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Appendix D: Evaluation of State Strategies

The most effective strategies to improve information flow will include continuous monitoring and a strong evaluation plan. This appendix discusses some of the data sources and evaluation measures states can use to assess their progress. It includes process measures that can help states quantify success in meeting the goals of their implementation plans. States also can look to short-term outcome measures related to improving information flow and provider experiences with health information sharing. Finally, states should consider longer-term outcome measures which point to the value of health information sharing in helping improve the quality and efficiency of patient care.


Data Sources

States may consider using the following data sources to evaluate their progress. States may only need or have access to certain data depending on their individual goals and resources. The list presents data sources in order of sequential impact, beginning with providers connecting to EHRs and HIOs, to changes in provider practice and patient care.

  • EHR data such as direct messages, CCDs and ADTs, to measure increases in the exchange of information
  • EHR Incentive Program data such as program registration and Meaningful Use attestation data from CMS and ONC, to measure the number of providers adopting EHR technology and meeting Meaningful Use milestones
  • HIO utilization data such as queries, data submissions, and alert notifications, to measure HIO service use
  • Surveys of providers in the state such as those conducted by trade associations, provider journals and publications, or state entities, to identify provider use and perceptions of EHRs, HIOs and the overall data sharing environment
  • Surveys of consumers in the state conducted by consumer organizations, consulting firms, or state entities, to gauge awareness and engagement with health information sharing
  • Claims and encounter data from Medicaid, Medicare and commercial insurance, to examine changes in clinical practice and health service delivery