Health info exchange in limbo
A state commission has decided to change tack on creating a statewide computer network that would link health care providers, throwing a splash of cold water on previous plans to launch regional networks.
Now the future of the West Michigan Health Information Exchange, for which an Alliance for Health committee spent months planning, is uncertain.
“Things are little bit in limbo at the moment,” said Gary Newell, executive director of the Alliance for Health’s Health Care Vision 2020. “The state of Michigan, the Michigan Department of Community Health, has taken a step back and is headed in a little bit different direction than before.”
Gov. Jennifer Granholm’s executive order budget cuts last week sliced the $1.7 million remaining in this year’s budget for health information exchange development. Although there is a long road ahead for the state budget for the next fiscal year, Granholm’s current proposal includes no funding for the program.
In March, the Michigan Health Information Technology Commission voted to move from a set of nine regional systems to a statewide backbone for the Michigan Health Information Network project. The commission last month sent letters to the health care community detailing the change.
“We really had a hard time getting statewide investors that have either health care systems that are large and have hospitals all over the state or payers and employers and insurers that pay for health care for people all over the state. They just didn’t want to pay for these nine regions, nine different times,” said Beth Nagel, MDCH health information technology manager.
MDCH gave the Alliance for Health a $600,000 grant in 2007 to plan a regional health information exchange for a 13-county area in West Michigan. The department handed out a total of $5 million in grants to nine regions, most for planning but two for implementation, Nagel said.
The AFH committee produced a business plan last fall and this spring hosted an open house where the local health care community met with four vendors under consideration to create the regional system.
“Right now, we have to assess what direction we want to go,” said Lody Zwarensteyn, president of Alliance for Health, a local nonprofit health care planning organization.
The state commission’s plan retains a place for local HIEs in providing a message gateway, service and support. The state would provide a Master Patient Index and a Record Locator Service. Those would not be directly accessible by end-users, such as doctors and hospitals, said John Hazewinkel, project manager for the MiHN Resource Center at Michigan State University, but would power the applications they would use.
Nagel said that four years ago, given the level of technology and the lack of success of statewide HIEs except in two small states, the Michigan HIT Commission opted to develop regional systems. The state was divided into nine regions or “medical trading areas,” based on business patterns developed through an analysis of claims data.
Now, however, “the Michigan Health Information Technology Commission went back and looked at that road map, because technology has advanced to the point where a statewide system could be supported,” Nagel said.
Passage of the federal economic stimulus package, which includes billions to develop health care information technology across the country, also played a role, said Hazewinkel. “The state’s current theory is that it can save a certain amount of money by centralizing a great deal of the technology.”
In addition, the American Reinvestment and Recovery Act includes provisions for IT funding for hospitals and doctors, particularly for electronic health records.
Newell said the business plan for the West Michigan HIE calls for three funding sources: fees for members of the governing board; membership fees for participants; and a per-transaction fee. For the most part, that financial structure could remain intact if the regional system is developed in conjunction with the state’s new plan, he said.
“The only kicker is, we did have in the plan that we were counting on some implementation money from the state. Now it appears they are going to focus their efforts on the state backbone. The grant for development is basically gone.”
Dr. Greg Forzley, medical director of informatics for Saint Mary’s Health Care and a member of the state HIE commission, said he views the changes as a way to retain the work that’s been done on a regional level in the wake of financial constraints.
“The dollars have sort of disappeared for that type of purpose,” said Forzley, who was one of the co-chairmen of the local HIE planning committee. “The commission said, ‘What can we do to take advantage of the work that’s been done.’”
The discussion is still open and commission members were to meet with regional advisers late last week, he added. The options are wide open, from establishing the MiHIN backbone as a public-private partnership to making it a public utility.
“It’s a draft situation at this point,” Forzley added.
HIEs in the Upper Peninsula and the three-county Capital City area have received state grants for implementation and are moving forward with regional systems, Hazewinkel said.
Nagel said the state recently solicited bids for business and technology consultants to help craft the new plan.
“I don’t know at this point that we have any clarity on who should pay or how much. We don’t know exactly what a business model would look like,” she said.
The effort put in by the Alliance for Health’s committee is still worthwhile, Hazewinkel added.
“It’s hard to measure the amount of awareness, the amount of cooperation that was generated,” Hazewinkel said. “Although we’re in kind of a holding period while we see what the state is going to do, we intend to build on the cooperation and goodwill that has been generated.”
“I think that it’s in some way unfortunate we have a change of direction, but this is an area that is always flexible,” added Newell, a former state representative. “This is uncharted territory. There’s nothing ever set in concrete about how these things are going to go.”