1. Texas Approach to Supporting Statewide Health Information Exchange January 2013

2. Presentation Overview • Background • Who, What, Why? • Texas Vision and Approach to Statewide HIE • HIE Support in Rural Texas • Resource Information

3. Who are we? • The Texas Health Services Authority (THSA) was created in 2007 by the Texas Legislature through House Bill 1066 • Public-private partnership, legally structured as a nonprofit corporation, to promote and coordinate the development of HIE in Texas • Governed by a 13-member Board of Directors appointed by the Governor with advice and consent of the Texas Senate

4. What are we doing and why? • Funding authority provided through the American Recovery and Reinvestment Act for planning and implementation grants to states to facilitate and expand HIE. • In March 2010, the Office of the National Coordinator (ONC) for HIT, US Department of Health and Human Services, awarded Texas $28.8 million over four years to plan and implement HIE in Texas. • Implementation of the Texas HIE Plan is being coordinated between the Texas Health and Human Services Commission and THSA.

5. What are we doing and why? • Meaningful Use Stage 2 focuses on actual use cases of electronic information exchange • Measure #1 requires that a provider send a summary of care record for more than 50% of transitions of care and referrals • Measure #2 requires that a provider electronically transmit a summary of care for more than 10% of transitions of care and referrals • Measure #3 requires at least one summary of care document sent electronically to recipient with different EHR vendor or to CMS test EHR

6. What is our Approach to Statewide HIE? GOAL Enable improvements in the quality and efficiency of the Texas health care sector by enabling HIE infrastructure for the state. OBJECTIVE Deliver private, secure, and reliable HIE services to all Texas patients and providers through local HIE networks where the capacity exists and through Health Information Service Providers (HISPs) where it does not. STRATEGIES • General State-Level Operations • Local HIE Grant Program • White Space Initiative

7. General State-Level Operations • Planning and Governance • Convene stakeholders and build consensus • State-Level Technical Services • Inter-HIE/HISP Connectivity • Gateway Services to NwHIN and State-Level Data Sources • Consent Management • Sustainability Dialogue • HIT Policy Development • Privacy and Security • Interoperability

8. Other Federal Agencies (i.e. VA, DoD, SSA, CDC, Medicare, IHS) Other States Texas State-Level Shared Services (Connectivity) Texas Medicaid and State Health Agencies (i.e. TMHP, DSHS) Other State Level Data Sources (i.e. Payers) Local HIE Local HIE

9. What are we doing to support local and regional HIE initiatives? • $19.5 million Local HIE Grant Program to support new or expanding HIE initiatives by partially funding planning, development, and operations of local HIE networks • Administered by HHSC with support from THSA • Funded 16 HIEs through this program; 12 moving into operations • HIEs committed to connect 80-90% of all hospitals and physicians in Texas • Significant local accountability

10. Local HIE Servicer Area Interactive map available at: http://hietexas.org/local-hies/hie-service-areas-and-info

11. Local HIE Profile Sheets • Contact Information • Governance • Technical Model • HIE Services • Privacy and Security • Sustainability Approach • www.hietexas.org/local-hies/overview

12. What should I do if I am interested in joining an HIE? • Determine which HIE or HIEs are covering your county. • http://hietexas.org/local-hies/hie-service-areas-and-info • Review the HIE profile sheet(s) to ensure you understand what services the HIE is offering, the technology model they are supporting, their approach to privacy and security, fees, etc. • Contact the HIE to learn how to sign up to participate. • Get involved with the HIE through its governance to help to ensure the HIE is meeting your needs and the needs of other providers in your community.

13. What are we doing to support providers not served by a Local HIE? • The THSA has qualified HISPs to support hospitals and physicians located in areas without a local HIE, or the Texas “White Space.” • HISPs provide secure email-based messaging solutions for the transport of clinical information between providers, including clinical summary exchange and electronic lab results. • HISP connectivity services enable subscribing providers to meet federal Meaningful Use requirements. • All HISPs are eligible to receive a subsidized payment on behalf of eligible Texas hospitals and physicians to reduce initial provider service costs.

14. Why is a THSA-qualified HISP a good HIE option? • Using a THSA-qualified HISP is a simple, efficient, secure, and low cost way to exchange patient information with other clinicians in compliance with HIPAA and federal Meaningful Use requirements. • SIMPLE– Enables exchange of patient information with other clinicians using secure e-mail. No new hardware – a computer with access to the Internet is all that is needed. • EFFICIENT- Pull the plug on your fax machine and send out referrals and consults via secure e-mail right from your computer. • SECURE- E-mail messages are secure and fully HIPAA-compliant, with all messages and attachments encrypted. • LOWCOST - The THSA is offering a subsidy in the form of a voucher to offset your initial costs ($400 per physician/$5,000 per hospitals). No long-term contract required.

15. How would a provider use a HISP? The diagram above depicts a primary care physician (PCP) making a referral to a specialist. The PCP could export a patient’s care summary from their EHR, attach it to a Direct message along with a referral order, and send it over to the specialist via the email-like HISP.  The specialist can then login to a Direct email account, open the message, download the care summary and referral, and import it into their EHR.  If the PCP or specialist does not have a compatible EHR, a PDF version of the summary and referral could also be attached and sent securely through a HISP.

16. What should I do if I am interested in using a THSA-qualified HISP? • Request a Voucher Number from THSA. • http://hietexas.org/white-space/voucher-requests • Select a THSA-qualified HISP. • Use the HISP you have selected to securely send clinical information to other providers.

17. Where can I find more information? • HISP Pricing and Profile Sheets • White Space Fact Sheet and Q&A • Voucher Request Process • Marketing Materials • All available at: www.hietexas.org/white-space/overview

18. Where can I read more? • www.hietexas.org - THSA/Statewide HIE Website • State HIE Plan • Local HIE Grant Program RFA, HIE Profiles, and Approved Business and Operational Plans • White Space Program Background, Marketing Materials, FAQ, and RFQ • THSA Annual Report to Governor and Texas Legislature • Privacy and Security White Papers • Links to other reports and other helpful sites

20. Tony Gilman Chief Executive Officer Texas Health Services Authority (512) 814-0321 tony.gilman@thsa.org www.HIETexas.org Follow THSA on Twitter @HIETexas