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Progress on the Road to Data Sharing

Progress in establishing a modern, secure and flexible system for health data exchange in California is more tangible than ever, according to presenters at a health information technology conference last week in Santa Rosa.

Members of the California Association of Health Information Exchange announced the results of a year’s worth of work in creating an interoperability landscape in the state, the highlight of which was the approval of a trust agreement framework one day prior to Redwood Med Net’s conference.  

California’s Data Use and Reciprocal Support Agreement, approved July 24, serves as a multi-party trust agreement that allows participants to use the federal Direct and Exchange projects, a standardized, secure method of sending encrypted health data over the Internet. CalDURSA is separate from the federal DURSA, experts explained, and is tailored to the policies, procedures and operational practices specific to health information exchange in California.

“This is a key document that we have lived and breathed for the last year-and-a-half,” said David Minch, president of CAHIE. “This is important if you are any organization in California that has data and needs to move data.”

CAHIE, a not-for-profit organization founded under the direction of the California Health and Human Services agency and the California Office of Health Information Integrity, is charged with creating a self-governance and trust model for statewide HIE in California. It serves as a forum for a collection of IT community leaders, service providers, payers and state agencies.

While secure, streamlined data-sharing networks do ultimately result in improved patient care, Minch encouraged conference participants to focus on creating appropriate business-to-business partnerships first and foremost.

“Health information exchange actually has nothing to do with patient care and everything to do with business strategy,” Minch said. “I know that is not a popular attitude, but it is a realistic approach. CAHIE’s push is to create connectivity and let people figure where their business strategy fits in.”

Federal standards exist for interoperability throughout the states via the National Association for Trusted Exchange. NATE allows for interstate exchange between providers for treatment purposes, as well as patient-mediated exchange through specific policies and trust agreements. But, as CAHIE members explained, regional HIE’s are also important.

“Care is local,” said Robert Cothren, executive director of CAHIE. “Regional HIE means we can concentrate on local information delivery and support local care. We can address the needs of the community and do so in the best way possible using models.”

The approval of CalDURSA establishes a safe, secure agreement for health information exchange using the California Trusted Exchange Network, the technical infrastructure for health information organizations within the state, and is compatible with federal guidelines.  CTEN services re-launched last week to coordinate with the agreement approval.

CalDURSA represents the next phase in a functional interoperability landscape, IT experts said. When data was first transferred to electronic health records, it created huge backlogs of information, referred to as “stovepipes.” These stovepipes necessitated the creation of exchanges, which in turn raised the need for a regulatory framework for the exchanges.

“We still have to fix the stovepipes we have created over time,” Cothren said. “This framework allows otherwise unaffiliated organizations to trust each other for the purpose of exchanging health information.”

The most salient component of California’s network is its compatibility with other systems, Cothren said. It can connect with existing health information exchanges such as DirecTrust,  eHealth and NATE, but it is more agile in meeting California-specific needs, he said. However, a fully functioning system is still a ways off.  Issues still to be resolved range from difficulty in linking HIEs to California directory services to incomplete and unorganized data sets that render information inaccessible.

Building on the foundation of information pathways to make data sharing more dynamic is the next step. Presenters at the conference spoke of the methods to create more sophisticated filters and sensors to retrieve and use data, such as cloud-based storage systems, avatars, smartphone apps and more advanced user interfaces.

“This is where the innovation takes place,” Cothren said. “We have to be able to get past the technology, and our current tools are not extensive or simple.”

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