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Connecting California: The Role of State Leadership in Advancing Health Information Technology


Connecting California: The Role of State Leadership in Advancing Health Information Technology CCST Board and Council Meeting Molly Coye, MD, MPH – PowerPoint PPT presentation

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Title: Connecting California: The Role of State Leadership in Advancing Health Information Technology

Connecting CaliforniaThe Role of State
Leadership in Advancing Health Information
  • CCST Board and Council Meeting
  • Molly Coye, MD, MPH
  • Chair, CalRHIO Planning Committee
  • CEO, Health Tech
  • October 19, 2005

The Vision
  • If I go to see my doctor, she or he will have
    all the information needed right on the spot. I
    won't have to fill in any more forms, lab tests
    won't be repeated, and my doctor will know if
    I've been to see another doctor, or to a
    hospital, and what medicines I'm taking.

The Vision
  • If I'm taken to the hospital in an emergency,
    the nurses and doctors in the emergency
    department will be able to find out all the
    information they need to take care of me - within

The Vision
  • I have my own personal health record, that I
    keep at home on my computer or as a printed
    record. It has all the information I need about
    my medical history, current conditions, medicines
    I'm taking, the doctors that are caring for me,
    and education about my medical conditions.

The Vision
  • If there is a public health
    records will be available to treat me or my
    family at any location.

The Vision Health care that is safe, of high
quality, and efficient, in an information-rich
environment that meets the needs of consumers,
patients, providers and others in Californias
Lessons from Katrina
  • There may not have been an experience that
    demonstrates, for me or the country, more
    powerfully the need for electronic health records
    ... than Katrina." Mike Leavitt, HHS Secretary

Lessons from Katrina
  • Starting yesterday (9/14), doctors in eight
    shelters for evacuees could go to the Internet to
    search prescription drug records on more than
    800,000 people from the storm-racked region.
  • Washington Post

National HIT Picture
  • Federal advocacy for healthcare IT
  • Secretary Leavitt a strong proponent
  • Limited federal funding
  • 125M proposed for health care HIT in FY 2006
  • Re-structuring the market
  • Establishing standards
  • Harmonizing privacy and security legislation
  • Safe harbor for hospital funding of physician IT
  • Accrediting products as standard-compatible
  • Stimulating development of models for national
  • Linkage to Pay-for-Performance
  • Medicare pilot
  • MedPAC proposal for pay-for-use of IT
  • Interoperability standards underway
  • Strong White House support
  • Congressional stampede

The Baseline Is California Ready?
  • Estimates, for all California consumers and
  • 10 online appointment scheduling
  • 20 pharmacy refills
  • 40 enroll in health plan online
  • 5 email with physician
  • 5 pay medical bills online
  • 10 customized health education
  • 5 personal health record online

Source Structured inquiry of California health
care leaders, November 2004
Is Technology Transforming California Healthcare
  • Estimates for Infrastructure
  • 10 physicians using EMR light
  • 30 integrated clinical data within
    integrated delivery networks (IDNs)
  • 5 integrated data plan - IDNs
  • lt2 community health data shared
  • lt5 telemedicine-enabled
  • 10 EMR light
  • 20 full EMR

Source Structured inquiry of California health
care leaders, November 2004
The Opportunity Safety, Satisfaction and
  • Increase access to information
  • Without HIE, 30 of the time, physicians could
    not find information previously recorded in a
    paper chart
  • Reduce duplicate testing
  • Same drug or radiology exam ordered 11 of the
    time patients agreed to duplicate testing 50 of
    the time
  • Ensure complete information
  • Physicians unaware of 1 in 4 patient
  • Eliminate uncertainty
  • On average, test results come from 5 or more
    locations problems with retrieval accounted for
    1 in 7 admissions and 1 of 5 lab tests and
    radiology exams
  • Reduce data collection/transfer costs
  • Cost of tracking down and obtaining information
    on the data user/originator sides range from 12
    - 28 per visit

Electronic Medical Records Getting it Right
and Going to Scale. W. Edward Hammond, III,
Ph.D. Commonwealth Fund background paper. publication 695. January 2004.
The Opportunity Cost and Savings
Potential benefits of EHR adoption (Assume 90
adoption over 15 years)
  • Annual Cost
  • National - 7.7 billion
  • 6.5 billion for hospitals
  • 1.2 billion for physicians
  • California - 77 million (est.)
  • Annual Savings
  • National - 81 billion
  • 77 billion improved efficiency
  • 5 billion reduced medical errors
  • California - 8.1 billion (est.)

Sources National estimates Rand California
estimates Extrapolation
The Opportunity Office-Based Patient Care
Health Technology Center
  • The Vision
  • Advancing the use of new technologies to make
    people healthier.
  • The Mission
  • To create a trusted source of expert information
    about the future of healthcare technologies.
  • The Means
  • A nonprofit pooled research center for delivery
    systems and health plans. Funding independent of
    technology developers and vendors.


HealthTech Partners
Stanford Hospital and Clinics University
HealthSystem Consortium (UHC) Froedtert
Hospital Hospital Corporation of America
(HCA) Greenville Medical Center Health Alliance
of Greater Cincinnati Blue Shield of California
Foundation Lucile Packard Medical Center Chinese
Hospital Health Plan Catholic Health
Initiatives CHI) St. Alphonsus Regional Medical
Center Rockingham Memorial Salem Hospital El
Camino Hospital Banner Health System
Baylor Health Care System Bon Secours Health
System Carolinas HealthCare System Catholic
Healthcare West Centers for Medicare and Medicaid
Services (CMS) Federal Liaison CHRISTUS
Health Parkview Health Partners HealthCare System
The Queens Medical Center Veterans Health
Administration Overlake Hospital UC Davis Health
System Methodist Health System Lumetra Ascension
Health CAPH John Muir/Mt. Diablo Health System
Group Health Cooperative Kaiser Permanente
Mills-Peninsula Health Services PeaceHealth Prem
ier, Inc. Providence Health System Sutter
Health VHA Inc. WellPoint Health
Networks Texas Health Resources New 2005 SCAN
Health Plan University of Chicago Hospitals and
Health System Palomar Pomerado Health Memorial
Hermann Sandia National Laboratories
TEKES/SITRA Trillium Health Centre Stormont-Vail
CalRHIOs Role
  • Independent umbrella organization
  • Leading a collaborative effort to
  • incrementally build a statewide information
    exchange for California
  • implement projects that build systems for data
    exchange, and demonstrate their feasibility and
  • ensure participation by safety net providers and
    underserved populations in data exchange and IT
  • build financial and business case models for
    health information exchange
  • facilitate creation of common governance,
    process, technology, and other elements needed
    for regional and statewide data exchange

CalRHIOs Role
  • encourage business, healthcare, and policy
    leaders to create private and public policy
    agendas and funding for data exchange and IT
  • help organizers of local and regional data
    exchange efforts within California work toward
    common goals and share what they develop and
  • ensure that Californias data exchange projects
    are consistent with national technology platforms
    and networks
  • identify legislation and regulation necessary for
    statewide data sharing

Statewide Highway for Health Information Exchange
National Health Information Network
A - 3
Payers found 15
Looking for Private Ryan in CA!
B - 1
Little RHIO B Found 1
Community A
Medical Group/ MSO None
C - 2
Multi-Community RHIO C Found 2
Geographic Coverage
Northern Sierra
CalRHIO and CAPG cover the entire state
Central Valley
Smart Health
Santa Cruz RHIO Santa Cruz CCN
Loma Linda Riverside
Santa Barbara
Long Beach
San Diego
2005 Projects
  • Linking hospital emergency departments across the
  • Defining the infrastructure necessary for
    statewide health data exchange
  • Supporting enhanced safety in medication
  • Improving the efficiency of administrative
    functions for plans and providers
  • Giving consumers more direct access to health
    information in a Personal Health Record

CalRHIOs Future Role
  • Core functions of CalRHIO
  • Convene and support communications,
  • Resource center
  • State policy analysis and development
  • Representation to federal agencies
  • Health care IT in 2010
  • National highway for data exchange established
  • Public utility or commercial models
  • State and federal privacy and security
  • Standards support interoperability
  • Two key tasks for CalRHIO
  • Statewide exchange of health data
  • Statewide adoption of electronic health records
    and supporting applications by all health care

Other States Act
  • Nationwide 150 bills in state legislatures
    addressing HIT
  • 13 states have introduced or passed HIT
    legislation or have Governor support through an
    Executive Order
  • 40 states have one or more community-based data
    exchanges or grants for regional health
    information organizations
  • 28 states have formal efforts for secure health
    care data exchange underway
  • Source Health Information and Management Systems
    Society (HIMSS)

New York
  • Legislature Created Major Funding
  • 1 billion over 4 years to
  • Finance HIT investment in projects that will
    build a statewide infrastructure to share
    clinical information
  • 1.5 billion over 3 years through fed/state
    Medicaid waiver for HIT investment
  • Created HIT grant sources and other budget
    initiatives in 2005-6
  • 3 million for physician HIT development
  • 10 million for pay for performance (P4P)
    initiatives which will connect to HIT development
  • Focus
  • Regional HIE projects
  • E-prescribing
  • EHRs

  • Governor leveraging HIT to reform states
    Medicaid Program
  • Gov. Phil Bredesen announced pilot to improve
    health care delivery in SW Tennessee managed by
    State in partnership with Vanderbilt University
    Medical Center
  • 1 million patients in 3 counties 5 year
    demonstration pilot
  • Funded by AHRQ, technology provided by Vanderbilt
    University and Accenture
  • Focus
  • ED linkage
  • Clinical and administrative, eventually financial

  • Governor takes lead in Call to Action Summit
  • Gov. Janet Napolitano led October Summit to
    create a successful statewide electronic medical
    records system
  • More than 300 representatives from the health
    care, technology and government sectors attended
  • Gov. acted on recommendations from a steering
    committee she had formed to develop a roadmap for
    providing EMRs to all Arizonans by 2010
  • Funding TBD

  • Legislation calls for statewide network
  • Nation's first legislated statewide electronic
    health network.  (Took four years to pass law.)
  • Universities of Kentucky and Louisville to create
    the Kentucky Health Care Infrastructure
    Authority, which would coordinate efforts such as
    conducting pilot projects and managing the
  • Gov. Ernie Fletcher (R), a physician, to appoint
    members to a Kentucky e-Health Network Board,
    which would oversee the development and
    implementation of the network.
  • The board to meet monthly and include health care
    providers, patient representatives and other

  • Governor creates advisory board
  • Gov. Jeb Bush, May 4, 2004, created the Health
    Information Infrastructure Advisory Board.
  • Established to advise the Agency for Health Care
    Administration (AHCA) which administers Florida's
    14 billion Medicaid program, licenses and
    regulates more than 32,000 health care facilities
    and 30 HMOs, and publishes health care data and
  • Funding from AHRQ Grant

Gulf States
  • Infrastructure expected to emerge post Katrina
  • Example developed in 10 days
    available from anywhere in US
  • an online service for authorized health
    professionals to gain electronic access to
    prescription medication records for evacuees from
    Hurricane Katrina
  • medication and dosage information to renew
    prescriptions, prescribe new medications, and
    coordinate care

Why Now?
  • Federal leadership, pressure and pending
  • Technology makes data exchange possible,
  • California and other states are mobilizing
  • Standards are under development
  • State leadership

Potential State Role in California
  • Funding
  • Waiver Enable Medi-Cal to pay its share of
    investments in community-wide IT infrastructure
    provide financial incentives to providers who use
    HIT add telemedicine as covered service
  • Funding
  • Explore use of proceeds from converted
    not-for-profits to create investment
    fund/revolving loan fund to support RHIOs
  • Authorize finance authority or other entity to
    establish revolving loan fund
  • Create budget line-item to fund CalRHIO
  • Mandates
  • Mandate that every California nursing home
    resident have an EHR with retrievable medication
    data by July 1, 2006
  • Mandate that every Californian have a PHR by 2007

Potential State Role California
  • Legislation
  • Researching need removal of legal barriers to
    acquisition and effective use of HIT
  • Example privacy and security of personal health
  • Researching need legislation to create
    certification process for RHIOs
  • trusted intermediaries charged with facilitating
    HIE and promoting public health
  • promote consumer trust
  • limit liabilities resulting from good-faith
    participation in HIE

Are we prepared for the Big One?
How can we help?
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