NORTH STAR STATE ILLUMINATES ONE WAY TOWARD E-HEALTH

Minnesota’s health-care sector has a long history of adopting electronic technologies. Now, a new law (HB 1078) catapults the state into the forefront of the movement toward health information exchange (HIE).

HIE is a broad term that describes the electronic transfer of health-care information across organizations. For example, it may refer to the exchange of electronic medical records among providers or the submission of electronic claims for reimbursement.

Hammered out after intense negotiations among legislators and health industry leaders, the law:

• mandates that by 2009, all providers and group purchasers will be able to exchange health-care administrative transactions (eligibility, claims, payment and remittance advice) in a standard electronic format; and

• requires that all hospitals and health-care providers have an interoperable electronic health records system by 2015.

The two provisions are expected to save significant amounts of money and improve quality. According to America’s Health Insurance Plans, for example, electronic claims are roughly half the cost of paper claims. As for quality, by obtaining a patient’s medical history at the point of care, providers will be able to avoid mistakes such as adverse drug events.

The law directs the Commissioner of Health—in consultation with the public/private Health Information Technology and Infrastructure Advisory Committee—to develop a statewide plan to meet the 2015 goal, including uniform standards for the exchange of information. Standardization is crucial if providers and payers are to be able to “talk” to each other. “Without interoperability, a patient’s data from across providers cannot be brought together at the point of care,” said Representative Paul Thissen.

Standardization also helped secure the support of industry leaders, said Patricia Anderson, State Employee Relations Commissioner, at a recent State Alliance for e-Health meeting. Providers had resisted “going electronic,” in part because of the fear that they might purchase one brand of software, only to have the government mandate the use of another one. But now the state and industry leaders will debate and decide on uniform electronic formats.

The legislation includes no penalties for failure to meet the deadlines, nor does it include any direct state funding for the two main measures. “The participation of providers and payers in the negotiations, and their agreement to the final product, means (I hope) that electronic claims submission and interoperability will be developed and implemented voluntarily without the need for heavy-handed bureaucracy,” Representative Thissen said.

The Lynchpin

A key point of the law is that it updates the state’s health records privacy laws to enable greater use of HIE.  “We wanted to strike a proper balance between the huge advantages of real-time exchange of information and protecting the confidentiality of health records,” said Representative Thissen. “In particular, under the new law, two things will be possible that were not before.” 

First, the law provides a legal definition of “record locator services.” These services will be Internet-based "pointers" that will allow the treating provider to see the names of providers the patient has seen in the past. No other medical data will be included. The current provider can then ask the previous one(s) for past clinical information. Patients may opt out of the system.

Second, the law allows one provider to submit patient consent electronically to another provider in order to obtain their medical records in real time. Under prior law, a provider would have to send a written form, signed by the patient, to the second provider.

The law also stipulates that record locator services may be liable for inappropriate disclosures of patient information. To help ensure patient privacy, the law requires the operator of a record locator service to maintain an audit log of providers accessing its information.

All Systems Go

With the legal path clear for the real-time exchange of health information, and providers and purchasers on board, Minnesota was ready to begin creating an organization that will in fact exchange health information. On Sept. 10, Allina Hospitals & Clinics, Blue Cross and Blue Shield of Minnesota, HealthPartners, Medica and the state of Minnesota announced the formation of the public/private Minnesota Health Information Exchange. It is expected that the Exchange will serve over 3 million patients when it goes live, in early 2008, making it one of the largest HIEs in the nation. 

Start-up costs for the exchange will be paid by the state and other founding members. Operational costs will be covered by fees that subscribers will pay for the Exchange’s services. Initially only medication history, lab orders and test results will be exchanged. In the future radiology reports, disease surveillance reports and electronic prescriptions will be supported.

Other Initiatives  

Minnesota is moving forward with other initiatives to increase the adoption and use of HIT. For example, the Minnesota state employee health plan is using its market power to improve health-care quality and decrease costs with an initiative mandating e-prescribing for plan members.

By 2009, all pharmacies serving the health plan must accept e-prescriptions, and by 2011 all providers who treat state employees must e-prescribe. Those who fail to meet the deadlines will face removal from the state employee health plan network. Anderson predicts that this requirement alone will mean that within a year and a half, 95 percent of all physicians in the state will be e-prescribing.

The state has provided limited grant funding for financial and technical assistance for providers in rural and underserved communities to help them purchase and implement electronic health records. Lawmakers were concerned that without such help, there was a risk of creating a two-tiered system of “technological haves and have-nots” that would leave many Minnesotans without the benefits of e-health.

Separately, the Legislature passed HB 548, which authorizes a pilot project to establish electronic health records for employees of the Minnesota State College and Universities System. 

Health information technology (HIT) has been a hot issue in state legislatures this year with more than 240 HIT-related bills introduced. Of those, 45 bills passed in 28 states and the District of Columbia. For a listing of those bills, go to this NCSL Web page: http://www.ncsl.org/programs/health/forum/Hitch/enacted.htm