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For a state HIE, HITECH Act stimulus funds go only so far

The state of Texas, recognizing that HITECH Act stimulus funds won't cover the cost of its health information exchange infrastructure, is turning to a public-private alliance to get the HIE built.

The Texas legislature has a fiercely independent streak that reflects the state's history. That independence provided an interesting model for how Texas chose to spend its federal funds to build its health information exchange (HIE). The two-step twist the state is putting on health IT? Building a state HIE out of a public-private partnership as opposed to a monolithic state agency.

Manfred Sternberg, chairman of the board of the Texas Health Services Authority, is charged with disbursing Texas' nearly $29 million in HITECH Act stimulus funds. Along with state HIE leaders from Oregon and New York, he spoke during a May 18 conference call. Like officials from other states, he acknowledged that HITECH Act funds will not be enough to implement a fully functioning HIE network. In his case, he said, he "hasn't received a nickel" from the state government, either.

"I don't think it's enough. It's a drop in the bucket," Sternberg said. One hospital system might spend $50 million to $100 million implementing an electronic information system, but it cannot cover a whole, much larger state with less. "Will it get us going? Probably. But remember, it's stimulus, it's not value. If there's no value in the health information exchange we create, when the stimulus money goes away, so will all the participants. … [O]therwise, this will be a boondoggle, and it won't be sustainable," he said.

That is why Texas is getting private enterprise in on forming the state HIE, Sternberg said. From providers to consumers, all the stakeholders have their own agendas for what to get out of HIE. If the state can build a system that serves them all, Sternberg said, it will become meaningful to all.

Texas received a $1 million state HIE planning grant. When federal authorities approve the state's plans for building the exchange, it will qualify for the balance of the grant, which will fund implementation and operations. The authority's board has assembled a team of stakeholders -- including state leaders, care providers, payers, consumers and health IT vendors -- to help write the plan, and has divided them up among four workgroups -- governance and finance, technical infrastructure, privacy and security, and EHR adoption and consumer engagement. Each workgroup is chaired by a physician, who seeks to build consensus among the stakeholders.

I jokingly say, 'Everything's bigger in Texas, except health information exchange,' but when we get it -- and we will --
it'll be big.

Manfred Sternberg, chairman, Texas Health Services Authority board

The most difficult part building consensus is keeping all the parties happy as plans evolve. Consumers, for instance, typically do not want their health information to be seen by employers, the government or insurers, Sternberg said. (Being careful to mention that he was speaking on his own behalf and not on behalf of the state government, Sternberg said he agrees with consumer advocates who favor an opt-in, consumer-controlled health data bank for HIE. In this model, patients control their own data and who accesses it, according to their own personal privacy policies.)

Government and insurers, however, do sit at the HIE table, and need access to pieces of patient data at different times. Who gets the data will be a huge decision for states to make, and they must take customer input into account. As a greater amount of genetic data gets cataloged, for example, it will reveal health trends, not just for individual patients but for anyone who shares the same genes, Sternberg said. If health officials can demonstrate the value of genetic data to the average patient, consumers will thus realize the benefit of making personal health information available to those third parties.

Getting consumers engaged in decision making now, as the state HIE is getting built, is crucial -- and perhaps the biggest challenge to HIE development. The second-biggest challenge? Getting insurance companies to stop dragging their feet. According to Sternberg, inefficiencies inherent in the health care system are profitable to payers, because it allows them to deny more claims -- and they are not in a hurry to fix them.

"I jokingly say, 'Everything's bigger in Texas, except health information exchange,'" Sternberg said. "But when we get it -- and we will -- it'll be big."

Let us know what you think about the story; email Don Fluckinger, Features Writer.

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