So far, four of 62 hospitals in West Virginia (not counting those run by the Veterans Affairs Department) and 120 clinics are connected to what is called the “robust” version of the exchange in which participants can post and access and query data for emergency and non-emergency treatment and public health reporting. The exchange also has about 300 accounts with about 600 providers participating in West Virginia Direct, a provider-to-provider secure messaging service that uses the federally developed Direct protocol, Nary said.
The exchange was created by the state Legislature, backed with a $3.5 million appropriation, in 2006, three years before federal funding was available for state exchanges under the American Recovery and Reinvestment Act of 2009, which provided the West Virginia exchange with another $7.8 million.
Thus far, Nary said in a telephone interview, few EHR vendors have incorporated the Direct protocol into their systems, but usage should pick up as Direct messaging capabilities are a requirement to obtain certification of a system under new technical guidelines for Stage 2 the ARRA's EHR incentive payment program. As to the scant number of hospitals joining, there have been contractual issues with the technology service providers and financial issues, Nary said.
“I know, going through contract negotiations with a vendor, there can be hurdles along the way,” Nary said. In addition, both physician and hospital participants in the exchange are receiving their services free of charge, courtesy of the grant funding. A financial committee is working up business plan for the long run, but that uncertainty around pricing and financial sustainability may have been a barrier to participation.
“It's kind of hard to sell something when you can't say what it's going to cost at this point,” Nary said “That's a big issue with a lot of exchanges, being able to show value.”