……………………………………………………………………………………..36
Methodological Limitations……………………………………………………………………………37
Measures of HIE Capability …………………………………………………………………………………..38
Measures of HIE Activity ………………………………………………………………………………………40
General Measures of HIE …………………………………………………………………………….42
PIN Priority MU Measures ……………………………………………………………………………42
Composite HIE Score ………………………………………………………………………………….46
V. AIM 3: ASSESS OVERALL PROGRAM EFFECTIVENESS …………………………………………48
Chapter Summary ……………………………………………………………………………………………….48
What Were the Factors that Influenced HIE Progress? …………………………………….. 48
What Were the Overall Program Impacts? ………………………………………………………48
Conclusions ……………………………………………………………………………………………….48
Introduction ………………………………………………………………………………………………………..49
Data Sources ……………………………………………………………………………………………..49
Limitations …………………………………………………………………………………………………50
Factors that Influenced HIE Progress……………………………………………………………………..51
Quantitative Effects of Program Factors …………………………………………………………55
Quantitative Effects of Contextual Factors ………………………………………………………56
Summary of Hypothesis Testing Results ………………………………………………………..58
Key Program Impacts ………………………………………………………………………………………….58
Infrastructure and Services Established Related to MU ……………………………………. 62
Interaction of MU and the State HIE Program ………………………………………………….63
Additional Program Impacts ………………………………………………………………………………….63
VI. LESSONS LEARNED: KEY DRIVERS, CHALLENGES, AND SOLUTIONS …………………. 65
Chapter Summary ……………………………………………………………………………………………….65
Key Drivers ………………………………………………………………………………………………..65
Challenges ………………………………………………………………………………………………..65
Conclusions ……………………………………………………………………………………………….65
Introduction ………………………………………………………………………………………………………..66
Approach …………………………………………………………………………………………………..66
Key Drivers ………………………………………………………………………………………………………..66
Partnerships, Collaboration, and Stakeholder Buy-In ………………………………………..66
Leadership and Governance …………………………………………………………………………68
ACA and Delivery System Reform …………………………………………………………………70
Key Challenges …………………………………………………………………………………………………..70
Costs, Resources, and Time …………………………………………………………………………70
Data Quality ……………………………………………………………………………………………….70
Interoperability ……………………………………………………………………………………………71
EHR Developers and HIE Vendors ………………………………………………………………..72
Final Report | IV
NORC | Evaluation of the State HIE Cooperative Agreement Program
Privacy and Security ……………………………………………………………………………………73
Achieving Broad-Based Exchange…………………………………………………………………74
Competing Priorities for HIE Users ………………………………………………………………..76
Sustainability………………………………………………………………………………………………………77
VII. POLICY IMPLICATIONS ……………………………………………………………………………………….79
Chapter Summary ……………………………………………………………………………………………….79
Policy Implications ………………………………………………………………………………………79
Conclusions ……………………………………………………………………………………………….79
Introduction and Methods……………………………………………………………………………………..79
Policy Implications ………………………………………………………………………………………………80
State Role ………………………………………………………………………………………………….80
Federal Role ………………………………………………………………………………………………81
Shared Needs and Responsibilities ……………………………………………………………….83
REFERENCES ………………………………………………………………………………………………………….85
Final Report | V
NORC | Evaluation of the State HIE Cooperative Agreement Program
List of Exhibits
Exhibit 1:
The HITECH Act’s Framework for Meaningful Use of Electronic Health Records.. 13
Exhibit 2:
Evaluation Aims, Research Questions, and Activities/Data Sources ………………… 16
Exhibit 3:
Grantees’ Leadership and Organizational Model (N=56)………………………………… 22
Exhibit 4:
Approach to Sub-Nodes by General Approach to Enabling Exchange, as of
2013 (N=56) ……………………………………………………………………………………………23
Exhibit 5:
Top Ten Operational Services Grantees Directly Provided or Enabled*, as of
July to December 2013 (N=56) …………………………………………………………………..24
Exhibit 6:
Directed Exchange Implementation Status, as of Q4 2013 (N=56*) …………………. 25
Exhibit 7:
Grantee Approach to Facilitating Directed Exchange Services, as of 2013
(N=56) ……………………………………………………………………………………………………25
Exhibit 8:
Query-based Exchange Implementation Status, as of Q4 2013 (N= 56*) ………….. 26
Exhibit 9:
Advantages and Disadvantages of Models for Query-Based Exchange ……………. 27
Exhibit 10: Grantees’ Consent Models (N=56) ………………………………………………………………28
Exhibit 11: Legislation Passed to Promote HIE Participation, EHR Adoption, or Both,
as of 2013 (N=56*) …………………………………………………………………………………..29
Exhibit 12: Use of Accreditation/Certification of HISPs and/or HIOs as Policy Levers,
as of 2013 (N=56) …………………………………………………………………………………….30
Exhibit 13: Top Ten Services Grantees Planned to Directly Offer or Enable, as of July to
December 2013 (N=56) …………………………………………………………………………….34
Exhibit 14: Measures used to Calculate State HIE Capability at Baseline and Changes over
Time ………………………………………………………………………………………………………38
Exhibit 15: Acute Care Hospitals Participating in Exchange, as Reported by Grantees
(N=56) ……………………………………………………………………………………………………39
Exhibit 16: Ambulatory Entities Participating in Exchange, as Reported by Grantees
(N=56) ……………………………………………………………………………………………………40
Exhibit 17: Measures used to Calculate State HIE Activity at Baseline and Changes over
Time …………………………………………… …
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