Implementing electronic prescribing in California may prove a whole lot less challenging than instituting electronic transfers of lab results and sharing patient care information across unaffiliated health organizations. But all three goals of a network of health information exchanges in the state are going to take a whole lot more effort and coordination.
That was the message emanating from a conference conducted via webinar and telephone Friday hosted by Cal eConnect, the agency leading promotion and coordination of electronic health records in the state.
Cal eConnect is the state-designated not-for-profit organization charged with disbursing $38.8 million in money from the Health Information Technology for Economic and Clinical Health Act. The act was part of the 2009 economic stimulus package.
Laura Landry, newly appointed interim CEO of Cal eConnect, said officials in the Office of National Coordinator for Health IT have “become increasing clear, that they want us to focus on the top three areas. … In order to meet the timeline, we have to rely on the resources in the state.”
That timeline involves displaying “demonstrable” progress by this January, “substantial” progress in the March to June period and by December 2012, showing that every medical provider has options to participate in electronic transfers of prescriptions, lab results and patient information.
“If you have data on transactions of a number of providers who are doing electronic prescribing, lab data or moving information across platforms, we need to know,” said Mark Elson, Cal eConnect’s chief policy and information officer.
Elson said that, based on examples provided by ONC, Cal eConnect’s effort will include initially demonstrating that there is a least one lab sending results electronically in every county covered by an HIE, that there is at least one pharmacy accepting electronic prescription and one qualified HISP enabling clinical care data exchanges.
Landry and Elson’s comments were primarily aimed at cajoling the 19 HIEs in California into cooperation so they would be eligible for federal money encouraging the nation’s movement toward electronic health records. Until her appointment as interim CEO, which took effect Sept. 1, Landry had been a member of the Cal eConnect board and had been executive director of the Western Health Information Network of Southern California.
HIEs participating in Cal eConnect’s conference last Friday included Redwood MedNet, Orange County Partnership Regional Health Organization, HealthShare Bay Area, Los Angeles Health Network for Enhanced Services, Coastal eHealth Connection, Marin Health Network, San Diego Beacon Community, North Coast Health Information Network, Southern California Oncology Association and Tulare Kings Foundation for Medical Care.
Elson said his survey of operational HIEs (of which there are only four) showed that one was using electronic prescriptions and two others would do so within two years. Of another 14 pre-operational HIEs, 43 percent responded they would use e-prescribing within two years.         Â
Several HIE representatives agreed that the existence of a state pharmacy board and organizations representing pharmacy interests in Sacramento would likely make for a relatively easy transition toward e-prescribing. However, they noted that bringing pharmacies located in rural areas or mom-and-pop operations into the world of online prescription writing would be more difficult.
Some HIE officials also noted that electronic exchanges of lab results have “been stop and go for years” because so many different medical providers use different forms for conveying very similar information. Similar hurdles exist when it comes to sharing clinical care data across multiple and unrelated medical service providers, they agreed.
“The CCD (clinical care data) and the lab problem is going to be more of a challenge than the e-prescribing stuff,” Landry concluded.
Landry said “the landscape has changed since 2009” when Cal eConnect was first created and when state and local health officials were operating with less clarity about priorities in electronic health records.
In 2013, Cal eConnect’s efforts will center on public access to patient information and on public health reporting, both involving standardized electronic transmission, said Landry.
Cal eConnect’s task will be to create “large connectivity options” and to make them available to medical service providers, she said. She added that Cal eConnect will review systems in New York, Florida and Texas, which are using HIE models similar to regional extension centers in California.
“The state arm is playing a consultant’s role rather than a technical services role,” Landry said. “Our job is to make sure that data flows regardless of who is making it flow.”
Last week’s conference via Cal eConnect website and telephone was also designed to lay the groundwork for two days of in-person events in November in Sacramento.
Policy and governance will be major agenda items in the next HIE Community of Practice meeting scheduled Nov. 7. , will be held with. Cal eConnect is convening a stakeholder summit on Nov. 8.
The summit will “bring everybody together on the key items,” Landry said. “We will be unveiling the bones, if not the meat, of what the strategic plan is.”