Texas Health Information Exchange

Health Information Exchange
The U.S. government established Health Information Exchange (HIE) to help improve patient care across the country. This mandate was created on the premise that sharing health information across, between, and within health communities would help enhance an individual’s healthcare experience across their lifespan (Wu & LaRue, 2017). As part of this process, many hospitals in the United States have electronic health records, but only a few participate in computerized health information exchange. Nonetheless, states have also adopted HIE as a premise for sharing patient health information between healthcare providers like hospital and nursing facilities, home health agencies, and private practice physicians. States like Texas has adopted HIE as a means of enhancing patient care and outcomes among different patient populations in the state. This paper examines the current state of development for Texas health information exchange and current participation rate.
Current State of Texas Health Information Exchange
The evolution of Texas’s healthcare market is influenced by various factors including the size and diversity of the state as well as its dependence on private sector solutions to meet public needs (National Opinion Research Center, 2013). Texas is one of the largest states in America whose geographical distribution includes several large, densely populated cities that are spread across huge stretches or rural areas. However, the state has predominantly small physician practices since nearly 75% of Texas’ physicians are in small practices. Over the past few years, Texas has experienced changes in its healthcare sector and market due to regulatory changes that permit medical institutions to employ physicians in healthcare settings for resident training programs. This has contributed to the development of more networks by hospitals and physician groups to help enhance patient care across the state. Since most hospitals and systems are seasoned electronic health users, the engage in private exchange of health information. As of 2010, Texas had spent more than $28 million in its health information exchange program. These funds were channeled toward creating a strategic and operational plan for HIE and provided by State Health Information Exchange Cooperative Agreement Program (Texas Health and Human Services, 2018).
The current state of development of health information exchange in Texas entails implementation of the three strategies of the Texas State HIE plan (Texas Health Services Authority, 2017). These strategies were developed and are currently implemented as part of the strategic and operational plan created through the state HIE program. The strategic and operational plan contributed significantly to the development of HIE infrastructure across the state both at the state and local levels. Currently, Texas’ health information exchange is in Stage 5 of development i.e. operating stage, which focuses on the establishment of a fully operational health information organization. This is evident in the fact that local HIE organizations in Texas have established connectivity, technical services, and governance throughout the state. The Texas Health Service Authority acts as the state HIE organization as its connects local HIE organizations through establishment of technical services. The Authority also coordinates the administration of the various HIE organizations across the state to establish confidence in the legal and technical foundations of the HIE infrastructure.
Participation rates in Texas health information exchange is significantly high since most of the existing hospitals and healthcare systems across the state engage in private health information exchange. These high rates are also attributable to the fact that Texas has adopted a thin-layer strategy approach for developing and establishing health information exchange. Through this approach, the state promotes local health information exchange solutions that are centered on community needs. The approach is characterized by provision of general state-level operations for HIE, establishment of a competitive grant program for HIE, and development of a white-space coverage program to offer direct services to healthcare providers (National Opinion Research Center, 2013). The establishment of local HIE programs that focus on community needs has made it easy for hospitals and healthcare systems in Texas to engage in health information exchange and resulted in high participation rates.
Texas health information exchange seeks to enhance patient care and outcomes through improving exchange of health information among physicians and hospitals. Through the local health information exchange programs, the state HIE has the ability to enhance coordination of care. In this regard, Texas HIE provides a framework for healthcare providers to work together in addressing the growing awareness and demand for better coordination of care. Local health organizations work collaboratively to identify community healthcare needs and develop healthcare practices that are centered on coordination between different care providers. This results in public health initiatives that are based on community needs as the various players in Texas health sector understand and address public health needs and concerns. Through exchange of health information among and between local healthcare providers, evidence-based research is utilized as the premise for developing healthcare practices that help to address public health needs. Local hospitals and healthcare systems share data on evidence-based practices that can be utilized to address different healthcare conditions in Texas.
Texas HIE vs. Other States
There are other states with similar demographics to Texas that have adopted relatively different approaches in health information exchange. Some of the states with similar demographics to Texas include California, Florida, and New York. Unlike Texas, New York has adopted a wide-layer approach for its health information exchange in which various regional HIE organizations are established. These regional HIE organizations in New York are linked to a network of networks known as the Statewide Health Information Network for New York (SHIN-NY). This network permits the electronic exchange of clinical information and provides statewide linkages of regional HIEs. The linkages are managed by the New York eHealth Collaborative (NYeC) and supervised by the New York State Department of Health (Landi, 2018). Due to the existence of different regional HIE organizations, New York HIE has been characterized by controversies because of competition between these different HIEs.
In California, the State government has contracted health information exchange capabilities to an existing health information organization (HIO) i.e. the California Office of Health Information Integrity (CalOHII). This organization is mandated with the task of managing exchange of health information between providers, hospitals, and other relevant bodies. CalOHII collaborates with the state Department of Public Health and other state agencies to manage health information exchange through public-private partnership. On the contrary, health information exchange in Florida is a combined effort between a previously existing state agency and a newly established organization. In this case, the previously existing Florida Agency for Health Care Administration works in collaboration with the newly established Florida Health Information Exchange to manage exchange of clinical information between healthcare providers (Health Information & Law Project, 2013).
In conclusion, health information exchange has emerged as a crucial component in improving patient care and outcomes. Technology adoption in the healthcare sector has contributed to the establishment of electronic health records for managing patient data. Healthcare providers are required to exchange clinical information electronically to help shape healthcare practices and enhance patient care processes. As a result, the U.S. government established health information exchange (HIE) to help healthcare providers exchange clinical information for improved care practices. States are increasingly developing and establishing their health information exchange infrastructures and programs. As shown in this discussion, California, Florida and New York utilize different approaches for health information exchange in comparison to Texas. Texas utilizes a thin-layer strategy that comprises local HIE organizations and has a significantly high participation rate in HIE.



References
Health Information & Law Project. (2013, December 13). Status of Health Information Exchanges: 50 State Comparison. Retrieved January 24, 2019, from http://www.healthinfolaw.org/comparative-analysis/status-health-information-exchanges-50-state-comparison
Landi, H. (2018, September 24). One New York Regional HIE Opposes Expansion of Another, Highlighting Issues with Competition Among HIEs. Healthcare Informatics. Retrieved January 24, 2019, from https://www.healthcare-informatics.com/article/hie/one-new-york-regional-hie-opposes-expansion-another-highlighting-issues-competition-0
National Opinion Research Center. (2013). Evaluation of the State Health Information Exchange Cooperative Agreement Program. Retrieved from U.S. Department of Health and Human Services website: https://www.healthit.gov/sites/default/files/tx_casestudyreport_final.pdf
Texas Health and Human Services. (2018). Statewide Health Information Exchange. Retrieved from Texas Government website: https://hhs.texas.gov/about-hhs/process-improvement/health-informatics-services-quality/statewide-health-information-exchange
Texas Health Services Authority. (2017, October). 2014 Texas State HIE Strategic Plan. Retrieved January 24, 2019, from http://www.thsa.org/wp-content/uploads/2017/10/StateHIEPlan_THSA_2014.pdf
Wu, H. & LaRue, E.M. (2017, October). Linking the Health Data System in the U.S.: Challenges to the Benefits. International Journal of Nursing Sciences, 4(4), 410-417.