Authority Works to Help Systems Across PA Share Health Data

Central Penn Business Journal

July 14, 2014

To understand the Pennsylvania eHealth Partnership Authority, it's helpful to think of electronic health records in levels.

The first level is providers implementing EHR systems. Up a step, health information organizations such as the Keystone Health Information Exchange focus on sharing EHR information among provider systems, often grouped by geography. At the top is the authority, which is working to link those HIOs and solve the problems the HIOs can't address discretely.

According to authority Executive Director Alix Goss, that includes things like maintaining a master patient index and a central opt-out registry and harmonizing legal agreements "so we can all play together effectively and trust each of the end points on the network."

It also handles the directory of direct email addresses by which health information can be sent securely even if a provider is not part of an HIO. However, the authority does not hold any clinical data or, Goss stresses, have anything to do with the Obamacare insurance marketplaces.

"We're about enabling patient care through the exchange of health information," Goss says in summary. Patients move around, she says, and stuff happens: "Our health information needs to be there when we need it to be there."

On the HIO level, progress is apparent from the numbers. KeyHIE, for example, was started in 2005 and by mid-2011 had 27 member organizations, including eight hospitals and 42 clinics contributing data on a regular basis. Today, KeyHIE claims 38 care delivery organizations, 284 care sites, 1,178 networked users and 1,109 clinician users.

Even so, the HIOs are still in their infancy, according to Martin Ciccocioppo, vice president of research for The Hospital & Healthsystem Association of Pennsylvania.

"It's growing, it's more robust now than ever," he says of the HIOs. "However, it is not ubiquitous."

"The Meaningful Use incentive program has gone a long way to supporting that, but we have a long way to go for the clinicians that chose not to participate or were not eligible," Goss agrees. That program began as a result of the American Reinvestment & Recovery Act enacted in 2009; led by the Centers for Medicare & Medicaid Services and the Office of the National Coordinator for Health IT, it offers first incentives for implementing EHRs and later penalties for not participating.

The overall EHR job is huge, Ciccocioppo says, including providing a gateway to all of the health reporting and interaction between providers and the departments of Health, Public Welfare, Corrections, and Labor and Industry.

However, he says, the value to the hospital and physician community is clear. Once the system is fully implemented, providers should be able to just use that system, instead of all the one-off connections they're currently doing with the various state agencies.

Authority progress

The Pennsylvania eHealth Partnership Authority was created by Act 121 of 2012 and consists of fewer than a dozen people, several of whom recently moved over from HAP. Ciccocioppo is not among them, but he was instrumental in drafting the legislation that created the authority.

The first part of the authority's mu!tiyear strategy was to design the platform needed for the health information superhighway, Goss says.

"What we're doing right now is piloting that to prove out whether what we thought was going to work is actually going to work," Goss says. Assuming it does, "Over the next year or two we're going to be solidifying the infrastructure."

"It's a key time right now in essentially proving not only the technology but that the policies and procedures that had to be agreed to by all these different pilot organizations can stand up to the legal scrutiny," says Ciccocioppo. The time is also important, because federal funding that provided much of the authority's support concluded in February, making its request for part of the pending state budget crucial.

"We expect it will raise revenue from charging fees, but it's not there yet," Ciccocioppo says. "We had hoped that the value proposition would have been better or been more clear at this point. It's just taken a lot longer than we've expected to be able to show with these pilots that the system works."

The authority has encountered some harriers along the way, Goss says, "either in the lack of incentive or in longstanding policy regulations or laws. We are engaging in research, lots of conversation, trying to determine how to create a win-win in removing barriers while respecting the appropriate tension between a provider's desire to have all the information about a patient and a patient's desire for privacy."

Despite all the complexities, Goss says the primary goal is simple: "Digitizing data needs to become ubiquitous, and people need to understand the criticality of sharing that."

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