Louisiana plans to use $10.5 million in stimulus funds to help establish a statewide health information exchange by building on existing efforts, with organizers hoping to eventually make the exchange part of a medical home care model.

The money from the American Recovery and Reinvestment Act of 2009 provides a wonderful opportunity for Louisiana and the country, said Cindy Munn, who chairs the Louisiana Health Care Quality Forum's committee on health information technology. The Quality Forum, a non-profit group, is the state-designated entity to lead the stimulus health IT planning.

 

Right now, Munn said, Louisiana doesn't have a structured plan for a health information exchange. "We have different components of health information exchange but we do not have a formalized state plan," Munn said. "That's one component that we have to look at, how can we capitalize on what's out there?"

 

The Quality Forum would like to take advantage of the efforts already underway in the state and any existing infrastructure, Munn said. Those efforts include:

Munn said other areas of the state were ready to do some regional exchanges and held off in order to see what the federal government's requirements were going to be and whether a more coordinated, statewide approach would be possible.
The Quality Forum and the state want to get the greatest return possible on the stimulus grant money, Munn said. The $10.5 million is a lot of money, but it's not going to cover all the needs Louisiana has. The forum will explore all the possibilities so it can maximize the funding, she said. One way might be to collaborate with other states on purchases to get better pricing.

 

Munn said the health information exchange is just one piece of changing the healthcare delivery system. "What the government is saying is, 'You can have the HIT infrastructure. You can have the capability of doing health information exchange. But unless it is used day to day, unless it is functional, you're not going to get the improved outcomes,'" Munn said. That is why the federal government is going to be looking for "meaningful use" of the health information exchange, so Louisiana can see improved patient outcomes according to Munn.
Meaningful use has yet to be defined by the federal government, although a definition is expected by year's end. The forum has recommended that meaningful use be measured by outcomes, or the impact the tool has on individual and population health. Project manager Jenny Smith said the forum has also applied for a stimulus grant to create a regional extension center, sort of a one-stop shop to help with the challenges of implementing electronic health records.

 

The regional center could help physicians answer some important questions, Munn said, such as what hardware and software will be required? What workflow redesigns will be necessary? How does a practice select the appropriate components so that it meets the outcomes the federal government is looking for when it comes to meaningful use criteria? The forum is looking to subcontract with different groups to help with "boots on the ground support," Munn said.
The Louisiana Health Care Review, the state's Medicare Quality Improvement Organization, would appear to be a logical choice for that support.

 

Chief Executive Officer Gary Curtis said the organization has worked with some 300 physicians this year to help them find out about electronic health records, what they can mean for the physicians' practices, figure out a time frame to adopt the technology's use and what the systems cost.

 

"We're not a vendor. We just help physician offices purchase the best one for their practice and goals," Curtis said. "And then we help them implement the systems because there are a lot of hiccups."

 

The federal government plans to spend close to $20 billion in stimulus funds to help hospitals and doctors switch to electronic health records. But those incentives will only go to providers who are meaningful users of a certified electronic health record; reporting on quality measures; and connected for health information exchange. The idea is to improve the quality of care and reduce costs. Providers who don't use the technology by 2015 will be penalized through lower reimbursements.