Data Could Be King in Reformed Health Care System

Laura Landry can tell you exactly why health information matters.

Landry, the interim CEO of Cal eConnect, California’s newly created entity to oversee health information exchange, had a story to tell during the organization’s annual stakeholder summit last week in Sacramento.

“It’s not my government background that qualifies me for this job,” Landry said. “It’s not my tech background. And it’s not my policy background.” What qualifies her for the job, she said, is much simpler.

“I went blind in my left eye,” Landry said.

About 10 years ago, Landry had vision problems during a weekend. “All of my health information was all locked up,” she said. So Landry went through a battery of tests she’d already had, she said.

“About 12 hours later, after taking all those tests again, they came to me and told me they knew what they were going to do. They said, though, there was only one problem,” she said. “They couldn’t complete the therapy they wanted to do within the 12-hour window that was most effective for that therapy.”

You could call it a moment of vision. When her eyesight was threatened and time was so short and critical, Landry said, it became crystal clear just how important health information exchange can be.

“How can we improve health care?” she asked. “We could make data necessary.”

Overlapping Authority

Reliable communication of health data could streamline patient care on both an individual and public health level. Identifying where patients with like conditions are within a geographic area could trigger more services for those conditions where they’re most needed and most effective.

But tracking down and using that information can be a nightmare, according to many of the stakeholders at the conference.

“From an HIE perspective, many times we don’t know if anyone has direct control over the data, sometimes it’s co-hosted, it’s not clear who can access it,” said Alex Horowitz of Believe Health, a community health consulting group. “It’s so hard to sort it out, even just in one county.”

The state medical system has been built piecemeal, Horowitz said, like a stack of Jenga blocks. It’s hard to pull one piece of information without involving multiple agencies and multiple denials of help.

Horowitz had an idea for Cal eConnect. Building a map of which state agencies control what information would go a long way toward solving real-life health information exchange problems, he said.

“We deal with Stanislaus, Fresno and Kern counties,” he said. “But it turns out that 12 of the 13 [sets of data] we need are at the state level, and no one really knows how to get that data. It’s just this incredible spider web.”

‘We Want Ideas’

Dozens of ideas and suggestions were floated at the stakeholder conference.

“Many state agencies need data from health care providers for public health data,” Landry said. “And it would make life easier if that data could flow. We want ideas about how to do that. We are pretty sure that we could improve quality of care, reduce duplicative or multiplicative data entry, improve quality of data and reduce reporting time.”

Right now, for instance, the state health care system spends money on surveys to help identify health trends and needs in an effort to determine in geographic and financial terms where the state should spend its energy and effort.

If you could track trends over time by using electronic clinical and community indicators, such as tobacco use or body mass index numbers, that would make the whole evaluation process smoother, Landry said.

“The aggregation of data, that’s the public health benefit,” she said, “and doing that would be saving a lot of money on surveys.”

She said there are cost savings and streamlining opportunities throughout California. “Transportability of data allows us to get the data to providers, and public health is just one user of that data,” she said.

Hurdles and Progress

Creating a statewide HIE system in a place as large and geographically diverse as California is challenging, according to Linette Scott, the state’s interim deputy secretary for health information technology. About 90% of California is rural and doesn’t have the technological infrastructure to support information exchange or electronic health records.

The privacy issue around patient records also has slowed progress on information sharing, Scott said.

Progress has been made across a range of challenges, Scott said, in some cases, more progress than she expected.

Some of the notable milestones:

  • The San Diego Beacon Collaborative launches its HIE system on Dec. 1. “That’s huge,” Scott said. “A huge part of this effort is process change — and if you don’t support the business process change that goes along with EHR, then it will fail. EHR will fail if you just turn it on.”
  • Approximately 10,000 health care providers are upgrading or installing EHR systems in the state, she said, and are heading toward meaningful use. That’s due in part to the federal EHR incentive program, Scott said. “A key driver for everything is always money, so we’re very excited to have the EHR incentive programs up and running,” she said.
  • The state recently opened the application process for EHR incentives, initially for hospitals. Since Oct. 3, 141 California hospitals have registered for incentives, representing about $160 million in incentive dollars, Scott said.
  • The state has spent about $9 million in federal money for workforce development so far, she said, which translates into 2,059 new students enrolled in California college programs, with 712 of them already completing their programs.
  • To address the geographic challenges, California started a telehealth project. The first step has been to set up a broadband network across the state. “We have many rural parts of the state, and they don’t have the connectivity, so this is tremendously important,” Scott said. “The goal is to connect 800 sites.”

In general, she said, the Affordable Care Act has prompted a sea change in health care information progress in California. The state also has made investments of time, effort and resources.

“In the funding environment here, HITECH money is a seed, but it’s really much broader than that,” Scott said. “It’s how we’re transforming the health care landscape.” The HITECH Act refers to the health IT provisions of the 2009 federal economic stimulus package.

The Next Step

One of the biggest hurdles they’ve faced, according to Landry, is institutional inertia. She said the system must change, precisely because it is so often chaotic and at cross purposes.

“I think we’re about to have an exponential shift,” Landry said. “We’re about to have people so fed up that it will get fixed.”

That’s where Cal eConnect is hoping to help, she said, by identifying and articulating where things might be more streamlined.

“I do see us as the communication channel,” she said. “The people whose job it is to articulate the issues, so people who want to solve system issues can solve them.”

Cal eConnect will be gathering information and ideas between now and the end of the year. The group intends to draft an action plan by Dec. 9, and finalize the proposal by Dec. 31.

“This is not the end of a conversation,” Landry said. “This is us wanting to take real steps and real action. Our commitment here is to make actionable progress.”

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