May 14, 2007

States Convene to Discuss the State of E-Health
By Kathryn Foxhall
For The Record
Vol. 19 No. 10 P. 14

Within a few weeks, the new governors’ panel on e-health may be considering suggestions about the interstate licensure of physicians and other health professionals, as well as harmonizing state laws on liability, malpractice insurance, and privacy.

The State Alliance for e-Health, cochaired by Tennessee Gov Phil Bredesen and Vermont Gov Jim Douglas, has approved plans for its task forces to examine those issues and bring back recommendations later this year.

The alliance, which held its second meeting March 30, was established with a grant from the Office of the National Coordinator (ONC) for HIT to resolve some of the thorniest issues restraining the e-health revolution, namely the variations in state healthcare laws.

Among other actions at the meeting, the panel approved plans for its healthcare practice task force to continue examining whether to institute interstate medical licenses since state licensure is “an impediment to the delivery of e-healthcare across state lines.”

Holly Miller, MD, a task force member and chief medical information officer at Cleveland’s University Hospitals, said the issue is particularly important for remote areas receiving telehealth services where professionals work across state lines. On the other hand, she said, “It’s very difficult for states to enforce and administer licenses and provide the quality oversight across state lines.”

In the near future, the task force expects, at minimum, to examine licensure differences for physicians, pharmacists, and nurses.

This year, it will also make recommendations about how states can prevent liability issues from becoming barriers to e-health. The task force said this is a necessary step because new systems will open a plethora of liability issues. Currently, members noted, there is a dearth of medical malpractice cases related to IT, and there is limited liability insurance for e-healthcare.

One question, according to the task force, is whether physicians should get a break on malpractice insurance for using HIT since its use is generally thought to support patient safety.

The alliance also approved its privacy task force’s plans to develop a set of principles with which to assess state laws on protected health information. It will begin reporting by July.

Sally Hunt, West Virginia chief privacy officer and a member of the task force, noted that state privacy laws are built “upon your own state’s cultures, values, [and] the way people think in your state. If laws are passed today, it’s probably very much impacted by the level of education that consumers and legislature have about health information technology. So we see differences across the country. Whose laws are working well? Where are they still relevant? What can we do to advance health information exchange while maximizing privacy and security?”

First on the task force’s privacy-related agenda is a look at mental health and substance abuse, HIV and other communicable diseases, genetic information, and disability because those are “the kinds of laws that have the highest levels of protection.”

In the meantime, the alliance heard that states themselves are not standing still on e-health. “Generally speaking, half of the states are in the middle of attempting to implement plans for HIT,” said Gerry Hinkley, an attorney who works with state health information.

In 2005 and 2006, 37 bills were passed in 24 states, while this year, 68 bills have been introduced in 30 state legislatures, he said. Some legislation has created commissions or other groups to develop recommendations or has directed an agency or other existing body to examine the issue. Other state bills target the integration of healthcare quality goals into HIT, said Hinkley.

But he also noted, “Many states are shouldering substantial financial participation in providing seed funding for initiatives focused at the RHIO [regional health information organization] level or focused on specific types of care that are perceived to require additional state source funding to get them off the ground.”

For example, during the last two years, Maine has authorized bonds for health information exchange; Massachusetts has approved $38 million for “documented needs” in HIT; and Michigan passed $30 million in HIT funding.

Hinkley said that for some states with substantial rural areas, “the delivery of care through telehealth is being perceived as an important element of the development and maintenance of electronic health records. What we are seeing is a coming together of the telehealth movement with the electronic health record movement as really being components of a larger solution.” Toward that end, Arizona and New York have legislation to fund telehealth.

A number of forward-thinking states, said Hinkley, have also focused on emergency department linking systems, in part because that is where numerous patients receive care without adequate documentation. For example, a Colorado proposal would create a statewide emergency continuing care capability to improve patient safety.

Also at the meeting, 13 state Medicaid agencies announced an agreement to build a health information structure to be shared with all states for rapid HIT deployment throughout the provider community.

According to Anthony Rodgers, director of the Arizona Health Care Cost Containment System, the agencies are using federal transformation grants totaling $61 million for the project and will cooperate in the planning and development of the structure.

“We are also going to look at our reimbursement strategies and reimbursement policies to see how we can come up with a useful tool to reimburse physicians who have electronic health records [EHRs], who use our clinical tools, because we believe the return on investment to us is huge,” Rodgers said.

Statewide access to EHRs, he said, will engender a new generation of consumer, provider, and payer decision support and analytical tools that will be integrated into the systems and help drive efficiencies.

Information on the state alliance can be found at www.nga.org by clicking on Center for Best Practices, then health quality and health information technology.

— Kathryn Foxhall is a freelance writer in the Washington, D.C., area. She covers health informatics, public health, health policy, reimbursement, mental health, and other issues.