The Wyoming Department of Health (WDH) this week awarded a $4 million, 3-year contract to Affiliated Computer Services, Inc. to build a network and electronic health record system that will enable providers to access and share clinical information on the state's Medicaid patients.

The WDH is well positioned to lead the effort to improve health information connectivity within the highly rural state, according to Wyoming Medicaid director Teri Green, who said Medicaid has a provider enrollment rate of nearly 100 percent.

"Right off the bat, that gets us connected with just about everybody," she said, noting that WDH spent three years planning and designing the HIE. "And that connectivity, we feel, is just key to providing more access to health care services and health care information."

The plan is to eventually expand the HIE to include information on Medicare and privately insured patients. WDH, which expects to apply for federal stimulus funding, is paying for the current contract entirely with state funds but hopes that as the network is expanded, other payers will assist with funding by paying for the information exchange required for their respective patients.

The HIE initially will provide hospitals and physician practices free access to a robust database of Medicaid claims data. Clinical information will be added over time by providers, as well as lab results, immunization records and Medicaid management information such as prior authorizations.

ACS, which has been providing fiscal agent services to Wyoming since 1993, will also install a clinical rules engine that analyzes a variety of health and management data and then generates alerts for physicians.

"Our experience with physicians is that they want information that's very accurate, doesn't contain false positives and is very digestible," said Will Saunders, chief operating officer of Government Healthcare Solutions for ACS, which was recently acquired by Xerox Corp. for $4 billion.

"We've been doing that for our customers for years. The major difference now is that we'll have access to this clinical data that the HIE can supply to our rules engine."

The EHR will have several components, Green said. ACS will build interfaces for automated access by EHR systems now being used by Wyoming providers. A Web-based "EHR-lite" will allow providers who have yet to invest in an EHR to access patient health histories in the Medicaid database and input current clinical data. Patients will also be able to access and manage their own health histories via a personal health record (PHR).

The PHR will allow patients to set their own appointments, exchange e-mail communications with a provider, review a plan of care, view medication instructions, receive medication and other reminders and input vitals such as daily blood pressure and weight measurements.

"There will be a lot of automation in communication," Green said. "It won't replace in-person communication but it will certainly provide an avenue for people to be more connected from a healthcare perspective."

Green expects the HIE to be operational within a month, although it will initially operate in a pilot phase and opened only to those who "have been helping us to work out the bumps so we can really refine the connectivity and the actual EHR itself."

The HIE will be rolled out to other providers after that, which Green believes will probably be in the early months of 2010.