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Stakeholders
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Needs
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Hospitals / Health Care systems
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Health Care systems with a multi-campus structure require the ability to transfer health information between campuses. In addition, they require the ability to transfer health information between providers in their network and the hospital campus. Technology options for connected systems include push and pull or bi-directional options.
Stage 2 and 3 of meaningful use will increase the HIE requirements for hospitals and health care systems. It will require these entities to exchange information outside of their networks. Some technology options to offer hospitals include gateways to connect to NHIN, public health, Personal Health Records and others.
Hospitals and health care systems also need the ability to exchange administrative data with payers and the state.
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Primary Care Physicians (from both large and small practices)
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PCPs need to exchange clinical data with providers and hospitals. In addition, they need to exchange administrative data with payers and the state. Stage 2 and 3 of meaningful use will increase the HIE requirements for providers. Potentially, providers will be required to connect to at least three external providers in a primary referral network or establish an ongoing bi-directional connection to at least one HIE. Some technology options PCPs may be interested in, include gateways and clinical (secure) messaging.
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Specialty Care Physicians
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Specialty providers need to exchange clinical data with providers and hospitals. In addition, they need to exchange administrative data with payers and the state. Stage 2 and 3 of meaningful use will increase the HIE requirements for providers. Potentially, providers will be required to connect to at least three external providers in a primary referral network or establish an ongoing bidirectional connection to at least one HIE. Some technology options PCPs may be interested in, include gateways and clinical (secure) messaging.
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Payers
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Payers require a cost effective method for processing electronic claims, eligibility verification, prior-authorizations, and NCQA/HEDIS reporting. Payers are also looking for ways to improve patient wellness and care coordination programs.
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State Medicaid
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According to the Program Information Notice released by ONC for the State HIE Cooperative Agreement Program, state Medicaid agencies must coordinate with the state designated entity or grantee in their state. In some states, the Medicaid agency is the grantee.
State Medicaid agencies are also in the process of upgrading their Medicaid Management Information Systems (MMIS) in accordance with the CMS Medicaid Information Technology Architecture (MITA) initiative. Under this initiative, Medicaid agencies will need to accept electronic claims and eligibility information, and will need to coordinate with the HIEs in their state. A technology option that offers gateways can be useful.
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State Government/Governor's Office and State HIT Coordinator
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The state government, and typically the governor's office, is tasked with the creating a statewide HIE. Each state is pursuing different methods to create a statewide HIE, but many are designating an entity that will act as the HIE for the state. Technology options can include a hybrid federated architecture or a centralized architecture option. Stakeholders make these decisions based on multiple factors.
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Reference Laboratories and Diagnostic Facilities
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Laboratories and diagnostic centers have crucial patient information such as mammograms, x-rays, and medical records needed at point of care to ensure quality of and access to health care. Technology with image exchange can be an important factor for stakeholder buy in.
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Public health
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Public health departments require reporting of immunization data, syndromic surveillance data, and certain lab data. While providers, hospitals, and labs are not required to submit this data electronically, public health departments are pushing towards that goal in order to streamline processes, increase quality of data, and decrease cost. Technology options that offer a gateway to connect public health to the HIE can be important.
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Consumers or patient groups
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Privacy and security are the top requirements of consumer and patient groups. While they want interoperability of health information, it is incredibly important that it be in a secure way, and at the discretion of the consumer/patient. A system with a wide variety of consent configurations, that can be changed along the way, and includes a Patient Health Record gateway can be helpful.
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Purchasers and Employers
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Purchasers and employers have the potential for lowering insurance costs and improving employee health and attendance through the use of health information exchange.
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