California pursues multiple paths to health information exchange

Farzad Mostashari, MD, the national health IT coordinator, traveled to California last week to highlight the approach the state has taken to accelerate health information exchange. California has increased its number of health information exchanges (HIEs) from seven in 2008 to 19 today, with the ability to cover most of the state’s population.

That has occurred as a result of the infrastructure, technology, standards and policy being put in place, and expedited by incentives, grants and by changes in how health care is paid for and how coordinated care is rewarded, Mostashari said March 9 at a meeting of the California Association of Physicians Groups in Los Angeles.

One of those exchanges is Inland Empire Health Information Exchange (IEHIE), which is made up of 48 providers in Riverside and San Bernardino counties, and which is scheduled to become operational April 1.

Mostashari said health information exchange will not become a reality as a single vision or system but instead will include many models and business plans. He added that states would continue to play an important role in smoothing the development of exchange, but not necessarily through a single statewide exchange.

“We’ve taken steps to establish some of the building blocks and we need to push, push, push! And everyone needs to do their part. It’s time for patients to expect that they can get copies of their own record electronically,” Mostashari said in comments during a tele-briefing shared with reporters.

The meaningful use stage 2 proposed rule emphasizes sharing health data to coordinate and improve care and to engage patients.

ONC has provided grants to states to create organizations that will lead development of HIEs and needed services that are building blocks for sharing information. Cal eConnect is the state-designated group designed to enable more health information exchange in California.

Overall, states will also have an important role to play in the governance and accreditation of HIEs that “will reduce risk, liability and fear of sharing,” Mostashari said.

Some California exchanges are community-based, such as the Santa Cruz Health Information Exchange, but others are integrated delivery networks, such as Kaiser Permanente or the Santa Clara Valley Health and Hospital System, a public hospital sharing information within its delivery network. In addition, groups are forming that want to share information for clinical coordination across providers and in accountable care organizations and across vendor boundaries, Mostashari said.

Cal eConnect awarded in 2011 five expansion grants totaling $3 million to five organizations across the state and plans another series to fast-track planning, innovation and expansion, said Laura Landry, interim CEO of Cal eConnect.

“We’re focusing on governance, technical assistance and coordination, to remove barriers and make recommendations for policy that will make it easier to move data and answer the questions about how they can and what they are allowed to do. We are providing real technical assistance helping people get connected,” Landry said.

Those receiving the first set of Cal eConnect grants included East Kern County Integrated Technology Association, connecting the Central Valley area to share care summaries, structured lab results, interfaces with immunization registries and e-prescribing through Surescripts network, and the Orange County Partnership Regional Health Information Organization in southern California, which is working with Medicaid populations doing post-discharge planning, scheduling and coordinating care.

The Los Angeles County/Los Angeles Network for Enhanced Services (LANES) is developing a long-term health data highway project. It includes hospitals, physicians, community health clinics, labs, vendors and payers, and is starting with adoption of EHRs for meaningful use and making community-wide data available to the participants. The LANES technical solution uses a standards-based directory service that will be able to connect with and authenticate to Cal eConnect core services.

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