You asked for information on Connecticut's and other states' activities concerning electronic health records.

SUMMARY

Generally, an electronic health record (EHR) is a personal medical record in digital format that is typically stored on and accessed through a computer or a network. It almost always includes information relating to the current and historical health, medical conditions, and medical tests of its subject. In addition, EHRs may contain data about medical referrals, medical treatments, medications and their application, demographic information, and other nonclinical administrative information.

As of 2006, adoption of EHRs and other health information technology (HIT), such as computer physician order entry (CPOE), has been minimal in this country. According to some surveys, less than 10% of American hospitals have functioning CPOE systems while an estimated 17 to 24% of physicians in ambulatory settings use EHRs to some extent (Health Information Technology in the United States: The Information Base for Progress, Robert Wood Johnson Foundation, 2006). Some of the reasons for the slow rate of adoption of HIT and EHR are:

1. interoperability (without interoperable EHRs, physicians, pharmacies and hospitals cannot share patient information; there are currently multiple competing vendors of EHR systems);

2. adding older records to EHRs;

3. privacy, that is, ensuring adequate confidentiality of the electronically managed individual records;

4. preservation of records;

5. legal status of EHR (medical records are legal documents which must be kept in unaltered form and authenticated by the creator);

6. customization (pricing for EHR systems is highly dependent on each practice's unique needs); and

7. social and organizational barriers such as restructuring workflows, physicians' and institutions' resistance to change, and creating a collaborative environment between health care providers and the IT community.

HIT and EHR-related state activity over the past few years has focused on a wide range of issues, including (1) authorization of a commission, committee, council, or task force to provide leadership, advise and make recommendations for statewide activity; (2) development of a study, plan, or recommendations to encourage HIT adoption; (3) integration of health care quality goals with HIT, including use of EHRs; and (4) creation of a grant or loan program designed to support HIT adoption or the electronic reporting of information.

Minnesota has been particularly active on these issues, establishing a private-public collaboration known as the Minnesota e-Health Initiative. Its purpose is to accelerate the adoption and use of HIT in order to improve health care quality, increase patient safety, reduce health care costs, and improve public health. It is guided by a statewide advisory committee that has developed recommendations for action.

Following is an overview of HIT and EHR activities in a number of states. (Most of the information comes from a 2006 American Hospital Association report entitled Health Information Exchange Projects-What Hospitals and Health Systems Need to Know.)

CONNECTICUT

A 2005 law (PA 05-168; CGA §§ 19a-25b,c) allows licensed health care institutions to create, maintain, or use medical records or medical record systems in electronic format, paper, or both if the system can store medical records and patient health care information in a reproducible and secure manner.

This law also allows health care providers with prescriptive authority to use electronic prescribing systems. The Department of Consumer Protection may, within available appropriations, help them comply with this voluntary effort.

FLORIDA

The 2004 Affordable Health Care for Floridians Act contains several measures aimed at improving access to quality and affordable health care. Those related to health information exchange include requiring public Internet access to medical and health financial information; creating the Florida Patient Safety Corporation to collect, analyze, and evaluate patient safety data and related information, and developing EHRs by the corporation and state agencies.

Also, an executive order issued by Governor Bush in May 2004 (Exec. Order No. 04-93) establishes the Governor's Health Information Infrastructure Advisory Board to advise and support the state's Agency for Health Care Administration in developing and implementing a strategy for adopting and using EHRs and implementing a Florida health information infrastructure. The 11- member board includes health care providers, IT experts, and health care policy experts.

GEORGIA

Legislation adopted in 2004 (SB 204) allows providers to create, maintain, transmit, receive, and store records in an electronic format. The law does not require providers to maintain hard copies of electronically stored records and considers a copy reproduced from an electronic record an original.

ILLINOIS

A July 2006 executive order of Governor Blagojevich creates the Division of Patient Safety in the Department of Public Health to, among other things, encourage all medical providers to use e-prescribing programs by 2011.

INDIANA

Recent Indiana legislation (SB 330, 2005) establishes electronic health care transactions by authorizing the use of electronic signature authentication and identification for individually identifiable health information. This includes the keeping and transfer of medical records, medical billing, health care proxies, health care directives, consent to medical treatment, medical research, and organ and tissue donation or procurement.

KENTUCKY

A 2005 “e-Health” bill, signed by Governor Fletcher in March 2005, creates a board to oversee the development, implementation, and operation of a statewide electronic health information network of voluntary participants using federal and voluntarily contributed funds.

Also, the Kentucky Health Care Infrastructure Authority, a joint venture between the University of Kentucky and the University of Louisville, will conduct research on health information electronic applications, operate pilot projects, and serve as a forum for the exchange of ideas related to health information exchange and infrastructure. The authority reports to the governor and various state agencies.

MAINE

A 2006 law (LD 637) establishes a telecommunications education access fund for qualified libraries, schools, and health centers (Federally Qualified Health Centers and other free-access health centers deemed qualified by the state) to help them pay for acquiring and using advanced telecommunications technologies.

Maine's major health care reform law (the Dirigo Heath Reform Act, PL 469), requires a state health plan. The 2004 plan identified two key objectives for health care quality: (1) improve data and IT systems to provide tools to measure and improve quality and (2) develop incentives and support for an EHR for each citizen while ensuring privacy.

MARYLAND

SB 251 (2005) establishes a task force to study EHR. It is composed of state legislators, deans of medical schools, and representatives of various government agencies and health care sectors (hospitals, laboratories, etc.). The task force must study EHRs and their current and potential use in the state, including electronic transfer, electronic prescribing, and CPOE. It must also address the cost of implementing these items and report to the governor by December 31, 2007.

MASSACHUSETTS

The governor's Executive Office of Health and Human Services is developing a five-year statewide health IT strategic framework and plan. The governor also joined with the Massachusetts eHealth Collaborative to announce the 2005 start of three pilot programs to test large scale, communitywide electronic medical records in three towns.

MINNESOTA

Minnesota is one of the most active states concerning EHRs. During its 2004 session, the Minnesota legislature made expanding the use of interoperable EHRs a top health priority and directed the state Department of Health to convene a group to offer recommendations on how best to accelerate progress in Minnesota.

As a result, the Minnesota e-Health Initiative was established as a public-private collaborative effort to improve health care quality, increase patient safety, reduce health care costs, and enable individuals and communities to make the best possible health decisions by encouraging the use of health information technology. The initiative is guided by a statewide advisory committee with representatives from hospitals, health plans, physicians, nurses, other healthcare providers, academic institutions, purchasers, state and local public health agencies, citizens, and others with expertise in health IT and EHR systems (Minn. Statutes, § 62J.495).

The initiative provides recommendations to the state health commissioner around four broad strategic goals: (1) inform clinical practice principally through widespread use of EHRs; (2) interconnect clinicians to securely share health care information across organizations seeing the same patient; (3) personalize care to help consumers and improve their health care, primarily through widespread access to personal health records; and (4) improve public health by using health information to protect and improve the health of entire communities.

More information on Minnesota's activities is attached.

NEW HAMPSHIRE

2005 legislation directs the state's Department of Health and Human Services to apply for federal funding to develop an electronic health information infrastructure that allows for performance measurement, care coordination, and case management in the delivery of state-funded health insurance services. The legislation also provides that as part of this infrastructure, the department may enter into collaborative agreements with the Department of Insurance, private health insurance plans, hospitals, clinics, physicians' offices, and other health care providers on the use of IT as a means of cost containment and quality improvement in service delivery. These agreements must conform to federal health privacy law (HIPAA).

NEW YORK

In 2004, the state established the Health Care Efficiency and Affordability Law for New Yorkers Capital Grant Program (HEAL-NY). The program provides $1 billion in capital financing to reform and reconfigure the state's health care delivery system and to encourage improvements and efficiency in operations. The state is currently considering applications for the first phase of the health IT initiative in which about $53 million in grants will be distributed. Grants will support the development of clinical information exchange projects, the creation of e-prescribing capabilities, and the use of EHRs.

RHODE ISLAND

SB 2651 (2004) established the Rhode Island Healthcare Information Technology and Infrastructure Development Fund in the Department of Health. The fund's purpose is to promote the development and adoption of health IT to improve the quality, safety, and efficiency of health care services and the security of individual patient data.

In December 2005, Rhode Island received a Robert Wood Johnson Foundation grant to support the state's IT efforts. Rhode Island plans to focus on short-term strategies such as increasing the number of health care professionals who adopt a common set of standards for exchanging laboratory data.

TENNESSEE

An April 2006 executive order of Governor Bredesen establishes a statewide eHealth Advisory Council to advise and support the state as it develops and implements an overall strategy for the adoption and use of EHRs and creates a plan to promote their use by the healthcare community.

A 2004 technology pilot project initiated by the state in 2004 (the Tennessee Volunteer eHealth Initiative) provided the foundation for hospitals, physicians, clinics, health plans, and others in southwestern Tennessee to work together to establish regional data-sharing agreements. TennCare, the state's Medicaid managed care program, was the catalyst for this.

Community Connection, a program operated by BlueCross subsidiary Shared Health, creates a patient-centered community health record that allows multiple providers treating the same patient to view that individual's medical record via a secure web site. TennCare enrollees are the first to participate in the program which will eventually be expanded and offered to all Tennesseans and also made available to other insurers.

VIRGINIA

The Governor's Task Force on Information Technology in Health Care, created by Governor Warner in 2005, is responsible for developing and implementing a state health information system that better uses technology and EHR systems to improve the quality and cost effectiveness of health care. The initial objectives are to evaluate the use of EHR and other technologies to improve the state's health information structures as well as to study how to ensure the privacy and security of health information.

WISCONSIN

Governor Doyle created the eHealth Care Quality and Patient Safety Board via a November 2005 executive order to review and make recommendations on issues concerning the creation of an ehealth information infrastructure in the state. This includes recommendations identifying funding resources and technology options, ensuring privacy and security, and encouraging the adoption of EHRs.

JK:ts