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Examples of State Strategies to Address Market Barriers and Increase Information Flow Between Health Care Providers

Oregon: Create Meaningful Economic Interests That Encourage Data Exchange

The state of Oregon has implemented several incentives for exchange of health information as part of its health care payment and delivery reforms. In 2011, Oregon House Bill 3650 established coordinated care organizations (CCOs), or local health entities, to deliver health care and coverage for the state’s Medicaid population. The state is using quality measures and associated payments to hold CCOs accountable for the health outcomes of the population they serve. Seventeen CCO incentive measures have been developed, three of which are clinical quality measures for meaningful use of EHRs. Payments are awarded to CCOs based on their annual performance on these measures.

The state of Oregon is also encouraging exchange of health information through its hospital incentive measures. As directed by the 2013 Oregon House Bill 2216, the state has developed 11 quality measures that are tied to hospital payments. One of the 11 incentive measures directly requires that hospitals participate in exchange by sharing emergency department visit information with primary care providers and other hospitals through the state’s Emergency Department Information Exchange initiative. Numerous other hospital incentive measures indirectly encourage exchange of health information, including reducing all-cause readmissions and ensuring appropriate follow up after hospitalization for mental illness.

Finally, Oregon is incentivizing exchange of health information through its Patient-Centered Primary Care Home (PCPCH) program. Clinics in the state can apply to be recognized as a PCPCH, and those recognized are eligible for incentive payments according to the types of measures they meet. PCPCH measures related to exchange of health information include sharing clinical information electronically with other providers and care entities, meeting Meaningful Use standards for EHRs and being able to provide patients with their medical record electronically upon request.

Connecticut: Use Legislative, Regulatory and Contracting Authority to Bolster Exchange

Connecticut signed into law a bill—Conn. PA No. 15-146—that prohibits hospitals, health systems and EHR providers from “health information blocking.”49 The legislation establishes that such action is an unfair trade practice. Health information blocking is defined in the statute as:

“(A) knowingly interfering with or knowingly engaging in business practices or other conduct that is reasonably likely to interfere with the ability of patients, health care providers or other authorized persons to access, exchange or use electronic health records, or (B) knowingly using an electronic health record system to both (i) steer patient referrals to affiliated providers, and (ii) prevent or unreasonably interfere with patient referrals to health care providers who are not affiliated providers but shall not include legitimate referrals between providers participating in an accountable care organizations or similar value-based collaborative care models.

Oregon: Set the Vision and Hold People Accountable

In 2009, the state of Oregon was charged with a legislative mandate to establish a strategic plan for health IT. Out of this mandate and subsequent legislative direction in 2015 the state established the Health Information Technology Oversight Council (HITOC), which is responsible for “setting goals and developing a strategic health IT plan for the state, as well as monitoring progress in achieving those goals and providing oversight for the implementation of the plan.”50 The HITOC members represent diverse sectors of the health industry and serve as the organizing body for Oregon’s efforts to advance adoption of EHRs and a statewide system for electronic exchange of health information.

As part of its efforts to facilitate exchange of health information in Oregon, HITOC is updating its strategic plan and accelerating efforts to bring new governance and funding to Oregon’s health information exchange environment.51 The OHA and HITOC are partnering with the Oregon Health Leadership Council (a collaborative group of commercial health plans), hospitals, health systems and others to develop a statewide health IT utility governance model that will seek agreement for universal data sharing across entities and bring public and private support to Oregon’s health IT infrastructure. As part of its work, OHA also envisions reinforcing the concepts of ONC’s interoperability pledge through participation in the new health IT utility model and highlighting state entities that are making particularly notable progress in information exchange.

Vermont: Serve as Convener

In an effort to facilitate exchange of health information and prevent barriers such as information blocking, in 2009, the state of Vermont passed a law that established a statewide health information exchange network—Vermont Information Technology Leaders (VITL). In 2012, additional authority was added to allow VITL to establish connectivity criteria for providers using the state HIO.52

The criteria VITL established included four incremental stages designed to achieve full interoperability among providers by stage 4. By establishing defined criteria, the state created leverage for providers who were newly acquiring, updating or replacing EHR systems to ensure that those systems had the functionality necessary to allow participation in exchange and achieve full interoperability.53 In addition to establishing connectivity criteria, the state of Vermont provided assistance to VITL, providers and EHR vendors by participating in conference calls and other forums to provide clarity on connectivity standards and state law.