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The State of Arizona is advancing an initiative for improved health information technology (Health IT) and health information exchange. With this initiative, the Arizona Government Information Technology Agency (GITA) seeks to improve the quality of patient care while reducing heath care costs.

According to Brad Tritle, Executive Director, Arizona Health-e Connection and former Strategic Initiatives Manager of Arizona's GITA, the initiative has the potential for enormous savings. "Up to 10 percent of health care costs each year could be saved with successful health information exchange," Tritle says.

AHRQ, in collaboration with the Office of the National Coordinator for Health Information Technology, provided funding to the Research Triangle Institute (RTI). RTI then formed a Health Information Security and Privacy Collaboration, granting funds to 34 states and territories for health information exchange and health IT efforts.

"Thanks to AHRQ, we have made great headway in addressing security and privacy concerns relating to legal and process issues that are barriers to health information sharing," says Tritle. He continues, "Improved health IT and health information exchange will significantly help payers. And, because the state is the largest employer in Arizona and is self-insured, covering approximately 120,000 people, the state has much to be gained with this savings."

Arizona has experienced momentum and interest in building support for health information exchange and health IT since September 2005, when Governor Janet Napolitano issued an Executive Order to develop the Arizona "Health-e Connection Roadmap." The roadmap is a plan outlining where efforts should lead within the fields of technology and health care. Governor Napolitano assembled hospitals, health plans, consumer groups, doctors, pharmacists, and laboratories to create the roadmap.

Within six months, the Health-e Connection Steering Committee had developed a completed roadmap for Arizona to achieve statewide electronic health data exchange among insurance companies, health care providers, and consumers of health care. The project also explored issues related to electronic medical records.

The major components of the roadmap include the following:

• Encouraging adoption of health information technology among health care providers.
• Identifying key infrastructure components that enable providers to exchange health information securely.
• Implementing both regional and centralized initiatives.
• Developing a not-for-profit, public-private governance organization with representation from all major stakeholders to provide leadership in implementing the roadmap (Arizona Health-e Connection is currently transitioning to the governance organization envisioned in the roadmap).
• Creating a value-driven, self-sustaining funding structure with many costs borne by those receiving benefits.

Through the Health-e Connection roadmap process, Arizona leaders identified privacy and security issues as a major concern in creating an e-health information exchange. Tritle notes that during the course of the work on the Health Information Security and Privacy Collaboration (HISPC) grant, it was discovered that many business practices related to health information privacy are actually stricter than HIPAA requires.

A legal working group has been established to address statutory and regulatory amendments that may be needed in Arizona to facilitate the sharing of health information. In addition, a technical working group is addressing role-based access and authentication for a master provider index.

"The work of these groups is the result of a contract extension to continue the work of the Arizona Health Privacy Project. By addressing our legal issues, we will be able to move forward with technical design to address access and authentication," explains Kim Snyder, Arizona Health Privacy Project Manager.

Now, Tritle says, "Arizona is poised to address the challenges related to health care security and privacy, guided by emerging national standards and best practices. This requires consideration of unique challenges based on Arizona's political culture, urban/rural healthcare delivery mechanisms, and the state's rapid growth rate."

On the Health IT side, the roadmap addresses electronic medical records, e-prescribing, practice management systems, and strategic health IT systems. For health information exchange, projects were outlined for patient health summaries, automated laboratory results delivery, patient record locators, a statewide Web portal, personal health records, public health alerts and queries, and secure instant messaging for the transmittal of health information.

Arizona Governor Napolitano and the State Legislature established a grant program to facilitate health information exchange-and the adoption of health information technology-among rural health care providers. The program was funded at $1.5 million for fiscal year 2007, and has been subsequently funded at the same level for fiscal years 2008 and 2009.

In the first year, the program funded the implementation of electronic medical record systems, core IT systems, and home telehealth programs, impacting 178,000 patients in over 30 rural Arizona communities. Future funding will be used as incentive to establish Regional Health Information Organizations in rural Arizona, as outlined the Health-e Connection Roadmap.

Arizona's project is consistent with the goals established by the Federal government to achieve 100 percent electronic health data exchange between payers, health care providers, consumers of health care, researchers, and government agencies as appropriate.

RTI International established HISPC under its Privacy and Security Solutions for Interoperable Health Information Exchange contract with AHRQ, awarded in September 2005. The contract is co-managed with the Office of the National Coordinator for Health Information Technology.

More information about Arizona's program is available at .