In developing a statewide health information infrastructure, Washington State Health Care Authority (HCA) didn’t have to start from scratch or rely on other state health information exchange (HIE) models.


“We have a lot of infrastructure already in place,” said Richard Onizuka, PhD, of HCA, and the lead person for the December 1st report (pdf), “Washington State Health Care Authority Health Information Infrastructure: Final Report and Roadmap for State Action.”


Washington State has two well-regarded and established HIEs: Whatcom County Health Information Network in Bellingham connects community health services, payers, hospitals and physician offices via an Intranet and Inland Northwest Health Services connects Spokane-area hospitals and regional medical services.


What advice did Onizuka have for other states developing an HIE roadmap? “Take advantage of your state’s existing health information infrastructure.”


The State has a huge advantage, with its various communities taking charge and collaborating with physician networks, large multi-specialty clinics, community health and tribal health services, and investing in health information technology.


Electronic medical record (EMR) adoption is fairly high in Washington State. Twenty-five percent of ambulatory providers, more than 50 percent of small physician offices and 88 percent of the state’s 24 largest multi-specialty clinics have EMR systems.


One of the other important aspects of the report is the recommendation for using a health record banking model. Onizuka said this model best fits Washington State’s needs because it was scalable, financially sustainable, consumer friendly and trustworthy and worked with the existing health information infrastructure.


The health record banking model allows consumers to decide who has access to their secure health records and which parts of their medical records they wish to be deposited in a health record bank. The health record banks would be set up to accept queries for authorized public health and research purposes.


As the health record banks are designed, HCA’s focus will be on assuring consumer trust, implementing standardized interfaces and securely managing the identification of providers and consumers.


“In recommending health record banks, the Washington State HIIAB has identified a secure, efficient, and cost-effective solution to reliably providing anywhere, anytime availability of medical records for both clinical encounters and patient-authorized medical research,” said William A. Yasnoff (pdf), MD, PhD, managing partner of NHII Advisors.


Yasnoff was a project consultant for HCA. “Since this approach empowers individuals to control all access to their own health information, it gives each consumer the freedom to establish their own personalized privacy policy,” he said. “It also leverages existing infrastructure by allowing operational medical record systems to be converted into health record banks. These advantages will likely lead to rapid adoption and widespread use not only in Washington State, but in other communities across the nation.”


Onizuka said the response to the report has been favorable. Right now HCA and the Health Information Infrastructure Advisory Board (HIIAB), which collaborated with HCA to put out the report, must wait to see if Governor Chris Gregoire puts the recommended funding in his budget. The report calls for the State to invest $8 million to $11 million to complete the initial design work and implementation plan, and partly fund between six to eight initial implementation sites for health record banks.


Onizuka said that the HCA has received positive signals from both the governor and legislature, which will look at the budget in January 2007. Still, should the amount of funding be cut, it only means that the number of pilots will be reduced.


In the meantime, HCA is on a mission to promote electronic medical record adoption in the healthcare provider community (recommendation number 4) and educate consumers and gain their trust in a health record banking model.