Texas Health Services Authority (THSA)
In 2007, the Texas Legislature created the public-private entity called the Texas Health Services Authority (THSA) “to implement the state-level health information technology functions identified by the Texas Health Information Technology Advisory Committee by serving as a catalyst for the development of a seamless electronic health information infrastructure to support the health care system in the state and to improve patient safety and quality of care.” 1 This entity has largely been dormant in the interim since its creation due to the fact that no budgetary allocation was adopted to accompany the entity. This legislation has become a catalyst for Texas to ramp up HIT implementation efforts, because a lot has been happening across the state in regards to these issues.
Opportunity and Requirements for Texas
The ONC has allocated $564 million in Federal funding for state-level HIEs as stipulated by Section 3013 of Title XIII, Part 2, of the ARRA of 2009. Texas is eligible for $28.8 million of Section 3013 funds for both planning and implementation of a statewide HIE that will network the regional HIEs across the state. The ONC's State Health Information Exchange Cooperative Agreement Program outlines health information exchange measures and milestones for states across five domains: Governance, Finance, Technical Infrastructure, Business & Technical Operations, and Legal/Policy.
State governments, or their State Designated Entities (SDE), are responsible for developing and implementing plans that take into account the necessary progress to be made in all five domains to assure the exchange of health information in their state is sufficient to support the Meaningful Use criteria to be established by the Secretary of HHS through the Federal rulemaking process. Compliance with the Meaningful Use criteria by Texas health care providers is essential for the providers to receive their share of the $17+ billion pool of ARRA funds and avoid future penalties.
The Meaningful Use criteria specify clinical, operational, outcomes, privacy, and security metrics for both hospitals and physicians. Meaningful Use defines the key performance indicators for improving coordination of care, continuity of care, disease management, operational efficiencies, patient safety, and public health. The performance indicators apply to individual hospitals and physicians, and their exchange of specific health information across organizational boundaries within their local provider community and with patients to support optimal care.
Therefore, the statewide exchange of data fundamentally begins in local communities and their health care “eco-systems,” from both the HHS /ONC perspective and the practical stakeholder engagement and value proposition perspective. HHS and ONC know that their billions of stimulus dollars will go only so far and that local value propositions for HIE participation are crucial for HIE sustainability. The exchange of data at a statewide level will only be sustainable and valuable to the extent that local and regional HIEs are sustainable by delivering local return on investment, particularly in a state as diverse and large as Texas.2
Texas through the THSA and HHSC applied for federal grant monies made available through the HITECH Act of 2009 for the HIE planning process. In an effort to ensure broad stakeholder input in the development of HIE strategic and operational plans, the THSA formed four work groups of multi-disciplinary, multi-stakeholder experts to inform the planning process for a statewide HIE. The four work groups were the:
1. Governance and Finance Work Group
2. Technical Infrastructure Work Group
3. Privacy and Security Work Group
4. Electronic Health Record (EHR) Adoption and Consumer Engagement Work Group
On December 17, 2009, the THSA released a Request for Qualifications for the purpose of selecting a vendor that would facilitate the statewide planning process and assist with the development of HIE strategic and operational plans. These plans would be the guide for implementation of statewide HIE services for the State of Texas.
During March 2010, it was announced that the State of Texas was awarded $28,810,208 in funding and the THSA selected the consulting group CTG to assist in the planning process for development of the Statewide HIE.
Texas Health Information Exchange Coalition (THIEC)
The Texas Health Information Exchange Coalition (THIEC), comprised of fourteen local and regional HIE initiatives, was formed in 2008 as a natural outgrowth of regional stakeholder interest, as physicians, hospitals and other healthcare and community leaders saw the value of exchanging data at a local level in order to collaboratively provide quality, cost-effective care and transform the delivery system. That interest has continued to grow, in light of the leadership at a national level to create Meaningful Use driven health exchanges.
The fourteen initiatives that currently participate in THIEC cover 71% of the Texas population, over 17 million people, and represent major urban areas (Dallas/Ft Worth Metroplex, greater Houston area, Austin, San Antonio, Corpus Christi, and El Paso) as well as rural areas (Texas Panhandle, Red River Counties, and the Gulf Coast). The participating HIEs are at various stages of development with some in operation, some in testing and others in planning stages. See description and map
THIEC began working with the Health and Human Services Commission (HHSC) and with the Texas Health Services Authority (THSA) in 2008 and is looking forward to further collaboration with the State in developing a comprehensive, strategic plan that will lead to effective and state-wide implementation. In anticipation of this State/ regional partnership, THIEC members are committed to leveraging the community support, trust, and resources they have built to facilitate adoption and timely implementation of a state plan..
THIEC members are encouraged by the HHSC and THSA's commitment to collaborate with and fund local and regional HIE initiatives in carrying out planning, as well as implementation, activities to ensure coordination with statewide goals. Providing planning funds for local HIEs will (1) effectively leverage the knowledge of existing Texas HIEs; (2) inform the statewide strategic planning process; (3) allow a level of detailed planning not possible at a statewide level; (4) engage local stakeholders in the planning process to develop collaboration and trust in the exchange of health information; (5) produce approaches and solutions that are scalable statewide and potentially nationally; and (6) position the state for more quickly achieving the goal - the meaningful use of health information exchange data to improve the quality and efficiency of healthcare delivered in the state.
Officials from the U.S. Department of Health and Human Services (HHS) view regional HIEs as the building blocks for a National Health Information Network (NHIN). When complete, the NHIN's network of regional and state HIEs should provide universal access to electronic health records across jurisdictions and health systems, both private and public, with the expected benefits of improved coordination of care, continuity of care, disease management, operational efficiencies, patient safety, public health, and eventually, lower costs.
The Office of the National Coordinator for Health Information Technology (ONC) has been tasked with facilitating the completion of the NHIN by 2014 and has been given billions of dollars by Congress for this purpose. Congress and HHS have also allocated over $17 billion in stimulus funds for hospitals and physicians to adopt information systems that connect into HIEs. Their data and studies show that the Federal government's health IT and HIE investments will result in safer, more cost-effective, equitable, and patient-centered care in the US.
A formal needs inventory has been prepared by this group, defining the roles of the various member HIEs and the roadmap for how HIEs might work toward greater interoperability at the state and federal level.