In “Take Me Home, Country Roads,” John Denver pines for one of the most gorgeous states in the country. Aptly nicknamed the Mountain State, West Virginia boasts natural beauty from the Appalachian Mountains on its eastern border to rolling farms along the Ohio River on its northwestern edge.
But this bucolic state also has an elderly population with a high rate of chronic disease, helping propel West Virginia’s health care costs as a percentage of gross state product to among the highest in the nation at 20 percent. Combining those factors with a median income that ranks 50th nationally has created a state-driven imperative for health care quality and cost-saving.
“West Virginia is not a rich state, and we need to operate health services as efficiently as possible,” says Sally Hunt, acting executive director of the West Virginia Health Information Network (WVHIN), which was formed to enable authorized health care providers, insurers and patients to share medical data instantaneously and securely. The goal is to eliminate duplicative, ineffective or counterproductive health services resulting from providers lacking information about patient test results or medical histories.
Attaining that goal is still years away and, like most RHIOs, it is hardly a foregone conclusion with WVHIN. However, the West Virginia RHIO clearly will not fail due to a lack of statewide unity. In 2005, Gov. Joe Manchin convened an electronic health records task force that recommended developing a health information network and created an inch-thick “roadmap” document that provides a guide on how to develop a statewide, interoperable network to share clinical data. The task force determined that the network is both feasible and cost effective.
In 2006, the state legislature passed a law creating WVHIN “to promote the design, implementation, operation, and maintenance of a fully interoperable statewide network to facilitate public and private use of health care information in the state.” It provided $1.4 million in seed money through June 2008 for planning and also directed the state’s health care authority to support the effort. Hunt, an attorney who is also the state’s privacy officer, was brought in at the beginning of this year to direct the effort.
EHR Experience Counts
In developing the roadmap, the task force in 2006 hired the West Virginia Medical Institute and consultancy Accenture to interview key health care providers, business leaders, insurers and government officials. There was unanimous agreement that WVHIN should function as a public-private partnership, initially developed with assistance from the state government, but ultimately supported by user fees, proving economies of scale to all users.
“My goal is to put in place a sustainability plan by year two,” says Hunt, who wants to augment the state funding with a federal grant. WVHIN has applied for a National Health Information Network grant for up to $1.5 million that would begin this October. “It would definitely jump start us,” she says.
In the meantime, the West Virginia Healthcare Authority, the state agency that administers hospital rate setting, certificates of need, health data research and executive-branch oversight of HIPAA, provides WVHIN’s office space, administrative support and initial funding.
Sonia D. Chambers, who chairs the authority, says the state’s relatively small population of 1.8 million and equally small size--at about 24,000 square miles it ranks 41st among the states--is an advantage when it comes to nurturing statewide support. “West Virginia has an awful lot of challenges, but one of the positives is that we can get all of the stakeholders around the table--and it doesn’t have to be a really big table,” she says.
Besides funding, educating consumers and providers and enlisting their buy-in for the final network model is critical. “I don’t think the technology is the hard part,” Chambers says. “The harder part is being able to have consumers and providers feel comfortable with the system that’s developed. West Virginia has a huge burden of chronic disease, including heart disease, obesity and diabetes. One of the things EHRs can aid us in is tracking and treatment of chronic disease. It’s a great tool to help remind patients to check their hemoglobin A1c and get foot and retinal exams.”
It doesn’t hurt that West Virginia already has some EHR penetration thanks to the presence of the VA and federal health care programs. “We have lots of pockets of physicians who have been champions for EHRs,” she says, including government outpatient clinics, the VistA physician-office EHR from the VA and smaller rural hospitals. “Our job is to build the platform and figure out how to connect them all.”
Privacy First
“As a physician and a specialist, I know that conversion to a digital network is vital to improve health care delivery and economics,” says Julian Bailes, M.D., a neurosurgeon, professor and chairman of neurosurgery at the University of West Virginia School of Medicine. Bailes, who has been involved in the RHIO effort since the governor asked him to lead the EHR task force in 2005, is also chairman of the 17-member WVHIN board of directors.
He acknowledges that several fundamental obstacles remain, including financial sustainability, privacy and security and, ultimately, the actual design and development of the network. However, West Virginia holds some good cards. “From the beginning, we’ve had very top-down support, including the governor, the legislature and the state health care authority. We’re also a relatively small state and despite some geographical and weather-related challenges, we do have really good communication,” he says.
Another source for success arises from the fact that early on the state partnered with Accenture to ensure that the roadmap initiative be truly inclusive, bringing together all health care players across West Virginia. “That was a good strategy because we can keep going back to the roadmap,” says Bailes, who separates the RHIO into two architectures, technical and functional. Technical architecture comprises the hardware, software and connectivity or hard-wiring of the system. Functional architecture denotes issues such as who gets connected, what geopolitical issues exist, who participates and how it’s sustained. “That’s the harder part,” he says, referring to the latter architecture.
Taking the step-by-step roadmap approach has garnered some early wins, like a grant from the Research Triangle Institute to work on privacy and security, which Bailes says is vitally important to consumers. “The number No. 1 priority is for us to establish privacy standards. Let everyone know that we’re a trustworthy network.”
Chuck Appleby is a freelance writing specializing in health care and technology.
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This article first appeared on August 29, 2007 in HHN's Magazine online site.
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