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What is HealthShare Exchange’s overall approach to developing the technology to support a regional HIE?

HealthShare Exchange’s technology approach is to:

  • Use existing and ‘commodity’ off-the-shelf industry solutions based on existing and emerging standards; 
  • Leverage existing provider and insurer stakeholder investments in technology;
  • Select technology that supports current and future business capabilities and allows for incremental implementation that builds on existing investments and is not “throw away”;
  • Align with and support the Pennsylvania eHealth Partnership Authority and the statewide HIE under development. 

In accordance with this framework, HealthShare Exchange will use the NwHIN DIRECT specifications as its start-up suite of protocols for exchanging health data among local providers and plans. This technology provides a simple, secure, scalable, standards-based way for participants to send authenticated, encrypted health information directly to known, trusted recipients over the Internet. The standards adhered to in this specification resulted from the NwHIN DIRECT Project, an open government initiative started by the Department of Health and Human Services’ Office of the National Coordinator for Health Information Technology. 

The use of DIRECT will allow hospitals participating in HealthShare Exchange to capitalize on their investments in electronic health records (EHRs) and other health care information technology. Many hospitals have EHRs that are DIRECT-capable or DIRECT-ready. According to 35 hospitals that responded to a DVHC survey fielded early this year:

  • over 90 percent had implemented an EHR;
  • nearly half are almost or fully DIRECT-ready;
  • about one-third are somewhat DIRECT-ready.
How will the specific technology needed be selected, planned, and implemented?

HealthShare Exchange is in the process of selecting a technology partner to assist with the 
creation of an HIE in Southeastern Pennsylvania. To that end, HealthShare Exchange:

  • Created a Vendor Selection Committee consisting of hospitals, insurers, and other stakeholders;
  • Invited potential partners to respond to a Request for Information (RFI) about how they would support the implementation of the HealthShare Exchange HIE;
  • Invited potential partners to respond to a Request for Proposal (RFP) about how they would support the implementation of the HealthShare Exchange HIE;
  • Conducted HIE service demonstrations with HealthShare Exchange’s stakeholder community in advance of selecting two vendors to participate in final offer negotiations.

Nine vendors responded to the RFI, and six vendors were identified as able to meet HealthShare Exchange’s technology needs. In light of the evolving healthcare technology environment, the Request for Proposal (RFP) phase was opened to include additional technology providers. 

The HealthShare Exchange Board will be responsible for the final selection of a vendor and negotiation of a final contract. The vendor selection process is expected to be completed by the end of Q1 2013.

How will HealthShare Exchange’s technology support the privacy of patient medical data?

Security of confidential patient information is a key concern of HealthShare Exchange, and the chosen technology approach is in full compliance with HIPAA and other applicable privacy regulations. HealthShare Exchange’s technology approach follows the Nationwide Health Information Network's (NwHIN) DIRECT technology framework as described above and is built on common Internet standards for secure email communication.

It is expected that HealthShare Exchange stakeholders will seek to evolve their technical capabilities to include integration with their EHR systems. HealthShare Exchange anticipates supporting end-to-end system connectivity to facilitate email-to-EHR communications. This model can co-exist with the DIRECT model of exchange to ensure that privacy-protected medical data is delivered only to those healthcare stakeholders who are authorized to evaluate this information, for care management purposes only.

What is the schedule and timeline for HIE technology implementation?

Once HealthShare Exchange selects a technology partner, an implementation schedule will be developed for the exchange. This schedule will include those hospitals and payers that have executed Letters of Commitment to the exchange and that wish to be part of the initial deployment phase of implementation. This plan and timeline will be developed in collaboration with the selected technology vendor. 

When ready, HealthShare Exchange anticipates a rapid deployment of health information to be exchanged given the deployment of a DIRECT model for initial health information exchange. 

How will participating stakeholders connect to the exchange? What resources and costs are involved?

How stakeholders connect to the HealthShare Exchange HIE depends largely on the nature of the health care IT tools and systems, such as secure email and electronic health records, that are already in place within their organizations. The most common scenarios for connecting to the HIE are:

  • sending and receiving clinical information via secure email according to DIRECT Project standards;
  • sending and receiving clinical information via a web portal;
  • sending and receiving clinical information from the organization’s electronic health record system. Incoming clinical information would be integrated into the appropriate patient electronic health records. Outgoing information would be sent from those records.

The resources needed by individual hospitals, providers, and other stakeholders to participate in the exchange vary greatly depending on the type of technology already in place and the desired method of connection. The EHRs and other technology in place at most of the region’s hospitals are DIRECT-ready to some degree, so hospitals are well-positioned to participate in the HealthShare Exchange HIE.