Legislators weigh future of e-health exchange [HBJ]

May 26, 2015

Hartford Business Journal

[Editor’s note: This story is an updated version of a story appearing in the May 25, 2015 edition of the Hartford Business Journal. The update reflects legislative action that took place after HBJ had gone to press last week.]

Less than a year after the official death of a multimillion-dollar attempt to give Connecticut doctors and other caregivers a way to share patients’ medical records electronically, lawmakers are grappling with how to move forward.

A bill progressing through the legislature reiterates the state’s desire to develop and maintain a statewide health information exchange (HIE) that would give providers a secure way to rapidly access patient files and analyze data. But a change to the bill’s language late last week — the result of negotiations between lawmakers and several state agencies — removed an originally proposed $50 million in funding to build the exchange, as well as a requirement that all hospitals install a certified electronic health record system within the next few years.

The bill now calls for the Department of Social Services to use “existing resources” to launch an HIE, though the legislature may include an unspecified amount of money for the effort in the bond package for the coming fiscal year, officials said.

Proponents have long argued that an HIE would enable cost savings, improve health outcomes, and create a level playing field for smaller providers who typically must pay hospitals to access and share patient information.

But despite its efforts, Connecticut has failed to launch a health records exchange. A previous attempt, run by a quasi-public agency called HITE-CT, received more than $4 million in federal stimulus funds between 2012 and 2014, but ran into financial problems, and ultimately gave up on building the system.

The investment originally proposed by Senate Bill 812 would have been the largest single commitment of Connecticut dollars ever for an HIE system.

The latest version of the bill is co-sponsored by Sen. President Pro Tem Martin Looney (D-New Haven) and Senate Minority Leader Sen. Len Fasano (R-North Haven). Last Thursday, Senate legislators wrapped the HIE proposal into a separate bill that would change rules surrounding the sale of hospitals in the state and require Access Health CT to create a website for consumer health information. Hospitals had raised concerns about the original health information exchange bill, which would have forced them to connect to the exchange within three years or less. Though virtually all Connecticut hospitals have electronic medical record systems capable of connecting to a statewide network, the Connecticut Hospital Association argued that pieces of the bill related to equipment and service donations to doctors, and who is permitted to access the system, would violate federal law. CHA told legislators that the complexity and cost of electronic health records makes the effort more suited for federal coordination. They also warned that interoperability across the healthcare system could take another decade.

Since 2009, Connecticut hospitals have received approximately $300 million in federal funds to build out their electronic health systems.

That money, hospitals say, “has covered only a fraction of the actual costs incurred, with far more work and expense left to be managed.”

Meantime, UConn Health Center’s John Dempsey Hospital doesn’t have a qualified electronic health system, and under the original bill, would have had to spend $85 million to get one up and running, the Office of Fiscal Analysis estimated.

Competitive concerns

It’s common for Connecticut hospitals and large provider groups to have advanced electronic medical record systems, particularly since federal incentives for health IT began flowing six years ago.

Though hospitals say they are capable of connecting to each other on their own in many cases, Fasano said the various health IT systems employed by hospitals aren’t achieving the health and cost benefits that he believes a truly statewide network could bring.

And Fasano suspects the problem is more about money and competition than it is about technical complexities.

He pointed to an April report from the federal Office of the National Coordinator for Health Information Technology, which found that some large providers used proprietary systems to block patient referrals to outside providers, in an effort to preserve or advance their own market share.

“There’s a lot of money, corporate money, to defeat the purpose of the health information exchange system, which is sad,” Fasano said.

Fasano wants Connecticut to purchase a turnkey-ready HIE from another state, like Rhode Island, which he said would be cheaper and take less time. Others states with operating HIEs include New York, North Dakota and Louisiana.

Though the exchanges are still young, a 2014 study of an HIE in western New York found that patients had a 57 percent lower chance of hospital readmission when their doctors accessed patient records electronically within 30 days of a hospital discharge, according to the Journal of the American Medical Informatics Association.

Picking up the pieces

Top of mind for state officials and lawmakers pushing for an exchange are the many missteps made during the HITE-CT effort, which officially ceased operations last summer.

A report authored last year by Minakshi Tikoo, a UConn Medical School assistant professor who coordinated the state’s HITE-CT agreement with the federal government, described the challenges and eventual failure of the effort.

Some board members didn’t attend meetings. HITE-CT hired a contractor, Axway, to build an HIE that would have cost more than the $4.3 million in federal funds available. The planned system was not ultimately a product that providers wanted, which meant it would not be able to sustain itself, the report said.

Axway sued HITE-CT in early 2013 after the board tried to renegotiate the scope of the contract. Work on the system stopped for a full year. HITE-CT settled the suit for $970,000 in late 2013 and the two sides agreed to remove the HIE from the contract. Axway instead built a patient index and health provider directory, which are infrastructure building blocks for an eventual HIE.

The infrastructure built by Axway is now in the hands of the Department of Social Services, which at the direction of the legislature has overseen the state’s healthcare IT efforts since HITE-CT’s disbanding 10 months ago.

Under the first version of the latest legislation, however, the state Department of Public Health would have taken over the state’s health IT efforts, including going out to bid for an exchange platform. That could create a territorial scuffle and was one reason DSS initially opposed the bill.

The next week, Senate legislators changed the language of the proposed bill to keep administrative authority over the HIE with DSS, but in collaboration with a health information technology advisory council, which would include the commissioners of DSS, DPH and several other state agencies, among other officials and appointees.
In an interview, DSS Commissioner Roderick L. Bremby made the case for his agency’s deliberate path towards an exchange that he thinks would ultimately cost less than $50 million to build. He said more work is needed to make sure the state buys or builds a system that providers will be willing to pay to use.

He estimated that it may take another three years to get an HIE up and running, depending on provider interest.

“I know it’s slow going,” said Bremby, adding that progress has been made.

DSS, for example, recently completed a revision of the state’s health IT strategic plan, and intends to begin talks with providers soon to ensure that a desirable HIE system is offered, he said.