Four years ago, Gov. Arnold Schwarzenegger (R) convened a summit and called for the creation of a statewide organization to help the state’s health care system move into the digital age.
It was to be a public-private entity encompassing health care providers, payers, patients, insurers, government agencies and consumer organizations with two main goals: investment in IT and the secure exchange of information using that technology.
Now, four years and many meetings later, the California Regional Health Information Organization says it’s ready to take its show on the road across the state and beyond, if the opportunity arises.
“We are ready to go in one sense,” said Molly Coye, chair of the CalRHIO board of directors. “We have a fully developed implementation plan and partners throughout the state but, on the other hand, we still need to be fully integrated into the state’s plans. For us to move to the next level requires formal, official recognition from the state that we are the designated statewide health information exchange.”
State officials aren’t sure exactly how the process might work or when. Part of the equation will be determined by language in the federal stimulus package that specifically allocates money for regional health information exchange.
“We’re still evaluating the system,” said June Iljana, spokesperson for the state Health & Human Services Agency. “We don’t know yet about the possibility of requests for proposals. We don’t have that level of detail right now,” Iljana said.
Some IT Leaders Say CalRHIO Might Not Be Good Fit
A new organization — the California eHealth Collaborative — was formed last month to fill what some of its members say was a void in IT leadership in California.
Will Ross, project manager for Mendocino Informatics and a member of the new group, said, “We are a group of concerned stakeholders that has initiated a new statewide conversation by launching the California eHealth Collaborative, a steering committee designed to provide inclusive and effective leadership for all health IT efforts in the state as we plan toward open and comprehensive deployments that leverage federal standards.”
Ross said CalRHIO has been invited to join the collaborative.
Ross and others contend CalRHIO has moved away from a role as an umbrella organization in a position to act on behalf of other HIEs and has instead become a health information exchange with one IT vendor and one business model.
Lori Hack — the former CEO of CalRHIO, current CEO of Object Health in Walnut Creek and a member of the new collaborative — does not appreciate CalRHIO’s campaign to win state designation.
“I am disappointed to see the continued barrage of press releases attempting to self-anoint instead of an open dialogue with the state and private sector health information exchange participants,” Hack said. “While their business model to utilize their vendor to deliver information to a community and be reimbursed on the savings is admirable, this is just one solution and should not be advanced as the definitive model for California,” she added.
Bill Spooner, chief information officer of Sharp Health Care in San Diego, co-chaired the technology working group at CalRHIO in its formative years. He’s concerned that CalRHIO might not be up to the task of overseeing information exchange for the entire state.
“My concern is that there hasn’t really been any vetting of the qualifications of CalRHIO — their accomplishments, their capabilities, their business model,” Spooner said. “The organization has definitely changed since the early days and from what I see there has not been a great deal of transparency of their activities since then.”
“This is a large, diverse state with many different kinds of health information exchanges already in place and working,” Spooner said. “We need to be very careful about how we designate one entity to oversee all that. It could amount to a monopoly if it isn’t done right,” Spooner added.
Spooner said he’d like to see some public dialogue about the process. “I don’t mean 84 town hall meetings or anything like that, but I do think this process should be out in the open as much as possible.”
Timing for CalRHIO Campaign
CalRHIO embarks on its campaign flanked on one side by a newly rolled-out partnership with 23 hospitals and on the other side by the promise of federal stimulus money. CalRHIO officials say the organization is flexible enough to fit the state’s needs.
“We recognize that partnership with the state will require some changes for us,” Coye said. “We realize we may have to make changes in governance and implementation plans. There will also be some requirements connected to the stimulus package. We’re aware of all that and we’re ready.”
The federal stimulus package signed into law last month includes detailed language and funding for state and regional health information exchanges.
About the same time the stimulus package was working its way through Congress, CalRHIO was putting the finishing touches on the first of what it expects to be many regional partnerships. Last month, CalRHIO and the Orange County Partnership Regional Health Information Organization announced they will exchange information in 23 Orange County emergency departments beginning in July.
The partnership will provide ED physicians with medical record information on 360,000 patients enrolled in CalOptima, which provides coverage for beneficiaries of Medi-Cal, Medicare and Healthy Kids.
Medi-Cal is California’s Medicaid program, and Healthy Kids is a public-private partnership that provides health insurance coverage to children.
Building ‘Information Super Highway’
CalRHIO officials compare their efforts to building a statewide information superhighway. “We’ll bring the highway as close to you as possible, then when your local HIE — a city or county or other group — is ready, we construct an on ramp,” Coye said.
“The [California Medical Association], the hospital association, health plans, state agencies — all the major stakeholders have been working at this for four years. There’s strong support for the concept and the program. What we need to do is find out what the state requires of us to make it fit with how the state wants to proceed,” Coye said.
CalRHIO recently released a white paper “Why California Is Ready for Statewide HIE.” The paper contends that “California has an existing ‘shovel-ready’ [health data exchange] project that, with federal funding, can be rapidly expanded to accelerate [health data exchange] deployment and adoption across the state.”
Coye said the California effort is ahead of about 90% of the rest of the country’s RHIOs and could serve as a model for others.
“We’ve been at this longer than most other places, and we’ve put together a pretty good business model that makes this sustainable, so yes, I think CalRHIO could be a model for other parts of the country,” Coye said.
But not everyone in California is convinced.
“I think CalRHIO is actually behind a good portion of the country and definitely behind several other HIEs in California” said Ross. “There are four HIEs in California working with (the Nationwide Health Information Network), and there are two others working with (the Agency for Healthcare Research and Quality) and none of them are CalRHIO.”