State HIT Plan
Alaska is the largest state in the nation geographically, encompassing an area greater than the next three largest states – Texas, California and Montana – combined. At the same time Alaska’s population is among the smallest of the states. The dispersion of such a small number of people over such a large area increases the difficulty and cost of delivering healthcare. Despite having the need, similar to many states, for a secure, coordinated healthcare network, Alaska faces unique challenges – large geography with a small population (~75% of Alaska communities are not connected by road to another community with a hospital; ~ one-quarter of the state’s population lives in towns and villages that are reachable only by boat or aircraft) and severe climate conditions (extreme weather, including snow, ice, and 70 degree below zero temperatures makes travel very difficult during parts of the year). These challenges, combined with a sparsely distributed medical community, physical barriers to communication and a large number of healthcare players create significant disparities in the delivery of healthcare in Alaska. Due to these disparities, there is a critical need for improved communications among healthcare providers through health information technologies in order to speed up healthcare access and provide efficiencies.
Alaska healthcare providers and patients continue to rely on an outdated healthcare infrastructure, with many providers using only paper based systems, which contributes to dangerous drug interactions, missed diagnoses, costly delays, duplicate testing and administrative overhead. According to national studies, these problems contribute to approximately 5 percent of healthcare expenditures or $250 million annually in Alaska and unnecessarily degrade the quality of healthcare for all Alaskans.
In May 2009, the Alaska legislature unanimously passed Senate Bill 133 (SB 133), an act creating a statewide Health Information Exchange (HIE) system that is interoperable and compliant with state and federal specifications and protocols for exchanging health records and data. SB 133 required the Department of Health and Social Services (DHSS) to establish a HIE with a non-profit governing board that represents Alaska's stakeholder communities. In November 2009, DHSS submitted a draft HIT Plan to the Office of the National Coordinator (ONC) for Health Information Technology (HIT) detailing the development of an economical, sustainable HIE in Alaska.
In March 2010, DHSS entered into a cooperative agreement with ONC to create an HIE in Alaska. In accordance with the American Recovery and Reinvestment Act (ARRA), the Governor named DHSS, Division of Health Care Services (DHCS) as the State Designated Entity (SDE) to implement Alaska's HIE under the ONC Cooperative Agreement Program. The Governor also announced Mr. Paul Cartland as the State Health Information Technology (HIT) Coordinator. In April 2010, DHSS contracted with the Alaska eHealth Network (AeHN) to be the non-profit governing board that will procure and manage Alaska's HIE.
In addition to SB 133 the Alaska Health Care Commission (AHCC) was established in December 2008 under Administrative Order 246 (A.O. 246) to address growing concerns over the condition of Alaska's healthcare system. In January 2010 the AHCC, in accordance with A.O. 246, provided a five year (2010 – 2014) strategic plan on transforming healthcare in Alaska. The AHCC was chartered to provide recommendations for and foster the development of a statewide plan to address quality, accessibility and availability of healthcare for all citizens of the state.
For the past five years, DHSS, AeHN, and key healthcare stakeholders have been actively pursuing health information technologies including HIE and promoting Electronic Health Records (EHRs). Continued HIT efforts offer great promise as a means to achieve more affordable, safe, and accessible healthcare for Alaskans statewide. These new technologies are being introduced to bring all levels of medical care together, from general practitioners to specialists, effectively bridging the healthcare gap experienced by many of our communities where shortages of appropriately trained healthcare providers have been difficult to resolve.
The assortment of digital applications available for use by healthcare providers and organizations includes EHRs, Personal Health Records (PHRs), Electronic Medical Records (EMRs), Computerized Physician Order Entry (CPOE) systems, HIE systems. Telehealth systems, such as teleradiology, telebehavioral health, telepharmacy, and distance learning systems utilizing videoconferencing equipment are also emerging as cost-effective ways to improve healthcare quality outcomes. Interoperable HIT systems built with these fundamental components can be utilized to enhance patient safety and continuity of care by streamlining access to critical healthcare information by both clinicians and consumers alike.
The expected outcomes of HIT utilization and having a fully implemented Alaska HIE will be to improve patient access to medical care, improve patient safety, reduce unnecessary testing and procedures, reduce health agency administrative costs, and enhance rapid response to public health emergencies.