State of Nevada Promotes Collaboration and Information Exchange Across the Health Economy

Capgemini works with Nevada Department of Health and Human Services to accelerate the implementation of Health Information Technology.

The Situation

US health care is undergoing rapid transformation as a result of the Health Information Technology for Economic and Clinical Health (HITECH) Act, passed as part of the American Recovery and Reinvestment Act of 2009. HITECH has injected over two billion dollars of investments in the creation, deployment, and adoption of Health Information Technology (HIT). While the funding is coming from the Federal government, the majority of the funds have been awarded at the State level. State-designated HIT coordinators are responsible for fostering a technical architecture that facilitates electronic Health Information Exchange (HIE) and adoption of federally-certified electronic health records systems (EHRs) by 2014. While EHRs digitize vital medical information on patients in hospitals and primary care settings, the HIEs allow that information to be shared electronically between health care providers in a way which has the potential to enhance the connectivity of services, medical outcomes, and the patient experience. The overall goal of HIE is quality, safe coordinated health care services.

As part of the Federal program, the Nevada Department of Health and Human Services (DHHS) was awarded approximately $6.1 million in 2010 to develop a State HIT Plan and establish a statewide HIE system. While the funding offers significant opportunities for Nevada, the implementation of a statewide HIE faces challenges in achieving integration across its 5,400 providers and 56 hospitals, as well as rapid population growth, shortages of health care professionals in certain areas (including urban centers), many smaller providers in rural and frontier parts of the State, and a fragile economy overall.

The $6.1 million in Federal funding is being administered by the US Department of Health and Human Services, Office of the National Coordinator (ONC). ONC is the Federal organization that is responsible for maintaining alignment of the overall State HIE program and to monitor the use of Federal funding. As part of the funding requirements, DHHS needed to create and have approved a State HIT Strategic and Operational Plan.

The Solution

To initiate its HIE program and meet program requirements for including key stakeholders in the planning process, Nevada Governor Jim Gibbons appointed the Nevada HIT Blue Ribbon Task Force to assist DHHS with developing the State HIT Plan. Task Force members represented a cross-section of stakeholders from provider and payer organizations, Medicaid, higher education, pharmacies and consumers, to provide feedback and recommendations which would shape the development of the strategic plan and proposed supporting legislation. DHHS worked with the Nevada Legislature to pass Senate Bill 43 on May 31, 2011. Aligned with Nevada’s State HIT Plan, this HIE-enabling legislation was signed into law by Governor Sandoval on June 13, 2011.

In parallel, the State also selected Capgemini to assist DHHS with the development and preparation of its State HIT Strategic and Operational Plan. The Capgemini team applied its knowledge of best practices in health care IT to define the overall approach and execution required to build, achieve adoption of, operate, launch and sustain a successful statewide HIE system in Nevada.


The Result

The plan was finalized and submitted to ONC in late January 2011, with approval granted in late May 2011. Key components of Nevada’s State HIT Plan include:

– Financial Sustainability
As part of the State’s strategy, a non-profit 501(c)(3) business entity will be established. This organization will develop, implement and operate the Nevada HIE Governing Entity (NV HIE). Accountable to the State HIT Authority, the NV HIE will include the required statewide HIE governing board. The entity will provide core, general and value-added HIE services, and assist the State HIT Authority in certifying other HIEs who wish to participate in the statewide system. Like any other business, its sustainability will depend upon offsetting costs against incoming revenues.


– Interoperability
The NV HIE architecture will be scalable, flexible, and underpinned by a community-driven SOA approach. It will connect and share information from disparate sources and provide a platform from which individual HIE services can be organized. The NV HIE will provide enabling meaningful use functionality including authentication, database services, integration services, interface services, and industry standard EMR (CCHIT certified) and HIE connectivity.

To facilitate interoperability, the NV HIE will support common applications and services from the central HIE platform, resulting in a shared service model which reduces both risk and cost, and helps smaller providers overcome financial barriers to utilizing HIE.


– Meaningful Use of EHRs
The plan identifies three key areas where providers in Nevada need additional support to meet Federal Government requirements for meaningful use of certified EHR systems. It provides an approach for driving full adoption of EHRs across organizational boundaries.

One of these areas is ePrescribing. Although in 2009 some 39% of providers in Nevada used systems which included ePrescribing functionality, only 13% of the prescriptions they generated were routed electronically. Often this was the result of small, independent pharmacies in rural areas having been slow to replace manual methods with a digital process.

To address this, the plan outlines measures for improving broadband connectivity between providers and pharmacies, incentivizing ePrescriptions, and engaging pharmaceutical companies to lead awareness and education efforts.
In June 2011, Nevada DHHS announced that the State HIT Plan had received approval from the ONC, paving the way for the establishment of a statewide electronic health care information exchange system. Nevada’s Governor Brian Sandoval commented: “Advancing the deployment of health information technology will not only improve the quality and efficiency of health care for Nevadans, it will also offer economic and workforce development opportunities.”


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