State Grants for Health Information Exchange

This week I was reading the monthly newsletter published by the Arizona Medical Association. This month's issue is devoted to health information technology projects being carried out in the state. I was particularly interested in the article written by Perry Yastrov concerning health information exchange in Arizona. Mr. Yastrov was the project director for Arizona Medical Information Exchange (AMIE), a proof of concept program to develop state-wide information exchange for the state Medicaid program. The project was funded by a federal Medicaid transformation grant. The three year effort came to an end late last year when funding ran out.

My understanding is that AMIE started from scratch. Policies and standards were agreed upon, procedures were developed, the technical infrastructure was built, a trust framework was adopted, and limited information exchange was piloted. Many stakeholders contributed to the effort. Several million patients were registered in the system. Now the participants don't have much to show for their work. The funding came from a federal grant program that did not include plans for sustainability. There have been numerous initiatives concerning health information exchange around the country that have met a similar fate. This leaves me wondering if we are spending our tax dollars wisely.

Earlier this year the Office of the National Coordinator for Health IT announced recipients of state grants to develop health information exchange (see State HIE grants.) Over $547 million in federal funding has been awarded to 56 entities to work on the same problem, state- or territory-wide health information exchange. To some extent, the awardees are expected to try to coordinate their efforts. The stated goal of this grants program is: "… building on existing efforts to advance regional and state-level health information exchange while moving toward nationwide interoperability." The outcome could be exactly the opposite.

One of the problems with health information exchange is that it does not scale well. A relatively simple approach can be taken to "pushing" data electronically from one provider to another. Tremendous complexity is required for fully enabled health information exchange that needs to occur seamlessly across various software platforms through jurisdictions that are governed by laws that often conflict. Just take a look at the particularly thorny issue of patient/consumer consent for an example of what I am talking about.

Since the days of the Constitutional Convention in the 1700's we have confronted the dilemma of how to balance federal influence and state's rights. That battle is still going on. I think the state HIE grants reflect the power and influence of state's rights advocates. Maybe this is a good way to distribute ARRA funds to stimulate the economic recovery. It may not be the best approach to stimulate the wide-spread development of interoperable HIEs needed for all stages of Meaningful Use. In my view, the federal government, as it spends money to promote health IT, should be taking a more aggressive role in harmonizing the various conflicting state laws and state initiatives to help us arrive at a place where health information exchange is facilitated, especially where information crosses jurisdictional boundaries. We should expand on best practices of the most successful HIEs, some of which have been working on the problem for over 20 years. Support infrastructure development and build out. We do not stand to gain much be reinventing the wheel 56 times. If we had had 50+ space programs, we would probably still be trying to land a person on the moon. Spend some of the money instead to discover truly sustainable solutions that can stand on their own without the continuous infusion of public funding and promote those to the state designated entities.