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Collaborative Joins Race To Oversee California’s Health IT Evolution

Another horse unofficially entered the race last week to become California’s lead organization administering billions of dollars in stimulus funds for health IT.

If there is a race.

The California eHealth Collaborative (known as CAeHC in writing and “cake” out loud) released its recommendations for a statewide health information exchange last week, making clear a long-assumed position that the new group wants to win state designation as the umbrella organization for health information exchange.

CAeHC joins the California Regional Health Information Organization (CalRHIO), which declared its interest in the assignment shortly after the federal stimulus package was approved in February. The four-year-old CalRHIO and CAeHC, born earlier this year, are the only two entries so far in a race that has yet to be officially declared or described.

“We are undertaking the process in HHS to determine whether or not a state-designated entity should be coordinating health information exchange,” said Jonah Frohlich, deputy secretary for health IT in the state Health and Human Services Agency.  “We anticipate issuing an RFP (request for proposals) or RFI (request for information) soon,” Frohlich said, adding that he expects the state to announce availability of funds before the end of September.

“The timing is somewhat dependent on the federal government,” Frohlich said.

Billions To Be Spent in California

California, like many states, is trying to get its affairs in order to accept and intelligently use considerable amounts of federal money to transform a paper-based health industry to digital technology.

The American Recovery and Reinvestment Act identifies about $36 billion to be used for health IT over the next several years nationwide. California is expected to get about 10% of that — or $3.6 billion.

Some of the first installments — as much as $30 million — could be spent relatively quickly, once the state determines how to spend it.

One of the first orders of business is determining whether the state itself should coordinate the connections that will allow physicians, hospitals, insurers, pharmacies and patients to share information electronically.

Some small states may elect to take on health information exchange but most large states, including California, are expected to contract the job to industry experts.

The horse race in California — if there is one — will pit one group of industry experts against another — or several others.

“There are only two declared candidates so far, but there are as many as a dozen other credible organizations that could respond to an RFP,” said Will Ross, a CAeHC leader.

CAeHC’s Recommendation

CAeHC’s proposal to the state calls for a public-private partnership with collaboration from industry, providers and consumers to oversee health information exchange.

The collaborative is governed by a steering committee headed by Laura Landry, executive director of Long Beach Network for Health and an original member of the Nationwide Health Information Collaborative, and Ross, project manager at Redwood MedNet, a rural health information exchange in Northern California.

“We believe the strongest solution includes public and private oversight,” Landry said during a teleconference/webinar announcing the proposal. “The focus needs to be on promotion of shovel-ready projects,” she said, adding that her group could quickly “build social capital by working with local stakeholders.”

Landry said it’s important that the state coordinating entity include “people who know how to collaborate, know how to harness other people’s expertise.”

For the past several months, CAeHC has orchestrated a series of educational health IT webinars, staged a statewide series of town-hall meetings to gather local stakeholder input on health IT opportunities and priorities, and hosted a public demonstration of the NHIN Connect Gateway.

CalRHIO’s Approach

Formed four years ago at the request of California Gov. Arnold Schwarzenegger (R), CalRHIO considers itself a mature, proven organization in prime position to coordinate the state’s evolution to digital health care.

Molly Coye, chair of the CalRHIO board of directors, said one of the state’s first orders of business should be to fill in the “white spaces” — those parts of the state without information exchange capabilities.

“There are large parts of the state that don’t have any local RHIO efforts and the most urgent task for the state is to make sure as much of state is connected as possible. We are in the best position to act as overall umbrella organizer and get that done,” said Coye.

“Where there aren’t local RHIOs available in geographic regions, we would be in a position to offer those services and local RHIOs could also make the choice to use some of our services and some of their own. Some RHIOs may want to use our core technology.  The situations range from places having lots of infrastructure to almost nothing. We have to be quite flexible,” Coye said.

Timeline May Speed Up

State timelines throughout the country are dependent on how quickly the Obama administration can formulate guidelines for health IT and pass them on to state and local governments. Working on a relatively rapid pace compared with most government undertakings, the Office of the National Coordinator for Health IT plans to have the framework erected within the next two months.

Or maybe even sooner.

“There are rumors that ONC may actually speed up that timeline,” said Coye.

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