The HITECH-funded State HIE Cooperative Agreement Program has created the foundational elements necessary for the exchange of health information, including governance and technical structure, privacy and security policies, as well as stakeholder collaboration.

That is the conclusion of a just-released case study on the State HIE Program and its efforts to fund states to rapidly build capacity for exchanging health information. Awardees are responsible for increasing connectivity and enabling patient-centric information flow to improve care quality and efficiency.

The Office of the National Coordinator for Health IT established the program in 2009, offering states and territories $564 million in funding and providing guidance for states to enable secure electronic information exchange. To assess their progress, ONC contracted with NORC at the University of Chicago to conduct a multi-year assessment of the program. The case study evaluated the experiences of six grantee states—Iowa, Mississippi, New Hampshire, Utah, Vermont, and Wyoming.

“Understanding the impact of the of the State HIE Program four years after HITECH is essential as states move forward with expanding their HIE efforts and leveraging existing infrastructure for healthcare and payment reform efforts,” argues the study. “The insights presented in these case studies may assist other states and policymakers in their ongoing HIE efforts, and identifies areas where important work remains to fully realize the benefits of HIE and to support healthcare and payment delivery reform efforts.”

All six states experienced IT-related challenges, from EHR and HIE developer limitations to lack of interoperability between systems and data capture and quality issues, according to the case study. To address these EHR and HIE developer issues, some grantees shifted to a best-of-breed approach, working with multiple HIE developers for different needs. When it comes to interoperability, many states look to the ongoing development and adoption of data standards as the long-term solution. However, in the short term, grantees are encouraging the use of certain standards among their participants and building capability in data translation and in-house teams responsible for data cleaning.

“Stakeholders believed it is too early to tell what kind of long-term impact the program has had on exchange [of health information], given the difficulty of measuring impact from the multitude of factors involved,” states the study. “However, they did feel that the value of program efforts would increase over time with support from new care models, such as ACOs and Patient Centered Medical Homes, and new payment models.”

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