HARTFORD, CT – Federal funding for a state-run health information exchange expires in 22 months, and Connecticut officials are working to get a system up and running before the money runs out.
The Health Information Exchange (HIE) will be a place for health care providers to share patient data electronically. Currently, many providers have their own electronic record systems, but aside from some small networks in the state, there’s no central location to share that information across health systems.
At the same time, research has linked the exchange of this information to reductions in hospital re-admissions and improved population-level immunization rates, but state officials first have to get providers, like doctors, hospitals, and medical groups, to agree to share information.
A recent policy brief from the Connecticut Health Foundation pointed out that “the success of the health information exchange will depend on its ability to demonstrate value – and that will require having robust participation, with many providers participating in each type of data exchange.”
Officials also created a nonprofit called the Health Information Alliance in July 2019 to help house and administer the exchange.
The Health Information Alliance has teamed up with the University of Connecticut to build out the infrastructure for the exchange. The nonprofit entity will then partner with participating organizations looking to share electronic health information and possibly purchase electronic health information, although the latter has yet to be decided.
One year after the exchange is operational, Connecticut hospitals and clinical laboratories will be required to connect and share electronic health records. Providers with electronic health records will have two years to connect and share.
Office of Health Strategy Executive Director Vicki Veltri said the nonprofit will handle the day-to-day operations, but the overall administrative authority still resides with her and the Office of Health Strategy.
At this point, nobody has signed up. That’s according to Allan Hackney, Connecticut’s Health Information Technology Officer.
He said the first goal is to get people signed up, connected, and sharing.
He said the $48 million in federal funds the state receives can help offset the cost of the providers who join the HIE. Presumably, there will have to be modifications made to whatever electronic health records systems the providers are already using, in order to join the exchange.
The information will be valuable for providers and insurers.
“What we can tell from the claims data is what a physician or a provider did, but not whether the patient got better,” Jill Hummel, president of Anthem, said recently during a forum sponsored by the Office of Health Strategy. “And it is not easy today to get that data. One of the things we need is a sustainable HIE.”
The state is looking at what to do when the $48 million in federal funds run out. The HIE will require $9.5 million to $10.5 million a year to operate, Hackney said.
“We’re just starting that hard discussion and my biggest fear is that if we think that … maybe just the insurers are going to pay for it, that is not going to be a sustainable solution because there’s so much focus on insurance costs,” Hummel said.
She suggested that maybe the state should be looking at the HIE as a public utility so that the cost is distributed.
“I don’t have the answer. I just know this is an important policy consideration,” Hummel said. “Because ultimately if you want to measure outcomes, you have to have clinical data, and it’s a huge barrier.”
Asked if he saw a danger in sharing data with insurance carriers, Hackney said they already get the data today.
“The insurance companies get clinical data every day,” Hackney said.
He said the insurance companies are looking for opportunities to do care coordination and opportunities to design better benefit plans.
He dismissed criticism that it might cause insurance companies to deny care, or to push patients to other health systems, if they are costing a carrier too much money.
Hackney said they would be able to see with an HIE whether someone was getting pushed to another health system and if they belong to an Accountable Care Organization, then that ACO would be responsible for their care regardless of where they were in the system.
Consent
Will consumers have to consent to their information being shared?
The issue of consent has not been settled, according to Hackney.
He said they have a consent design group working on coming up with guidelines for the Office of Health Strategy, which will then usher the matter through the regulatory process.
“They haven’t been finalized,” Hackney said.
Veltri said they will go through a regulatory process.
“We haven’t even undergone a consent policy adoption process yet,” Veltri said. “Cause we are still waiting on the design principles to be shared with the general public for comment and then reacted to.”
Hackney said informed consumers will be easy to identify and many are probably tracking this process already.
However, it would be safe to assume there are a lot of consumers of healthcare that have no idea this is happening.
“At the end of the day this isn’t typical dinner-time conversations that go on,” Hackney said.
Ellen Andrews, executive director of the CT Health Policy Project, agreed with that assessment.
“Connecticut residents have no idea this is happening,” Andrews said. “Decisions are being made without us about who can see our medical records and for what purpose. Our right to protect ourselves has to be in place long before even one person’s records are shared.”
