Arizona's Statewide HIE Utility

The Arizona Medicaid Health Information Exchange Utility is a Web-based system for exchanging patients' health records and other medical information among the state's Medicaid providers. [4] It leverages Medicaid's role as Arizona's largest insurer to influence providers to adopt electronic health records and exchange health information. Arizona's objective is to improve patient care for the Medicaid population and, indirectly, for other patients throughout the state.

"This is about health system transformation," says Anthony Rodgers, director of the Arizona Health Care Cost Containment System (AHCCCS), the state's Medicaid agency. "Arizona made an early commitment to managed care as a strategy for cost containment, and we are making an early commitment to technology as a strategy for patient-centered care."

Arizona aims to: 1) give all Medicaid providers access to beneficiaries' health records via electronic connection at the point of service; 2) make quality and cost information available to Medicaid beneficiaries and providers; and 3) develop a new generation of consumer, provider, and payer care management decision support and analytical tools that are integrated with electronic health records. [5]

Starting in June 2008, Medicaid providers in one pilot region, Maricopa County (Phoenix), will be able to exchange patient demographics and eligibility information, patient problem lists, medications, lab test orders and results, radiological results and images, inpatient discharge summaries, and clinical notes. Next, the state will build a data repository and electronic health record system to test in the pilot region and then, as quickly as possible, give all Arizona Medicaid providers access to the system.

AHCCCS operates the HIE through its internal data center, using state information technology staff to provide continuous support. AHCCCS managed care organizations will require their acute care and long-term care contracted providers to use the HIE. The health plans will offer training for providers and, when necessary, set up internet connections at health care settings. Ongoing costs will be part of the AHCCCS information technology budget.

AHCCCS plans to develop the HIE utility with "open source" (i.e., non-proprietary) software, which will give other states the opportunity to use and/or install the applications developed by AHCCCS without having to pay costly licensure fees. However, not every state will be able to take on a project of the same magnitude.

"Arizona Medicaid has several advantages," says Rodgers. "For example, we have a strong, internal IT staff that has the technical competence to handle a project of this complexity. Also, we have credibility with providers who expect the state to take a leadership role in HIT, and nearly every public and private provider already has a contract with the state through our Medicaid managed care organizations."

In addition to state resources, Arizona received a two-year, $11.5 million Medicaid Transformation Grant from the federal government to support the design and implementation of its HIE.