Data Exchanges Go Live in California, Nationwide

The future of health care may someday look like this: A physician checks a patient’s medical history with the click of a mouse. X-rays and tests are almost immediately available though a central system. Patients can review their personal health information online.

If all goes according to plan, Santa Barbara County and several other communities this summer will move that vision one step closer to reality, establishing what could be one of the most important building blocks in the creation of a larger national health information infrastructure.

The Santa Barbara County Care Data Exchange will let hospitals, clinics, payers and laboratories exchange information on a central, peer-to-peer networking system that operates in much the same way as online music sharing service Napster. Authorized users, including patients, can access clinical records. The project began in 1998 with the help of CareScience, a unit of software company Quovadx, and a $10 million grant from the California HealthCare Foundation. The system will have its official launch in July.

The system contains lab results, radiology images, transcription reports, clinical notes and medical, hospital and pharmacy information from claims. The next step is to add data from local retail pharmacies, according to Michael Schrader, chair of the technical advisory committee for the data exchange. Testing for the system, which began in late April, includes eight weeks of technical tests by a vendor involved with the project, two weeks of Internet security testing by a third-party firm and three weeks of testing from 10 clinicians in Santa Barbara.

A report from the California HealthCare Foundation found that financial returns from a system such as Santa Barbara’s were possible. The reduced health care costs are related to lowering the volume of manual data handling, which depends on the rate of physician adoption of the health exchange. The study examined six scenarios for small, medium, and large health care markets. The network would create positive financial results in all but small communities that have one hospital and fewer than 100 physicians. If efficiencies such as fewer hospital admissions, fewer medical errors, and fewer duplicate tests, were quantified, the savings from such a system would be even greater, the report concluded.

The Santa Barbara data exchange is one example of the sort of health information system that government officials and health IT organizations would like to see replicated nationwide. That’s one reason why groups such as the not-for-profit eHealth Initiative and HHS’ Agency for Healthcare Research and Quality are helping to fund these community demonstration projects to create a more interconnected health care system. Meanwhile, efforts to develop health information exchange programs that improve the quality and efficiency of health care delivery are emerging around the country.

San Diego Seeks Common Platform for Clinical Exchange

About three hours south of Santa Barbara, a similar effort is underway to create a community-wide data sharing system in San Diego. That project, led by the San Diego County Medical Society Foundation, started more than one year ago and will officially launch this month.

“It started with the recognition that it takes nurses, staff and physicians a couple hours a day to gather information,” said Dr. Stephen Carson, chief medical officer for the San Diego County Medical Society Foundation, the philanthropic arm of the San Diego County Medical Society.

The San Diego Medical Information Exchange Network will provide a common platform to deliver medical information that providers can readily access. Currently, the system contains alerts on disease outbreaks, a directory of health services from the San Diego County Department of Public Health and formulary, eligibility and benefit information from health plans.

Eventually, the network will feature hospital data, lab results, pharmacy data, X-rays and data from doctors’ offices. It’s also possible that patients who are authorized by their physicians could obtain a password to access their records, said Carson, who hopes to have 100 physicians using the system before the end of the year. The system will be rolled out to early adopters from June through September and offered to the entire community this fall.

Thus far, the medical society is working with companies such as SureScripts, which provides two-way communication between pharmacists and physicians, and diagnostic testing company Quest Diagnostics, among others. The San Diego County Medical Society Foundation has also partnered with the California Institute of Information Technology and Telecommunications for the information exchange.

Carson said he’s optimistic that the timing is right for such a system.

“The earlier Community Health Information Networks (CHINS) failed because all of the pieces were not ready,” he said. “The timing is right today, whereas 18 months ago it wasn’t,” he said.

Colorado Exchange Set To Launch

Mesa County, Colorado, is planning a community data exchange project based off technology from CareScience, the same company that helped develop Santa Barbara’s network. The first phase of the Mesa County Health Information Network, which will include lab, radiology, pharmacy and hospital data, won’t be ready for a few more months. The network will eventually include information from physician practices.

Curt Hatch, executive director of the Mesa County Independent Physician Association, said that the concept for the network started last spring. Three years ago, the county won a settlement with the state Medicare agency, and a portion of that money was set aside for a development fund. Community leaders decided that a health data exchange would have the most potential. “We didn’t want to spend a bunch of money achieving something incremental,” he said. The goal is to create a system in which providers can access and contribute to the data.

Thus far, the initiative involves the Mesa County Independent Physician Association, the Rocky Mountain Health Plan, Community Hospital, St. Mary’s Medical Center and Primary Care Partners. Part of what makes the project in Mesa County feasible, Hatch said, is that the community is relatively small. It’s almost 250 miles from any metropolitan area, and it only has two hospitals and one dominant health plan. The county has 85 primary care physicians, 35 of which already use electronic medical records, according to Hatch.

“We’re already in a really collaborative model,” he said.

Data Exchanges Have Long-Term Funding Challenges

Hatch estimates that the entire project will cost less than $2.5 million. Costs also are lower for Mesa County, according to Hatch, because the health information network will use CareScience, an established vendor. To supplement the system’s funds, Mesa County also applied for both the AHRQ grant that funds such projects and the eHealth Initiative’s Connecting Communities for Better Health grants.

But like many of these community data exchange projects, long-term funding for the systems is uncertain, and grants alone won’t sustain the systems in the long-run. In San Diego, the answer for now is to apply for a variety of grants to support the project. However, Carson said the project has adequate funding to be sustained in the long term. The foundation may one day seek funds from the various stakeholders — labs, pharmacies and health plans — that would see improved efficiencies and therefore, reduced costs from the information exchange, Carson said.

Project officials in Santa Barbara are considering a number of funding models for the exchange. In the beginning of 2004, the Santa Barbara County Care Data Exchange transitioned from a jointly-funded demonstration project to an independent, not-for-profit corporation. Philanthropic grants will continue to fund to the exchange this year. The corporation received a grant from the California HealthCare Foundation, said Phillip Greene, president of SBCCDE. The corporation also has applied for eHealth Initiative and AHRQ grants. However, Greene acknowledged that the data exchange can’t run on these funds forever.

The first option is to ask hospitals to sponsor a set number of physicians to use the system, which would cover the costs of the system. Given hospitals’ tight operating budgets and the fact that the majority of health care is delivered outside the hospital, this might not be the best option, Greene said. Another possibility, much like the long-term funding plans for the San Diego data exchange, would seek payment from payers, labs and other entities that Greene says would benefit from the system. A third option involves asking the groups participating in the project to go to their boards and ask for funding. The cost of the exchange would be divided up as a community service.

Until the long-term funding models are worked out, Greene, Hatch and Carson all predicted that providers would come to rely on the exchanges and make them a part of their day-to-day lives.

“Our assumption is that once the docs start using it, they can’t live without it,” Greene said. “Twenty years from now, these will be as common as ATMs.”

More on the Web

A report from the California HealthCare Foundation details the financial returns that are possible with health information exchange is available online.

The eHealth Initiative maintains a resource center on community data exchange projects and other IT issues.

The Markle Foundation’s Connecting for Health initiative has a working group on community-based health information exchange.

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