JEFFERSON CITY, MO – The Missouri Health Connection (MHC), which is under negotiations with Cerner to have the IT company be its technology service provider for the statewide health information exchange (HIE), is aiming to provide a direct-messaging query service by early January 2012, according to its president, Raul Recarey.

That's an aggressive timeline for the state-designated entity and public-private organization that began its HIE journey in December 2009. MHC, however, is on a mission: "It's important for us to roll out direct messaging as quickly as we can," Recarey said.

See also: Missouri health system to roll out new EHR.]

MHC is ironing out the details with Cerner in order to put together a timeline and milestones. The first phase, however, will be the deployment of secure direct messaging in a pilot, Recarey said. MHC is identifying which areas make the most sense to deploy the service and serve as a proof of concept for the rest of the state.

Direct messaging will be implemented in two phases. The "push" method enables providers to send or push patient data to another provider via a secure private virtual network. Cerner will be serving as the health Internet service provider, and MHC will act as the authenticating agency to ensure that the right user is accessing the right data at the right time. In this phase, healthcare providers need not have an electronic health record (EHR), he said. The second phase, the "push-pull" method, will enable query-type exchanges and require healthcare providers to use a certified EHR in order to query and pull up Continuity of Care Documents.

Now that MHC has signed on Cerner, the state-designated entity can "plug numbers in the calculator" and begin the complex work of developing a fee structure, Recarey said. The $13.8 million in federal funding under the American Recovery and Reinvestment Act is a "down payment" to help spur the statewide HIE along, but he said that members will need to create a financially sustainable program and a fee structure for all participants. MHC has already conducted a "tremendous amount" of analysis, sensitivity studies and surveys, he said.

[See also: Patient-centered medical home requires an EMR system.]

MHC receives no foundation grants or a line item in the state budget, although potential revenue sources exist. The state Medicaid agency, for example, needs an interconnectivity solution for its clinical system and MMIS (Medicaid Management Information System). Rather than build out its own unique system, the state agency will hire MHC to leverage its central exchange. "It's more cost-effective," Recarey said.

MHC comprises members of the state government, consumer advocacy groups, professional organizations, physician practices and private healthcare organizations. "It's everybody really at the table," he said. "It's one of the strong points in Missouri - a strong collaboration over a broad group of stakeholders." Having "everybody at the table" will ensure that Missourians are the "ultimate beneficiary," according to Recarey.

"This is something that's going to really empower folks to start taking control of their medical information," he said. "The real hope that everybody has is that this will empower individuals to take a proactive role in the management of their condition."