Dear HITCH members,

October 18, 2007

This e-news update includes the following:

eHI Attempts to Build a Consensus for Common Action,
Update From the Recent State Alliance for E-Health Meeting and,
A Reminder of the Upcoming HITCh Meeting at Fall Forum.

eHI Blueprint for Consensus

The eHealth Initiative’s Blueprint: Building Consensus for Common Action brought together a diverse group of stakeholders, over six months this year, to create a shared vision for improving health care with health information technology. Representatives of nearly 200 organizations took part including clinicians, consumers, employers and healthcare purchasers, healthcare IT suppliers, health plans, hospitals and other providers, laboratories, the life sciences industry, pharmacies, public health agencies, and state and regional leaders.

The group focused on five key issue areas and reached consensus on the guiding principles, strategies and actions for three of them: engaging consumers, transforming care delivery at the point of care and improving population health. To read the consensus statements, see http://www.ehealthinitiative.org/blueprint/key_elements/introduction.asp. The group did not reach full consensus on two areas: aligning financial and other incentives and managing privacy, security and confidentiality.

The key issues related to aligning incentives are :

For what behaviors should incentives be provided and how should they be structured and paid for (i.e. providing incentives for improved patient outcomes or for the adoption of health IT systems)?.
Who benefits from the adoption and use of health IT (and therefore should receive incentives or share in the cost)?

The key issues related to privacy, security and confidentiality are:

What level of control should consumers have over personally identifiable information (i.e. can they limit what data can be shared with which providers and can they limit the use of their data for purposes outside of health care delivery such as research)?.
How should privacy and consent issues be handled when using both identified and de-identified data for improving population health?

Phase two of the project will give additional attention to these unresolved issues. To see a copy of the full report go to http://www.ehealthinitiative.org/blueprint/eHiBlueprint-BuildingConsensusForCommonAction.pdf.

Update on the State Alliance for e-Health

The Alliance held its fourth meeting on October 3^rd. The Alliance received an update from Dr. Robert Kolodner, the National Coordinator for Health Information Technology, on the state of federal activities on HIT. The Alliance, moving forward with its agenda, approved recommendations from two of its three Taskforces. The recommendations adopted are listed below. In addition, the Taskforces issued reports providing the background discussion and research for their recommendations (Health Care Practice report and Health Information Communication and Data Exchange report). An archived copy of the meeting can be viewed here.

Health Care Practice Taskforce recommendations that were adopted:

Recommendation 1.3: The State Alliance should recommend that each health care professional board (e.g., nursing, medicine, pharmacy) develop, with its counterparts in other states, a nationwide core set of credentialing requirements that their respective health professionals would have to meet in order to obtain a license. Individual states may include state specific requirements in addition to the core requirements.
Recommendation 1.4: In order to reduce and/or eliminate the need for repeated primary source verification, the State Alliance for e-Health should recommend the states require their medical, pharmacy, and nursing regulatory boards utilize a single centrally coordinated credentials verification organization (CVO) for each profession to conduct the primary source one-time only verification of license applicants’ static credentials (e.g. professional school graduation) and update and maintain the verification of dynamic credentials (e.g. licensure status). These centrally coordinated CVOs should collect and verify a core set of credentials established by each profession (see recommendation 1.3). They should have a means of identifying practitioners with a high degree of confidence such as requiring the use of the national provider identification number or using such functionality as a master provider index algorithm.

The Federation’s Credentials Verification Service (FCVS) and its trusted agent platform, operated by the Federation of State Medical Boards (FSMB), is an example of a service that could assume this role for the boards of medicine. The pharmacy and nursing boards should work with their professional organizations, certification organizations, or other similar organizations with a mission to facilitate public protection to develop and implement centrally coordinated CVOs for their professions.
Recommendation 1.5: The State Alliance should recommend that all state boards require that applicants for initial professional state licensure must undergo state and federal criminal background checks prior to obtaining a license. These background checks may be conducted periodically thereafter.
Recommendation 1.6: The State Alliance should recommend that all Health Care Practice Taskforce recommendations, as applicable, be used as a model for other licensed health care professionals, (e.g. physical therapists) contingent upon verification that there are no unique requirements applicable to those professions.

Health Information Communication and Data Exchange Taskforce recommendations that were adopted:

Recommendation 2.0: Each state should develop or adopt a vision for state eHIE that leverages existing and planned public and private eHIE efforts and outline an eHIE roadmap by the end of 2008 that must be implemented by 2014. Components of the roadmap should, at the least, include how the state plans to (1) organize the implementation of eHIE in the state; (2) engage diverse stakeholders, including consumers, providers and payers; (3) develop and test exchange architectures incorporating existing and approved standards; (4) build financial, political support, and legislative authority for eHIE development; (5) ensure consumer protections are in place; (6) train and sustain an eHIE-capable workforce; and (7) enable intrastate collaboration and data exchange.
Recommendation 2.1: In close coordination with ONC and other federal agencies (e.g. CMS), NGA should play a leadership role on behalf of all governors to facilitate the coordination of individual state roadmaps in the context of a national interstate eHIE strategy.
Recommendation 3.0: Governors should designate a single authority for the state to coordinate state government based eHIE implementation activities and work, in collaboration, with public/private eHIE efforts.
Recommendation 4.0: Governors and state legislatures should align to establish flexible financial mechanisms to support and ensure sustainable eHIE.
Recommendation 5.0: To successfully implement HIT and eHIE initiatives and to adopt MITA, state Medicaid agencies will require new technology, project management, policy, legal, consumer protection and programmatic competency development. Therefore, states should fund greater development of technical assistance resources for state Medicaid/SCHIP and information technology agencies to build workforce competency for eHIE. Such resources could be aligned with the Health Resources and Services Administration technical assistance toolbox modules:
- Introduction to HIT
- Getting Started
- Opportunities for Collaboration
- Project Management and Oversight
- Planning for Technology Implementation
- Organizational Change Management and Training
- System Implementation
- Evaluating, Optimizing, and Sustaining
- Advanced Topics
Recommendation 6.0: State Medicaid agencies implementing electronic health record systems in the Medicaid program, should implement a standards-based personal health record function that is portable and includes appropriate privacy and other consumer protections. When available, state Medicaid programs should require use of certified electronic health records and networks with standards-based information exchange capabilities.
Recommendation 6.1: State Medicaid agencies should ensure portable, private and secure access to personal health information to their enrollees through HIT systems such as personal health records. The State Alliance should encourage states to provide human and financial resources to develop cultural and linguistic competency required to engage diverse Medicaid/SCHIP enrollees.
Recommendation 7.0: State Medicaid agencies should implement incentive programs and, or reimbursement policies such as pay for participation, rate adjustment, case management, and quality pay for performance that will encourage provider adoption and use of HIT systems and participation in eHIE.

Reminder HITCH at Fall Forum

Please join Project HITCh Tuesday, November 27^th in Phoenix for a pre-conference session preceding NCSL’s Fall Forum. We have a great program scheduled. Tony Rodgers, Director of the Arizona Health Care Cost Containment System and cochair of the State Alliance for e-Health Taskforce on Health Information Communication and Data Exchange, will give a keynote address at 3:00 pm. His talk will center on the transformation of Medicaid thru health information technology. Afterward, a business meeting will convene from 4:00 to 5:00 pm. The business meeting will focus on the proposed work plan for the next year based on the input received from the business session at Annual Meeting in Boston and from subsequent conversations with many of you.

Please let us know if you can join us for the Project HITCh meeting and the Women’s Health or Mental Health meetings. If you have any questions or would like more details about Fall Forum, please contact me at kory.mertz@ncsl.org or Donna Folkemer at donna.folkemer@ncsl.org.

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