Successful_Governance_of_Health_Information_Exchanges__Understanding_Hies_and_the_Role_of_Health_Care_Administrators

Successful Governance of Health Information Exchanges: Understanding HIEs and the role of health care administrators Executive Summary In the realm of health information technology (HIT), health information exchanges (HIE) are the next step to establish goals for increased meaningful use. As regions and states begin to establish HIEs, governance of HIEs has become an increasingly significant issue. The ideal structure and sustainability of the governance of HIEs is still in debate. Health care administrators need to get involved in the implementation of HIEs and its governing body early to ensure their organization’s needs are met and that the governing body understands the obstacles health care organizations face when managing HIT. Involvement of administrators in the governing process can help implement robust HIEs that yield organizational efficiency, cost savings, and improved patient outcomes. Furthermore, the dynamics of the clinical data collection can lead to health care and public health leaders developing programs to further improve the overall health of the community. Introduction Health information exchanges (HIEs) mobilize health care information through the use of electronic health records between organizations within a community or region. The goal of HIEs is to retain the meaning of information exchanged between different health care organizations. The ability to transfer information across organizations in a region can effectively create a patient-centered environment that is more efficient, effective, and safe (Healthcare Information and Management Systems Society). Health care costs are at an all time high in the United States. Health care organizations are utilizing health information technology (HIT) and HIEs to streamline health care services. HIEs are paving the way for improving safety, quality and efficiency of patient care. The health care industry has faced significant reforms in the past year. The Health Information Technology for Economic and Clinical Health Act (HITECH) passed as a part of the American Recovery and Reinvestment Act (ARRA). HITECH provided funding needed to start HIEs in the Unites States. HIEs serve to provide effective administrative and clinical benefits to all stakeholders, including providers, payers, and public health organizations. In an ideal setting HIEs will serve to reduce health care costs by eliminating redundancy and simultaneously improving care for patients. In the future HIEs can make electronic health records (EHRs) currently in health care organizations become more robust through interoperable systems and clinical data sharing. Currently, the Centers for Medicare and Medicaid Services (CMS) and the Office of the National Coordinator (ONC) are working to implement several regulations related to security, EHR certification, and criteria for meaningful use. The goal is to provide leverage for HIEs through incentives to providers, hospitals, and consumers to accept increased standards of care (Healthcare Information and Management Systems Society). The current challenge of HIEs is determining a sustainable governance structure. The elements of a governance structure would include a source of authority, a legal entity, manage stakeholders and participants, and would be heavily involved in the decision-making process. Health administrators need to understand how HIEs and its governance structure will implicate their organization and determine how it will change the course of patient care in the organization. Furthermore, it is important to become involved in HIE and its governances so that HIEs can receive feedback from end users to better understand what resources and assistances is needed in the area. Governance of HIEs HIE governance is described as, “the infrastructure and processes used to develop, implement, and enforce policies, procedures and practices including those policies, procedures, and practices that are specifically related to privacy and security, enabling health information exchange between organizations” (Dimitropoulos, 2007). The core functions of an HIE governance body will be convening, coordination, and potentially technical operations. The role of convening requires pulling together organizational leaders and building a structure for leadership. Leadership then supports the board, which oversees regular business operations for the organization. The coordination function requires facilitating statewide HIE implementation, aligning local, regional, interstate, and national strategies. Additionally, the governing body needs to coordinate promotion of consistent application of effective statewide HIE policies and practices. Governance includes facilitation of collaborative efforts to develop public policy options and ongoing health care reform efforts. The technological operations function can be outsourced to a third party or it can be a function taken on by governance. The operations function includes owning or contracting for hardware, software for statewide capacity; additionally the function includes managing technical operations to facilitate health data exchange (Dierker, 2007). Health care administrators need to understand these functions and determine how their organization will work with their regional HIE to make concerted efforts to establish a successful HIT infrastructure. Understanding the role of governance and how it directly relates to each health care organization is important. Having this tie to governance can ensure open lines of communication and smooth implementation of HIT with significant meaningful use and optimal interoperability with other organizations. It is essential to remain apprised of areas that need troubleshooting and of any shortfalls of current HIE infrastructure to ensure continuous quality improvement of HIE. This in turn will provide continuous quality care for patients within a state and potentially nationwide. Governance Models In order to determine the ideal governance structure stakeholders need to begin by assessing the current delivery and financing structure of health services, current HIE operations, and the size of the community or region the HIE will coordinate. After the assessment the region can understand the implications of their health care infrastructure and the agencies involved in the delivery of services for their region. These are the most important factors when deciding on a governance model (Accenture, 2009). Additional considerations now come into play; these include what is the desired level of centralized versus distributed control; and the degree to which enterprise architecture, standards and common services should be defined at a state level versus at the HIE levels (Accenture, 2009). Government Led Electronic HIE For this model the public sector directly provides governance and infrastructure for HIE. There are different advantages and disadvantages to having state governments handle the governance of HIEs. Having state government solely govern HIEs can show that government has a “heavy hand” in the industry and turn off stakeholders of HIEs. Providing state governments with the ability to govern HIEs can be a benefit because they have the ability to enable legislation. Furthermore, state involvement in governing of HIEs can obtain and issue financing without having to delay by going to main government (National Governors Association, 2009). State governments will be accountable for the privacy, security, fiscal integrity, interoperability of the system, and for universal access to HIT. Given this responsibility it is logical to have state government involved with the governance of HIEs. Funding and support of a governing body is simplified because the state is the starting point for funding and resource allocation. The self-sustaining nature of a state run HIE governance makes this an appealing option. The state of Delaware’s Health Information Network utilizes the public authority model and serves as the statewide HIE organization by overseeing and providing HIE services (AHRQ, 2010). Electronic HIE Public Utility with Government Oversight Utilization of this model will allow the public sector to regulate private sector provisions of HIE. Having a public authority structure can potentially address the perceived issues for existing public agencies. The function of government in this model can include: industry monitoring, policy development, and rate setting. Additionally, the state government will be accountable for fiscal integrity and addressing market failures that limit universal access to HIE. The state of Rhode Island is formulizing regulatory structures for HIE in their states (AHRQ, 2010). This structure has limitations because the private sector will be the primary provider of HIE services, but the public entity will need to build capital to create a sustainable HIE infrastructure. Sustainability of this governance structure can be the factor that impacts the success of the governing body. The state government will need to develop monitoring structures to assure appropriate charges for designated services and transparency. Another important regulatory responsibility will be providing universal access. Incentives and/or fees can be considered for this (AHRQ, 2010). Private Sector Led HIE with Government Participation This model allows the public sector to participate in private HIE governance and to exert limited control through financial and market-based mechanisms. Government will play an advisory role when it comes to public policy, regulations, and compliance. Privacy and security will be a function of both government regulations and self-regulation within the private sector. Maintenance of accountability for universal access and interoperability can be bolstered through incentive programs, market forces, and the threat of regulation. This structure can allow state government to participate in multi-stakeholder controlled electronic HIE organizations. The board of directors would consist of private corporate organizations/corporations with state government. There are several states currently participating in private sector HIE projects. This model will require consistent and regular monitoring from state government. Furthermore, there need to be mechanisms in place to address market inequity and inappropriate behavior. The threat of regulation can act as an incentive to drive appropriate industrial behavior. Drivers of accountability for the future may involve a deeming authority, offering accreditations, and HIE certifications. This will require developed business models. State funding will impact its ability to participate in the governance of a private sector HIE organization, but involvement of the government will require flexibility to address continuous changes in policy (National Governors Association, 2009). Keys to Success The requirements for governance of HIE will vary from state to state. It will depend on the size of the state, existing infrastructure, and financial status. The success of an HIE and its governing body depends on several factors. One must take into consideration the organization of state leadership. The structure of state leadership will determine the state’s level of involvement and resources available. Successful HIE governance typically involves creation of a public private leadership vehicle. The leadership vehicle can be utilized to attract multiple stakeholders into the HIE and for stakeholder involvement in governance. Involvement of multiple stakeholders is important because the success of a HIE and its governing body will require cooperation and buy in from all stakeholders involved (payers, providers, public health) (AHIMA, 2007). HIEs and the Role of the Health Care Administrator Health care administrators need to stay apprised of the status of their own regional or state HIE and consider the impact of governance of the HIE on their facility. It is particularly important for administrators working in organizations in states where HIEs and governance has not been concretely implemented. Governing bodies of HIEs can impact daily operations of an organization. This can occur at many levels. Most importantly it can affect daily patient experiences in the organization. Regulations and policies developed by the governing body of the regional or state HIE will trickle down the organization and administrators will need to prepare for changes that can impact strategic plans as well as daily operations. For organizations that already have HIT in place in their organization, they will need to consider how changes in policy and regulation related to meaningful use, interoperability, privacy, and security can impact their system and strategic plan for the future. Administrators need to consider if additional capital improvements will be needed to upgrade systems, extensive training of personnel, and physician buy in, among others. Involvement of health care administrators in HIE governance is a crucial element for its success. Administrators involved in governance of HIE will provide feedback representative of their administrators and clinicians and will be able to create a governing body that serves stakeholders in the best way possible. Recommendations In order for governance of HIEs to be successful it is important to bring in health care administrators from local hospitals to contribute on the Board of Directors. Various reports show that a combination of public and private involvement in governance of HIEs has yielded promising results (National Governors Association, 2009). Health care administrators must consider the impact governance of an HIE will have on the daily operations of their organization and its long-term goals. Policies related to HIT and HIEs are still evolving and will continue to evolve for years to come. Administrators must keep in mind strategies for maximizing meaningful use of HIT systems while protecting patient information. Transitioning an organization to be 100 percent paperless is a daunting task and requires patience and investments of resources. The ultimate goal administrators need to keep in mind is how technology can improve delivery of health care for patients. HIEs will eliminate clinical redundancy, improve reimbursement management, and increase efficiency. Furthermore, with proper management of data and guidance from HIE governance public health organizations can become empowered to improve long-term health outcomes. Conclusions Health care administrators have a large stake in the success of HIE governance. It is important for administrators to get involved with developing a governing body for their region or state HIEs early. The governance structures of HIEs can directly and indirectly affect the future of HIT, particularly the way HIT is administered in health care organizations. It is important to keep in mind the patient-centric goals of HIEs. Administrators who get involved early can help ensure HIEs meet the needs of all stakeholders, especially health care organizations. Early involvement can ensure a robust HIE, which can provide a dynamic system that accurately captures health care provided to members of the community. This information can be utilized by health care and public health leaders to develop education plans and public health programs. The clinical data collected through the HIE can also help administrators determine the service lines utilized and needed most by the community. This allows for dynamic strategic planning to expand, maintain, or contract currently offered service lines. Works Cited Accenture. (2009). Planning and Implementing a Health Exchange Network: A Guide for State Designated Entities. AHIMA. (2007, September). HIM Principles in Health Information Exchange. Journal of AHIMA , 78 (8). AHRQ. (2010). Health Information Technology: State and Regional Demonstration Projects. Agency for Healthcare Research and Quality. Dierker, L. (2007, October 18). State Level Health Information Exchange: Roles in Ensuring Governance and Advancing Interoperability. Foundation for Research and Education of AHIMA. Dimitropoulos, L. (2007, July). RTI for HHS. Healthcare Information and Management Systems Society. (n.d.). Healthcare Information Exchange. Retrieved 10 15, 2010, from Healthcare Information and Management Systems Society: www.himss.org/asp/topics_hie.asp National Governors Association. (2009). Public Governance Models for a Sustainable Health Information Exchange Industry. National Governors Association.