Friday, January 13, 2017

Merger May Revitalize California’s Flagging Effort To Pool Medical Records

California Healthline Reports on merger
by Chad Terhune

This announcement strikes close to my heart. In early 2005 then President George W. Bush II appointed David Brailer M.D. from California to be the first Chairman of the Office of the National Coordinator for Health Information Technology. His experience as the head of the now defunct Santa Barbara HIE was invaluable as he catalyzed the growth of what was then called RHIOs, or Regional Health Information Exchanges.

I was enthused and asked if I could come to Washington, D.C. to assist in the then visionary ideas of central repositories and linkages between providers and hospitals.  Dr Brailer asked me to remain in Southern California and  lead my own efforts.

His leadership and expertise guided me in my efforts to promote and implement the Inland Empire Health Information Exchange.  At this stage of early development many proponents were volunteers. There arose several advisory bodies, whose names changed, but whose personel remained the same dedicated group.

The challenges were and continue to be many. I list some of them here.

1. Building a sustainable business model from day one.  Avoiding state and/or federal grants
2. Lack of a demonstrable ROI for  hospitals and providers.
3. Funding the considerable hardware/software platform with interoperable functionality.
4. Initially the total lack of interoperability of EHRs.
5. Lack of real world platforms.  Picking one from many poor applications was a challenge in itself.
6. Hospitals and Providers looked at their own data as proprietary information and would not share.
7. Legal precedents were lacking, and created a need for responsibility, and privacy guidelines.
8. Ensuring HIEs would be compliant with HIPAA

During the past 12 years many things have occured.

1.  ONCHIT's interoperability standards
2   The requirement for EHR vendors to attest to their EHR's interoperability.  Unfortunately this fell on the already overburdened shoulders of providers and hospitals.
3.  Congressional funding via the  HITECH Act which included incentive payments to providers, and funds to develop a skilled worker set for  HIT.
4.  Public enthusiasm and knowledge of the potential for accessing their medical history from other locations than their principal place of health care.


Not all HIEs are equal
Few patients leave their region to obtain health care
Individual providers have no interest in interoperability outside their own group practice. They do not want to pay for HIE.
The further development of EHRs with  messaging capability, and patient portals now allows patients to download and print their own summaries.
The demonstrable threats to cybersecurity.   Although there have been no reports of intrustion into a HIE there have been many major breaches of large health systems and insurance companies. The saving grace for HIE is that it is not a real repository and only a system of links to dispersed data files.

Although it is stated there is a statewide depository holding all the medical records of millions of patients, this is a half truth.  There are really no depositories, rather a collection of data files dispersed in many locations that the Health Information Exchange can access via linkages.

With this in mind,

Claudia Williams, will lead The nonprofit California Integrated Data Exchange, 

Welcome to Obama administration veteran Claudia Williams, who will take the helm as chief executive on Feb. 1.  California is a big state, it's needs are regional and it's medical marketplace is diverse. There are several health systems that are so large and encompassing they have no need for an outside HIE since most of their patients never leave their care.  Kaiser Permanente is perhaps the model for that statement.

And welcome to best wishes and good luck.

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