Hartford Business Journal

www.HartfordBusiness.com May 25, 2015 • Hartford Business Journal 15 system, and it comes as lawmakers try to close a projected $2.7 billion budget deficit over the next two fiscal years. Co-sponsored by Sen. President Pro Tem Martin Looney (D-New Haven) and Senate Minority Leader Sen. Len Fasano (R-North Haven) the bill has made it through the Public Health and Judiciary committees. As of press time Thursday, it remained uncalled by the Appropriations Committee. Hospitals — which say they support the HIE concept and tax credits to help providers acquire systems — have raised concerns about the bill, which would force them to connect to the exchange within three years or less. Though virtually all Connecticut hospitals have elec- tronic medical record systems capable of con- necting to a statewide network, the Connecticut Hospital Association argues that pieces of the bill related to equipment and service donations to doctors, and who is permitted to access the system, would violate federal law. CHA told leg- islators that the complexity and cost of electron- ic health records makes the effort more suited for federal coordination. They also warned that interoperability across the healthcare system could take another decade. Since 2009, Connecticut hospitals have received approximately $300 million in federal funds to build out their electronic health systems. That money, hospitals say, "has covered only a fraction of the actual costs incurred, with far more work and expense left to be managed." Meantime, UConn Health Center's John Dempsey Hospital said it doesn't have a quali- fied electronic health system, and would have to spend $85 million to get one up and running, the Office of Fiscal Analysis estimates. Competitive concerns It's common for Connecticut hospitals and large provider groups to have advanced elec- tronic medical record systems, particularly since federal incentives for health IT began flowing six years ago. Though hospitals say they are capable of connecting to each other on their own in many cases, Fasano said the various health IT sys- tems employed by hospitals aren't achieving the health and cost benefits that he believes a truly statewide network could bring. And Fasano suspects the problem is more about money and competition than it is about technical complexities. He pointed to an April report from the federal Office of the National Coordinator for Health Information Technology, which found that some large providers used proprietary systems to block patient referrals to outside providers, in an effort to preserve or advance their own market share. "There's a lot of money, corporate money, to defeat the purpose of the health information exchange system, which is sad," Fasano said. Fasano wants Connecticut to purchase a turnkey-ready HIE from another state, like Rhode Island, which he said would be cheaper and take less time. Others states with operating HIEs include New York, North Dakota and Louisiana. Though the exchanges are still young, a 2014 study of an HIE in western New York found that patients had a 57 percent lower chance of hospital readmission when their doctors accessed patient records electroni- cally within 30 days of a hospital discharge, according to the Journal of the American Medical Informatics Association. Picking up the pieces Top of mind for state officials and lawmak- ers pushing for an exchange are the many mis- steps made during the HITE-CT effort, which officially ceased operations last summer. A report authored last year by Minakshi Tikoo, a UConn Medical School assistant profes- sor who coordinated the state's HITE-CT agree- ment with the federal government, described the challenges and eventual failure of the effort. Some board members didn't attend meet- ings. HITE-CT hired a contractor, Axway, to build an HIE that would have cost more than the $4.3 million in federal funds available. The planned system was not ultimately a product that providers wanted, which meant it would not be able to sustain itself, the report said. Axway sued HITE-CT in early 2013 after the board tried to renegotiate the scope of the contract. Work on the system stopped for a full year. HITE-CT settled the suit for $970,000 in late 2013 and the two sides agreed to remove the HIE from the contract. Axway instead built a patient index and health provider directory, which are infrastructure building blocks for an eventual HIE. The infrastructure built by Axway is now in the hands of the Department of Social Ser- vices, which at the direction of the legislature has overseen the state's healthcare IT efforts since HITE-CT's disbanding 10 months ago. Under the new legislation, however, the state Department of Public Health would take over the state's health IT efforts, includ- ing going out to bid for an exchange platform. That could create a territorial scuffle and is one reason DSS is opposing the bill. In an interview, DSS Commissioner Rod- erick L. Bremby did not wish to address any potential inter-agency tension. But he made the case for his agency's delib- erate path towards an exchange that he thinks would ultimately cost less than $50 million to build. Bremby said more work is needed to make sure the state buys or builds a system that providers will be willing to pay to use. He estimated that it may take another three years to get an HIE up and running, depending on provider interest. "I know it's slow going," said Bremby, adding that DSS, which is coordinating with a dozen state agencies, has made progress. DSS, for example, recently completed a revision of the state's health IT strategic plan, and intends to begin talks with providers soon to ensure that a desirable HIE system is offered, he said. n from page 1 Health exchange faces uphill battle

• Cover