 |
 |
|
Posted August 22, 2007
Patient Safety and Quality Healthcare: News
California Data Exchange Project Offers Valuable Lessons for National Health IT Efforts
Health IT leaders examine why one of the most ambitious health information exchange efforts disbanded and the implications for the future
Bethesda, MD, August 1, 2007 — A high-profile data exchange effort that recently disbanded provides important lessons on the challenges and promises of making health information more portable, say health information technology (IT) leaders in a series of Health Affairs Web Exclusive articles published today (http://content.healthaffairs.org/cgi/content/full/hlthaff.26.5.w568/DC2).
The articles by some of the nation's leading experts on health IT examine the Santa Barbara County Care Data Exchange, an early, ambitious effort at electronic health information exchange (HIE) that ceased operations in 2006. The project attempted to connect various health care providers and related organizations in Santa Barbara County through a secure network that would allow for the electronic exchange of clinical and administrative data.
In 1999, the California HealthCare Foundation awarded $10 million to create the HIE, which project leaders hoped could be replicated nationally. Authors Robert Miller and Bradley Miller from the University of California, San Francisco (UCSF), describe a project that was plagued by a variety of problems, including technology delays and uncertainty over privacy and liability issues. Once external grant funding for much of the data exchange's development had ended, uncertainty over the value proposition of HIE made participating health care organizations reluctant to invest in the data exchange, which led to the shutdown of operations. The project nonetheless sparked national interest and provided valuable lessons for regional health information organizations (RHIOs) across the United States that are now promoting HIE.
"The Santa Barbara experience shows us that some other data exchange projects could face similar barriers without a combination of grants, incentives, and mandates to help change the HIE value proposition for developing RHIO infrastructure and services," said lead author Robert Miller, a professor at the UCSF Institute for Health and Aging.
Former national health IT coordinator David Brailer, M.D., who helped design and guide efforts at the Santa Barbara County Care Data Exchange, says that the lessons learned from the project were instrumental in crafting U.S. federal health IT initiatives. Brailer cites eight major lessons from the Santa Barbara project:
- Tight, top-down control over implementation of data exchange efforts does not work, and projects need to be more decentralized.
- The needs of physicians and consumers should be included in the development process.
- RHIOs must identify business models for health data exchange that address health care providers' concerns that such exchange will harm their financial viability.
- Outright subsidies of health IT projects can undermine progress.
- It is important to include a wide variety of stakeholders — not just physicians and hospitals — in health care data exchange efforts.
- HIE can drive value only if it supports clinical decisions sufficiently to influence their outcome.
- Data standardization, prioritization, development and maintenance are needed for U.S. health IT efforts to succeed.
- A lack of clarity about privacy rules made it difficult for providers to develop new ways to share protected health information. In response, the federal government is now working with 43 states to develop a consensus on privacy rules.
These lessons from the Santa Barbara Project helped build the foundation for nearly every aspect of federal health IT policy, according to Brailer.
"Whether it succeeded or failed is not interesting. What matters is that the Santa Barbara Project happened, that it ended, and that we learned," Brailer writes.
The Health Affairs Web Exclusive package includes a series of commentaries on the Santa Barbara Project and its implications for other health information exchanges. Publication of the package was supported by the California HealthCare Foundation.
The Santa Barbara Project highlighted the legal, technical, and organizational hurdles of health care data exchange, according to California HealthCare Foundation officials. Coauthors Jonah Frohlich, Sam Karp, Mark Smith, and Walter Sujanksy recommend that data exchanges are implemented incrementally and engage consumers from the start to help craft privacy and security policies. They also call for faster development of national health IT data standards to help lower the costs of development. "Through a series of small steps, the larger goals of health information exchange can be realized," they write.
Although some consistency is needed to interconnect various health information exchange systems throughout the nation, a National Health Information Network (NHIN) will only be possible if local data exchanges are allowed flexibility in how they operate, what services they provide, how they deliver those services, and how they pay for those services, writes Marc Overhage, president and CEO of the Indiana Health Information Exchange. "Specifying a large range of services that a health information exchange must provide could hamper innovation and delay implementation of the NHIN," Overhage writes.
It is critical to understand who benefits from health information exchange to create a sustainable business model for HIE projects, writes Donald Holmquest, CEO of the California Regional Health Information Organization (CalRHIO). Creating such a business model is one of the biggest challenges for health data exchange projects. Patients, health care providers, laboratories, pharmacies, hospitals, health plans, and employers are among the many stakeholders who will benefit from HIE, Holmquest writes.
Health Affairs, published by Project HOPE, is the leading journal of health policy. The peer-reviewed journal appears bimonthly in print with additional online-only papers published weekly as Health Affairs Web Exclusives at www.healthaffairs.org. The full text of each Health Affairs Web Exclusive is available free of charge to all Web site visitors for a two-week period following posting, after which it will switch to pay-per-view for nonsubscribers. Web Exclusives are supported in part by grants from the California HealthCare Foundation and the Commonwealth Fund.
|
|
|
 |
|
 |
