Achieving High Performance through Implementation of Health Information

The significant funding now provided through the American Recovery and Reinvestment Act (ARRA) offers an opportunity to build a national infrastructure for health information exchange, opening the door for new efficiencies in the health care system, better access to health care, and improved overall quality of health for citizens.

As conduits of the ARRA funds, State Designated Entities (SDEs) are a key aspect in the establishment of a Health Information Exchange (HIE). SDEs, which may be a state agency, will play vital roles-as organizers, architects, policy shapers, educators, and guardians of the public interest and champions of change. To be successful, SDEs must manage the different elements associated with health care reform-more specifically, developing a statewide node of what will eventually be a national health information exchange.

In fact, with health care reform and the establishment of an HIE network, states likely face the largest health transformation they have ever undertaken. As the hard work ensues, we hope this paper will serve as a valuable resource for states as they move forward with health care reform and work toward the successful establishment of an HIE network.

The American Recovery and Reinvestment Act provides significant funding to help states develop a robust information technology infrastructure to enhance data exchange capabilities for the health care industry and assist in the nationwide adoption of health IT. States have an opportunity to take charge of their own health care reform by using this funding to develop and implement strong, comprehensive health IT systems, and educate stakeholders—from public health departments to patient advocacy groups—about the benefits of using health IT and data exchange.

Funding from the American Recovery and Reinvestment Act will be provided by the Center for Medicare and Medicaid and the Office of the National Coordinator. The Center for Medicare and Medicaid will offer incentives to foster the implementation of health IT systems among states. The Office of the National Coordinator will partly fund the creation and management of national policy, governance and standards, and provide the remainder through grants and other state mechanisms to plan the build out of state HIEs.

Grants from the Office of the National Coordinator will be made available to the SDEs responsible for applying for these grants and coordinating statewide health IT initiatives. Accenture’s goals are to help define the role SDEs will play in creating and managing state health information exchanges and establish guidelines for the build-out process.

Accenture has identified nine key elements SDEs should consider when building and managing the ongoing operations of efficient health information exchanges.

At the outset, states must choose to execute health IT initiatives through an already established state agency, or create a separate SDE to exclusively manage the development and integration of these health IT systems. SDEs overseeing these efforts should choose a governance model based on factors such as the current health care system, current health information exchange operations, the size of the state and the desired level of centralized versus distributed control.

From there, SDEs should contemplate constructing a road map for getting to the target operating models for each HIE, designing a financial model to adequately cover start-up costs and ongoing management and innovation expenses, and developing a stakeholder management program to promote cooperation among a large and diverse group of stakeholders.

Additional points of consideration for SDEs include developing and promoting the use of national and state standards; creating a security and privacy framework that fosters user trust; establishing a separate technical governance mechanism to create the statewide health IT and data exchange architecture and making key decisions regarding management of the system and the use of its data; drafting an adoption plan that logically integrates user groups at a reasonable speed for each; and developing education and training plans to help HIE network users become accustomed to a new way of working.

Accenture has developed a set of recommendations to let SDEs capably manage such an extensive statewide health transformation. Accenture suggests SDEs carrying out health IT initiatives be established separate from other state agencies. Establishing the SDE as a separate public/private partnership, especially in states with a multi-health information exchange network in place, will offer private and public stakeholders a chance to participate in a way that an established state entity wouldn’t allow.

SDEs must work with the state and stakeholders to identify real health outcomes to monitor and design a system for measuring meaningful improvements. Once goals and outcomes are defined, SDEs must map out which processes and communications are necessary to achieve those goals.

To leverage the knowledge and expertise of stakeholders, whose input will contribute to the development and maintenance of an effective and efficient health information exchange network, Accenture suggests SDEs create subcommittees, centered on critical areas of health care management, such as privacy and policy and clinical workflow.

Building a solid privacy and security network that fosters end user trust is central to the success of any health information exchange, as is clearly defining the technical approach for establishing HIEs that reach short- and long-term goals.

Included in the full report are more recommendations for each of these points, as well as for financial model development, standards creation, adoption and education.