- Earlier this month, the National Governor’s Association (NGA) provided new guidance for addressing and removing obstacles to health data exchange at the state level.
Legal obstructions, such as restrictive laws and fear of liability, and market-based barriers, including the lack of economic incentive and information blocking, muddle the exchange of health information between providers. As part of health information exchange roadmap, NGA outlines five steps states can take to streamline the flow of information.
NGA advises states to gather a team of leaders in specialized fields to spearhead the effort to expedite efficient information flow.
According to NGA, recommended team members include “representation from the governor’s office, Medicaid—including privacy counsel, senior policy officials, and health IT leadership—the state health IT coordinator, public health, the attorney general’s office and the agency that administer state employee health benefits.”
In addition to this core group, peripheral workgroups could involve external stakeholders including healthcare practitioners, health systems, privacy and consumer advocates, health information organizations (HIOs) and academic experts to act as advisors. State medical societies and hospital associations can also serve as advocates for encouraging broader participation by providers.
States are then urged to conduct landscape analyses to gain a better understanding of the scope of the legal and marketing issues using data reviews, focus groups, surveys, and informal interviews.
Legal analysis should address a “review of existing state privacy laws, primary privacy barriers for the provider community, perspectives of health care privacy advocates [and] patient preferences” and gauge the stakeholders’ interest in initiating changes.
Market analysis should focus on payment structures across public and private health payers, existing health information exchange infrastructure, provider participation levels, types of health information being exchanged, uses of that information, provider and vendor information blocking, and stakeholder interest in initiating changes.
Next, NGA encourages states to identify critical barriers to health exchange information within the state. States should prioritize the barriers most responsible for inhibiting progress.
NGA points out that attacking barriers in order of importance may allow “a state [to] discover that a particular strategy that addresses a high-priority barrier may work to solve a lower priority barrier, as well.”
Upon identifying and ranking barriers accordingly, states need to choose which strategies they can employ to accomplish their goals. NGA offers the example that even though “a state may fully align its laws with HIPAA,” its efforts to improve health data exchange are unlikely to effect change unless are made aware.
The overarching goal is to tailor each strategy to each state’s unique environment. NGA encourages a “comprehensive approach” aligning the legal and market barriers. Each strategy will be ranked on a three-star scale, from very effective (3 stars) to minimally effective (1 star).
The NGA roadmap includes a handful of suggested strategies states can use to address legal and market barriers. Legally, states should consider fully or partially aligning state privacy laws with HIPAA, creating standardized consent forms, and educating providers on state and federal law.
In terms of handling market barriers, states can create economic interests that encourage the exchange of health data, use legislative authorities to support information exchange, elevate best practices as a necessary priority for providers, and establish statewide health information exchange networks, such as VITL in Vermont, to improve interoperability and discourage information blocking.
The final step involves the implementation and evaluation of the core group’s plans. States should divvy up roles and responsibilities among the group and establish a timeline. The timeline should run according to the state’s legislative calendar and account for any procedural issues that might slow progress.
NGA also advises states to “develop an evaluation plan to monitor progress” and “determine the metrics that will define success for their initiatives.” This evaluation system should allow for quick corrections to the team’s plan.