ALBURQUERQUE, NM – By Dec. 11 the New Mexico Health Information Collaborative will find out whether it will be one of the first-round picks to become a federal Health IT Regional Extension Center.

New Mexico Gov. Bill Richardson recently designated NMHIC as the state's official health information exchange network.  In 2004, NMHIC received a matching grant from the Agency for Healthcare Research and Quality for $1.5 million over three years to support health information exchange (HIE). Early on, the collaborative had gotten several stakeholders to the table for this initiative, including large healthcare providers, state and national payers, employers, state agencies, academic institutions and consumers, said Maggie Gunter, president of NMHIC.

Since its founding by the Lovelace Clinic Foundation in 2004, NMHIC has established pilots to build the architecture for HIE and was one of nine participants in the Nationwide Health Information Trial Implementations.

"This gave us the ability to build a robust infrastructure," said CIO Dave Perry.

Investing in technology

NMHIC began to invest more heavily in technology to support the needs of its initiative.

NMHIC partnered with MedPlus, which put interfaces in the various healthcare providers' systems to enable the sharing of data across institutions. Thus far, its Master Patient Index has nearly 900,000 unique patient IDs, which is remarkable, given that there are just under 2 million residents in the state, said Gunter. NMHIC operates under a federated data model, which means data is stored on the data supplier's edge server.

Parallel to the HIE efforts, NMHIC has collaborated with the New Mexico Primary Care Association and the New Mexico Medical Review Association - the state's health quality improvement organization, to help drive physician adoption of health IT.

"We need to deploy EHRs with the purpose of demonstrating meaningful use," said Gunter. "We're excited for the opportunity to reach out to the smaller practices and Federally Qualified Health Centers around the state."

Many of New Mexico's primary care physicians are in practices of fewer than 10 physicians. The three-organization partnership hopes to have 1,000 physicians reach meaningful use of EHRs over a two-year period.

Taking on new challenges

In the past five years, NMHIC has made significant progress, although it's been a struggle to get all stakeholders to agree on policies and governance, which would allow the collaborative to go into production and provide data to clinicians at the point of care, Perry said. NMHIC has also had to address privacy issues around data exchange. The state, which has more stringent privacy laws than HIPAA, had to pass legislation to view electronic records as legal records, Gunter said.

"We're almost there," Perry said. Users will be coming onto the systems the first half of 2010, with urgent care and emergency departments a priority. NMHIC is working with the New Mexico Department of Health to provide electronic reporting of lab data and providing emergency departments with summary information at the point of encounter. NMHIC is currently determining what the they need, Perry said.

Up until now, NMHIC has been trying to define its sustainability model, Perry said. The collaborative has been able to demonstrate the benefits of HIE to payers in the form of reduced duplication of lab tests and radiology services. "We've made a good business case," he said. Although supportive, payers have not yet made the financial commitment. That's where ARRA funding becomes critical. "ARRA gave us the needed breathing room to continue talks with the payers and find a way to distribute costs equitably across stakeholders," Perry said.

"The ARRA laws have been a godsend," he added. The funding will help speed the expansion and focus on EHR deployment and meaningful use, he said. Gunter anticipates requiring $15 million to have patient records of all residents within the next four years but expects to receive $7 million from the ARRA HIE funds.

Since ARRA passed, more physicians have signed letters of commitment, he said. A number of hospitals have also approached NMHIC, Gunter said. "They recognize that this is a good thing; there is technical assistance and federal incentive for reaching meaningful use," she said.

NMHIC recently received a national foundation grant that will enable the collaborative to assess health information exchange's impact over time on key outcomes such as the reduction of duplicative lab and imaging tests, Perry said. "This is perfect timing to measure adoption and use and compare before and after," he said. The assessment will not only allow NMHIC to quantify the benefits, but it will help the industry quantify the benefits of health information exchange, he said.