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State HIT coordinators turn to cloud HIE models

In the face of budgetary crises and a cloudy political climate, two state HIT coordinators eschew traditional HIE infrastructure.

With short budgets, political turmoil and uncertainty surrounding payer and provider interest in state health information exchanges (HIEs), how's a state health information technology (HIT) coordinator to gauge how big to build an HIE? After all, the federal government mandated and funded statewide HIEs, so there's no opting out.

At least two states, Illinois and Iowa, have turned to a modular, cloud-based approach that doesn't necessarily require big investments at the start and can scale up as demand grows. Managers from both states offered updates on their HIEs at the State HIT Connect conference in Washington, D.C.

If cloud vendors can work out thorny privacy and security issues, these cloud HIE models could become viable solutions for states to meet federal mandates without breaking the bank.

Iowa is its own solution provider -- serving as a hybrid cloud host -- for its state HIE, delivering it to health data stakeholders via Software as a Service (SaaS), said Kim Norby, the state's HIT coordinator. Payers and providers will be able to sign up for services such as data analytics on top of basic HIE record querying, depending on how much they want to pay.

The state as the cloud host offers service-level agreements covering such matters as performance, security and disaster recovery. It also calculates the rates it charges based on a participant's storage and processing capacity used, not by per click or by the number of records accessed. With such a SaaS model, Norby said, the state can scale up as demand grows.

Iowa's HIE plans to roll out Direct message exchange and some analytics services this month, with patient record lookup services to follow in December. For now, the state is starting small, for several reasons -- a major factor being a lack of electronic health record (EHR) readiness and maturity.

His co-presenter, John Lekich, project director for the state of Illinois, agreed that's a problem: "The standards environment in this world is a mess. We have some ideas on how to approach [the problem], but we need to work with our clients in figuring out where they are, what kind of EHR they have and what kinds of standards it can support."

Illinois, facing dire budget constraints, opted to outsource its HIE to InterSystems Corp. Building it in a "pay-as-you-go" cloud HIE model has made the project much more affordable than the state commissioning its own large, proprietary infrastructure without knowing how many physicians will ultimately participate.

The vendor, Lekich said, also recruits physicians to participate. Some 500 have signed up so far, even though the state HIE is still in its infancy: Core services such as the master patient index and master provider directory are presently under development.

Eventually, he said, the HIE plans to support a number of services, including emergency department patient data access, meaningful use reporting services for providers, patient specialist referrals and public health reporting.

If cloud vendors can work out thorny privacy and security issues, these cloud HIE models could become viable solutions for states to meet federal mandates without breaking the bank, Harsha Rao, session moderator and principal at McLean, Va.-based Booz Allen Hamilton Inc., told SearchHealthIT in an interview.

"In general, if you look at some of the publicly available HIEs -- Verizon has a cloud-based HIE, Covisint has one -- it allows a state to go in and get the full functionality of an HIE without a whole lot of capital expenditure...and ramp it up," Rao said. "I think that's the key value proposition for cloud-based HIEs."

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