Extending the Value of the Direct Project in Arkansas

Erica Galvez | September 27, 2012

Arkansas is rapidly becoming a leader in health information exchange. Since launching their statewide secure messaging tool (SHARE) in January 2012, Arkansas’s Office of Health Information Technology (OHIT) has registered more than 2,100 clinical and administrative staff to use it, with another 3,000 in queue to be fully on-boarded. SHARE uses the national standard for secure health information transport developed by ONC’s Direct Project. For a rural state that started their State HIE Cooperative Agreement with no existing exchange infrastructure and limited electronic health record (EHR) adoption, their progress is laudable. 

While SHARE supports information sharing in clinical settings to enhance things like continuity of care, OHIT is also spreading the value of this secure messaging tool to a variety of data trading partners looking to gain efficiencies in administrative and other health care-related areas. This thoughtful approach allows the value of the SHARE tool to be realized many times over by existing and emerging trading partners, the first of which happens to center on state employee benefits.

Extending SHARE to Support Prior Authorizations

The Arkansas Employee Benefits Division (EBD), which manages the group health and life insurance plans for 145,000 state and public school employees, is beginning to use the SHARE secure messaging tool to enhance its prior authorization process. EBD Executive Director, Jason Lee, sits on OHIT’s HIE Council, and recognizes that the SHARE functionality might alleviate one of EBD’s biggest pain points, “a large portion of our beneficiaries’ medical services require prior authorization from medical providers before we approve payment for those services.  As a result, our intake coordinators spend a great deal of time communicating with health care providers via phone, fax, or paper.”

EBD will use SHARE to streamline the existing prior-authorization process for medical and pharmacy services. Instead of the current back and forth via paper and phone, EBD will automate the process with SHARE to solve administrative headaches and impact clinical outcomes.  Lee envisions SHARE enabling his staff to increase the number of pre-authorized procedures processed, thereby reducing the amount of time employees must wait for procedures and potentially reducing the number of duplicative tests and unnecessary procedures conducted.

Gaining Efficiencies and Cost Savings for Patients

In addition, EBD anticipates that the shift to electronic communication will result in cost savings for their members. Lee described a recent situation where a patient was enrolling in EBD’s disease management program to help control his Type II diabetes. In order to complete the enrollment, the patient needed his physician’s office to send a copy of his medical records to EBD at a cost of $25 to the patient—a cost that EBD expects to eliminate by receiving records and documentation via SHARE.

“Here is a patient that is doing the right thing and trying to control a serious disease, and he has to spend time and money getting his records to us.  We’d like to help that situation if we can.”

Incremental Implementation to Get it Right

Lee and his team are excited about the benefits they will gain by using the SHARE secure messaging tool, but they are moving slowly and deliberately to get it right the first time. Since they are working with protected health information (PHI), “We don’t want to rush this process and make rookie mistakes,” Lee said. EBD did a “soft launch” in July 2012 to a few staff members to help them get used to the system and workflow. The organization hopes to be fully live and exchanging information electronically with providers as standard business practice by December 2012.

As personnel have been learning the system, Lee indicated they’ve already identified a potential challenge with provider “discovery;” that is, the ability to identify the specific provider or facility with which they want to communicate. The organization is working with OHIT to make sure they have the necessary tools and understand how to find providers, as well as how those providers find EBD.

The Next Evolution

Although EBD’s cautious approach may feel slow, they are unwaveringly enthusiastic about the value of the SHARE secure messaging tool for their work.  Once secure messaging is fully rolled out, Lee expects it to be the “next evolution in how EBD communicates with providers.”  He added, “Twenty years ago, we asked people, ‘Do you have a fax machine?  What’s your fax number?’  Now we are going to ask, ‘What is your SHARE address?  Can you send me that electronically?’”

For More Information

To learn more about Arkansas’s progress and the Arkansas Employee Benefits Division, visit: