The board responsible for overseeing electronic health information exchanges in the state continues to move slower than the state's leading hospital and doctor groups would like.
Today, at the board's monthly meeting, leaders of the Kansas Hospital Association and the Kansas Medical Society urged the panel to adopt standards already developed by the federal government for determining what basic medical information is available for exchange among providers.
"Isn't this something we can do now?" asked Jerry Slaughter, executive director of the medical society.
"I don't think we need to chew on this. I think we just need to do it," said Dr. Jennifer Brull, also a member of the KHIE, Inc. board and a leading advocate for the adoption electronic health data.
But other board members — including Karen Braman, the chair, and Helen Connors — said they preferred to have more information before adopting the federal standards even on an interim basis.
"I think we need to make an informed decision about this," Braman said. "It wasn't even on the agenda."
Ultimately, the board voted to send Connors to a meeting of extension center officials and representatives of one or more of the electronic health record vendors. She was authorized to convey the board's support for adopting standards that would at minimum accept the basic federal standards plus immunizations. The board also agreed to take the matter up again at its August meeting.
KHA letter to the KHIE board
'Artificial barrier to connectivity'
Slaughter and others said it was important to get some movement on the standards because without any indication of the board's intention the vendors of electronic health record systems are being murky about the pricing for their products and services.
That murkiness prompted Tom Bell, president of the Kansas Hospital Association, and also a member of the KHIE, Inc. board to write a letter to the board (PDF), which was included in the meeting materials.
"There is real concern that some vendor practices are creating an artificial barrier to HIE connectivity in our state. It is our request that KHIE should examine the environment...and help find solutions," Bell wrote. "If these issues are not addressed, KHIE may lose the ability to create an exchange environment in Kansas that meets the needs of our state."
At issue are: EHR installation fees, monthly fees, so-called "hub" fees, as well as a general lack of transparency in pricing by vendors.
Michael Aldridge is director of the Kansas Regional Extension Center, which acts as a liaison between health care providers and EHR vendors.
He told board members that seven of the eight EHR vendors endorsed by his office would not commit to a comprehensive pricing schedule until KHIE sets the standards, which technically are known as the "Minimum Data Set of Operability." Before that data set is determined, he said, vendors cannot determine an exact cost for tailoring software to handle the data.
It is up to the KHIE board to establish the minimum data set in Kansas.
The existing federal "minimum use" standard for electronic health information includes six data types: demographics, medications, allergies, lab results, problem lists and diagnoses. Some members of the KHIE board asked that a seventh data type, immunizations, be added.
KHIE policy draft
In other business Wednesday, the board:
• Received from its policy subcommittee a first draft of regulatory decisions (PDF) the board could act upon perhaps as soon as the next meeting. One was to decide whether patients should be allowed to opt "all-in or all-out" on sharing of their medical information among medical providers. That is, patients could opt completely out of having their health information transmitted electronically, but they couldn't elect to just withhold certain types of information, such as histories of mental illness or sexually transmitted diseases.
• The board discussed how to proceed with recruiting a chief executive officer. A search subcommittee had identified three people qualified for the job. It offered the job to one who declined; the second candidate had already taken another position; and the third candidate was not offered the job because the search committee felt he "wasn't a good fit from a policy standpoint," Braman said.
The board decided to weigh at its next meeting the relative costs of hiring a recruiting firm or hiring an interim CEO who would then help conduct the search for a permanent CEO.
Board member Dr. Mike Atwood said without a CEO, KHIE lacked a public leader, a face and a voice in the provider community.
"I feel we are shirking our duty if we continue to allow a vacancy in leadership," Atwood said.
• Heard it had final approval of its Strategic Operation Plan (PDF) from the Office of the National Coordinator, which means that the remaining $8.1 million of a $9 million grant from the ONC is now available to fund KHIE operations.
• Discussed buying insurance to protect against potential lawsuits stemming from breaches in privacy protection or security or other problems. Without protection for anti-trust lawsuits, the annual premium would be $4,758 with a $100,000 deductible for $1 million in coverage. The board decided to purchase the insurance, provided that the ONC grant dollars can be used for that purpose.
• Agreed to retain a law firm and its subsidiary for consulting services. Spencer Fane Britt and Browne from Overland Park will provide legal consulting. One of its lawyers, Jeff Ellis, has been working with the group since it started taking shape several years ago. The firm's health care strategy subsidiary will also be retained for policy development consulting.
The board meets next at 11 a.m. August 12 at the Kansas Medical Society (map). The meetings are open to the public.