Survey of states finds boom in e-health strategies
Almost all states are actively engaged in e-health strategies to facilitate use of information technology to make the health care system more efficient and provide greater value and higher quality. That's the principal finding of a 2007 survey of states conducted by the National Governors Association and Health Management Associates. The survey and report were supported by the Commonwealth Fund.
The researchers found that while states see e-health initiatives as a high priority, they and their private sector partners face significant challenges accompanying such initiatives, including issues of time and cost needed for implementation and for a return-on-investment.
The paper defines e-health as any health care practice supported by electronic processes and communication, including health information technology (HIT) and health information exchanges (HIE). Across the United States, the researchers found, states have taken on the challenge of promoting e-health policies and initiatives, encouraging a wide variety of public and private sector efforts.
States are said to be motivated by their interest in improving performance, assuring quality, and obtaining greater value in their role as health care purchasers, providers, and regulators, and as protectors of public health and catalysts for private sector action.
There reportedly is broad agreement that HIT can significantly improve health care delivery and quality and reduce its costs. "Indeed," the researchers said, "HIT has the potential to transform health care delivery and produce great improvements in efficiency and effectiveness for all the programs in which states have a role and an interest."
But states face many constraints on what they are able to do, due to limits on available state funds and the presence of many competing demands for those resources. As a result, the report says, important goals, including those that might lead to a nationwide health information network, remain on the horizon as states pursue a variety of strategies and approaches toward their attainment.
Survey responses were received from 41 states and the District of Columbia. Among the key findings:
- All states place a high priority on e-health activities. No state said its e-health activities were not significant and nearly 70% said their activities were "very significant." Among the initiatives states listed as their most significant were electronic HIE activities, adoption of HIT components, quality and transparency initiatives, registries, and efforts to resolve privacy and security issues.
- State governors' two highest e-health priorities for the next two years are developing electronic HIEs and developing policies fostering local or state-level electronic HIEs to assure interconnectivity among health care providers. More than 75% of responding states said electronic HIE activities were among their highest priorities, with 11 states forming a statewide committee, commission, or board to study electronic HIE issues, 17 states reporting other HIE planning and monitoring activities, and seven states describing either developing or implementing electronic HIEs. Also, four states said their significant activity involved providing grants, loans, or pro bono technical support to spur both HIT and electronic HIE development.
- State HIT initiatives span a broad range of activities. Many states identified HIT components such as telehealth, e-prescribing, replacing their Medicaid Management Information System, electronic medical records, electronic health records, patient health records, decision- support tools, chronic disease management, case management, and web-based tools as their most significant e-health activities. The report says such activities not only help states operate more efficiently, but also help them improve health care quality and give them opportunities to participate in e-health partnerships with private payers.
- E-health applications enable states to implement quality and transparency initiatives. Five states reported significant e-health activities focusing on quality and transparency, including efforts to collect and distribute data on health outcomes, costs, utilization, and pricing, thus increasing accountability in public and private health care delivery systems.
- Privacy and security are key state concerns and a focus for state action. Some 31 of the 42 respondents said they have state privacy laws and other protections in place, and 28 reported establishing policies and procedures to address data privacy and security breaches. Five states said their privacy and security activities were their most significant e-health activities.
- Different consent requirements is the greatest barrier to release of health information within an electronic HIE, especially for services related to substance abuse, mental health, and HIV/AIDS. Respondents said the second-greatest barrier was federal privacy requirements. In particular, 24 of 38 responding states said federal laws related to substance abuse services create a barrier when implementing an electronic HIE. And 13 states said that state and federal confidentiality and consent laws create obstacles for e-health activities, while nine states reported HIPAA pre-emption standards as a barrier. Other barriers cited included the technological challenges of securing data and authentication.
- States are interested in knowing and improving availability of medical data to health care providers and Medicaid enrollees. One barrier found for consumers is lack of computer access. One-third of responding states had recently assessed the extent to which the Medicaid population has access to computers and the Internet. One-third of the respondents also said they had started education efforts about e-health specifically intended to inform consumers from culturally and linguistically diverse communities. And two-thirds of the states had assessed provider connectivity. Barriers cited for electronic medical records included initial and ongoing costs associated with the implementation process, lack of quantifiable return-on-investment, and difficulty finding an interoperable electronic medical record application.
- States have formed public/private consortia to develop standardized measures of utilization and performance. Some 18 states reported working with private payers to develop statewide measures of utilization and performance.
- States have adopted HIT activities in a wide variety of programs. States reported a range of e-health activities in five health care programsMedicaid, employee health benefit plans, state-operated mental health hospitals, state prison systems, and public health. The greatest number of state e-health activities was in public health, with the second-highest number in Medicaid. Registries were reported as the most prevalent e-health activity, followed by telehealth and decision support tools.
- Public health has extensive experience operating registries, which will be foundational to other e-health activities. Public health agencies in many states have spent decades operating registries related to immunization, surveillance, disease, newborn screening, and early and periodic screening, diagnosis, and treatment. States said their experiences with these registries will support their efforts to develop other HIT and electronic HIE activities.
- Almost all states reported Medicaid e-health initiatives. Some 37 of the 42 responding states said they had Medicaid e-health initiatives. More than half reported implementing web-based Medicaid Management Information Systems, telehealth, and decision-support tools. Web-based provider enrollment and certification and immunization registries were reported in about one-third of the responding states.
- The most significant barrier reported to the widespread adoption of interoperable HIT and a nationwide network of electronic HIEs was obtaining funding for implementation and long-term operations. More than half of responding states identified lack of funding as the greatest barrier. Other impediments cited included stakeholder engagement, lack of standards, privacy and security concerns, terminology, and legal constraints for e-prescribing.
- States say their most important lesson learned is the need for collaboration and stakeholder engagement. Other lessons learned include the need for sufficient time and careful planning, clear and effective communication, dedicated resources and start-up funding, and using a versatile electronic HIE model that does not lock out prospective participants because of its dependence on a particular vendor or service.
Download the report at www.commonwealthfund.org/publications/publications_show.htm?doc_id=669309.
Almost all states are actively engaged in e-health strategies to facilitate use of information technology to make the health care system more efficient and provide greater value and higher quality.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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