Washington State Health Care Authority's health record bank initiative in three communities will go live at the end of February or early March and the request for proposal for the Health Record Bank of Oregon will be released in the same timeframe.
While both projects target specific populations or communities and are in different stages of development, officials in both states say they hope their projects will lead to statewide implementation of health record banks, or HRBs, for all residents and health information exchange at the point of care.
Washington State Health Care Authority, or WSHCA, which oversees the state public health programs, got involved when forward-thinking state legislators began efforts in 2005 to establish a statewide health information infrastructure to improve the safety and quality of healthcare delivery, said Juan Alaniz, project director for the HRB initiatives.
A State Senate bill tasked WSHCA with creating and then collaborating with the Health Information Infrastructure Advisory Board, or HIIAB, to implement the infrastructure. Alaniz said the direction WSHCA took was influenced by its administrator Steve Hill, who believed that disruptive technology was required to reform healthcare delivery. "Simply putting in electronic medical records is not an answer," Alaniz said. "They can't communicate outside the provider walls. If you can't share information, then it's not helpful."
On a statewide level, Gov. Chris Gregoire's Blue Ribbon Commission on Health Care established six goals, which Alaniz said "fit nicely with the general direction of the advisory board."
At the end of 2006, with a consumer-centric and consumer-controlled principle guiding the project, HIIAB recommended that the health record banking model be piloted in the community with a target date of 2012.
Six communities, all with existing healthcare IT infrastructure required by the project for leveraging purposes, vied for the three spots. Bellingham, Cashmere and Spokane were selected based, among other things, on their readiness.
The board had originally pledged $8 million to $11 million for the project, but the state budget deficit left only $3.4 million, or approximately $1 million per community, which was not enough to fund the operation. While the project was scaled down, each community "put more skin in the game" and committed $600,000 per pilot, Alaniz said. "They're the real heroes," he said. "The community is spearheading these efforts."
Over the next three months, WSHCA will evaluate what its proper role will be in the health record bank. Alaniz anticipates that WSHCA will be called on to help develop standards and serve as regulator and facilitator, not only for the chosen communities but for the ones that didn't make the cut and are still interested in developing HRBs.
"Since the overwhelming majority of healthcare for a community population is delivered in that community, developing HRBs in communities, as is being done in Washington State, is probably the best approach," said William Yasnoff, MD, PhD, managing partner of NHII Advisors, and consultant to both Washington and Oregon projects.
In that same time period, with enrollment for health record bank accounts ongoing until June, WSHCA will look at consumer and provider survey responses and analyze consumer adoption and data use, as well as data adoption into the provider workflow.
For now, HRB accounts are offered to consumers at no cost. With additional state funding questionable, communities will have to develop a sustainability model on their own. Public utility models, guarded and protected advertising and the sale of data for research are just a few of the ideas being discussed, Alaniz said.
While WSHCA ponders sustainability for its HRBs, the Oregon Department of Human Services, or DHS, and the Division of Medical Assistance Programs, or DMAP, are looking to secure a contractor to implement and maintain the Health Record Bank of Oregon.
With $5.5 million secured in June 2007 by a Medicaid Transformation Grant from the Centers for Medicare and Medicaid Services, or CMS, DHS/DMAP was tasked with developing a health record bank for Oregon Medicaid recipients. The 18-month grant was recently extended a year to March 2010. Barry Kast, project director for HRB Oregon, anticipates receiving another CMS extension through 2011 and foresees potential funding from the economic stimulus package for this "shovel-ready" healthcare IT project.
Kast said that Medicaid beneficiaries are in need of personal health records, which they can print out and take to providers, because of their high use of healthcare services and transient nature. It's common for Medicaid beneficiaries to lose and then gain eligibility, and move and change plans numerous times, he said. "Every one of those moves is a discontinuity of data," he said. "A health record bank will overcome those gaps."
While technology problems are the easiest to overcome, Kast said the hardest part of the project would be provider adoption and individual engagement and personal responsibility.
"We need to build a proof of concept and demonstrate that people will use it," he said. According to an Oregon study, 60 percent of the Medicaid population has access to the Internet. One of the tasks will be installing a mechanism to secure access for the remaining 40 percent, he said.
DHS/DMAP are contracting the entire project, which includes building the system that safely shares and stores the health information. Whether the awardee is a technology service provider or a community entity that partners with a healthcare IT vendor, "it's definitely going to take a consortium to put this together," he said.
Further down the road, Kast said the goal is to move HRB Oregon from the Medicaid population to the general population, with DHS/DMAP handing over control to a private, likely not-for-profit entity. DHS/DMAP are hoping that HRB Oregon becomes the platform for a statewide health information exchange. Indeed, the Oregon Health Fund Board identified HRBs as a potential model for health information sharing.
