Philip W. Magistro

Gov. Edward Rendell signed an executive order last week creating the Pennsylvania Health Information Exchange, which is a framework that will give health care providers improved access to clinical data and lead to safer and more efficient patient-centered care. The initiative is part of the governor's Prescription for Pennsylvania health care reform plan.

"By offering health care providers the ability to electronically share patient information, we will be able to improve patient care and safety and reduce health care costs that are a result of today's independent information technology systems," Gov. Rendell said in a statement.

The Pennsylvania Health Information Exchange - or PHIX - will provide the information technology architecture to support statewide interoperable electronic health records (EHRs) and electronic prescribing by sharing data that is captured at the point of care in a physician office or hospital. Most doctor's offices, hospitals, laboratories and pharmacies now have their own separate information systems. With an information exchange, those entities will be able to share information with various health care providers and other authorized parties for treatment purposes.

Health information exchanges (HIEs) will help to provide clinicians with important medical details about the patients they treat.

Consider the example of a person who lives in Harrisburg , travels to Erie on business and is involved in an auto accident: He is taken to an Erie hospital's emergency department and has identification, but he is unconscious and can't provide information on his medical history. With an information exchange, the emergency department physician enters the patient's name into a computer and immediately learns that the person had an EKG and blood tests during an annual physical and is taking medications for high blood pressure, high cholesterol and is allergic to penicillin.

The ability for the physician to have access to the patient's recent lab tests, radiology exams, hospital discharge notes and medications prescribed gives him the ability to quickly make the appropriate treatment decisions. Having access to all of the care given to this patient keeps the physician from ordering duplicative tests that may have been recently preformed, thereby reducing costs.

As part of the initiative, the Pennsylvania eHealth Initiative (PAeHI) recently presented two white papers to the Governor's Office of Health Care Reform as a framework for the adoption of the state's HIE, EHRs and e-prescribing.

"Building a Sustainable Model for Health Information Exchange in Pennsylvania " and "Establishing Widespread Adoption of Electronic Health Records and Electronic Prescribing in Pennsylvania " were prepared at the request of the Governor's Office.

PAeHI's recommendations to the governor included the following:

1) Patients come first.
2) Consumer privacy, security and confidentiality are paramount.
3) Multi-stakeholder collaboration is needed to implement achievable and measurable results and provide value.
4) Both the state and payers should provide leadership and financial support, including incentives, to foster broader adoption.
5) Uniform standards must be established regarding EHRs and HIEs.

Philip W. Magistro, health IT project manager in the Governor's Office for Health Care Reform, during a speech on health care policy and IT initiatives last week at Siemens Medical Solutions headquarters in Malvern, Pa., sponsored by Delaware Valley HIMSS, described the governor's executive order for creation of an Office of Health Information Technology, which will oversee the creation of a state HIE.

Magistro said the Office of Health Information Technology will begin the process of selecting a vendor to create the state's HIE. A request for proposal will be created and the initial HIE work will include Geisinger Health System in Danville, Pa.; University of Pittsburgh Medical Center; and Susquehanna Health in Williamsport, Pa. All three health systems have been active in creating regional health information organizations in their respective areas of the state. "The goal, however, is to include everyone from across the state," Magistro said.

" Pennsylvania 's Health Information Exchange comes about as part of the PAeHI's work, which will continue to provide guidance to the state's office of health information technology," he said.

A common discussion with an HIE in any state, Magistro said, is the issue of sustainability. "No revenue stream is planned, though Pennsylvania 's HIE may run on a transaction fee, subscription fee or possibly follow the federal funding model," he said during last week's address.

The Pennsylvania HIE will follow other health information technology standards panels, including Certification Commission for Healthcare Information Technology and the Health Information Security and Privacy Collaborative. Pennsylvania 's HIE is part of the governor's Prescription for Pennsylvania (RxforPA.com) executive order announced in October 2007.

Magistro described the e-health initiative as following the design of the national road system, with a number of driveways leading into it (those being represented by the various participants in the HIE). Interestingly, when Newt Gingrich spoke at Siemens in 2007 he mentioned that a national HIE should model the federal interstate highway system.

In describing the schematic for the state's HIE system, Magistro noted that health care providers would request data, which would then go to a record locator service and a master patient index.

The Pennsylvania Health Care Cost Containment Council estimates that out of $4 billion of medical charges, $3.7 billion are going toward chronic diseases, such as diabetes. As part of Gov. Rendell's Prescription for Pennsylvania health care reform plan, he created the Chronic Care Management, Reimbursement and Cost Containment Commission in May 2007 to improve how Pennsylvanians with chronic disease receive health cre.

The commission will design the informational, technological and reimbursement infrastructure needed to support implementation of the state's chronic care model, which is designed to improve quality outcomes and cost-effective treatments for patients with chronic diseases. Implementation of the Chronic Care Model will be through collaborative arrangements, either statewide and/or regionally.

The importance of a patient registry within the state's HIE was underscored by Magistro. "This registry, when created, will provide treatment recommendations and a Web-based provider EMR," Magistro said. "Electronic health records and e-prescribing are key to the plan and are the building blocks for Pennsylvania 's HIE. Electronic prescribing is an important piece, but we want full EMR adoption as the ultimate solution."

Magistro said that the governor realizes "not every provider will be able to implement an EMR at this time," adding that they could "backfill EMRs into Pennsylvania 's HIE as time goes on." Magistro noted that there is currently not enough money to provide an EMR to every health care provider in the state. As part of the governor's executive order and use of the chronic care model, it is possible that one day there may be the opportunity for payers to provide the EMR, he said.

Mr. Mitchell is managing editor of ADVANCE.