Emerging solutions to interstate exchange challenges highlighted by the State Health Policy Consortium project

Background: Through the State Health Policy Consortium (SHPC) project, funded by the Office of the National Coordinator for Health IT (ONC), RTI is providing support services to states to conduct multistate projects to resolve barriers to interstate health information exchange (HIE). Objective/Purpose: As HIE capacity grows across the country, issues related to interstate exchange persist, such as differences among States related to patient consent. Others are emerging, such as the trust fabric between the entities that enable HIE in each state. The work of the SHPC project is to support forward looking solutions to enable exchange, regardless of geographic location. Methods: Applicants are asked to submit a 2-page concept summary of the issue and proposed activities, outcomes, and support requested. All applications must have three or more states involved in the project and each entity is required to achieve support from their State HIT coordinator. Results: Active SHPC projects cover a number of issues including: coordination of consent requirements and management, brokering exchange between Health Internet Service Providers (HISPs), supporting the exchange of behavioral health data between states, utilizing health IT to enable exchange during a natural disaster, building shared provider directories, and creating a shared repository of HIE interface specifications. Discussion/Conclusions: A number of common themes have emerged as global issues among the various consortium projects. These include the use of Direct secure messaging as an interim step while the structures for query-based systems are being set up, enabling the fabric of trust between various entities involved in each individual HIE project, and the technical ability to create interfaces between systems that will allow more advanced exchange to occur between states. Consortium projects have begun to yield lessons learned, best practices, and other tools and resources that can assist other states to address these issues when they encounter them.