No HIE Is Excluded and All Are Invited

The title of this post refers to the California eHealth Collaborative (CAeHC). As a point of full disclosure, I am on the CAeHC Steering Committee.

This post has three parts.

1. About the California eHealth Collaborative
2. Open Letter to CalRHIO
3. After the Letter & Before the Meeting

About the California eHealth Collaborative
The Collaborative was formed last month due to a confluence of factors. One factor (out of many) was the emergence during 2008 of a strong cohort of six operating HIEs in California. Our collective perspective was that the presence of so many local HIE projects with deep and credible experience in the emerging federal architecture for interoperable health IT signaled an opportunity to advance the eHealth conversation in California. In particular, other large infrastructure states, and especially New York, showed us a credible road map for a statewide collaborative process. In February the conversation finally moved a few of us into action. A website was launched for the California eHealth Collaborative and outreach was begun to initiate our vision of an open and level playing field for HIEs in California. Starting with the basic principles of openness, no HIE is excluded and all are invited to participate in the emerging community discussion. Recognizing the importance of thoroughly understanding the options, the first product added to the website was a series of weekly webinars featuring national subject matter experts. In the near future, the next step will be to unroll the collaborative process to all eHealth stakeholders in the state.

Concurrent with our community effort of HIEs seeking to launch a full and open collaboration across the state, CalRHIO announced a half day meeting in Los Angeles on Wednesday March 25th to discuss regional HIE efforts in California. On Friday March 20th, CalRHIO released an agenda for the meeting. At the top of the agenda, four goals were listed:

1. Define the HIE vision for California
2. Identify HIE assets and gaps at local and statewide level
3. Discuss roles of local HIE efforts and CalRHIO’s state-level role and opportunities for collaboration and leveraging to operationalize vision
4. Discuss opportunities for operationalizing a shared vision in light of the federal HIE stimulus
   

Clearly these goals were designed to lead HIEs through a process of rubber stamping a state-level role for CalRHIO. Accordingly, on Monday March 23rd I wrote an email reply to all 20 participants invited to the meeting.

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Open Letter to CalRHIO
March 23, 2009 8:30:24 AM PDT

Jennifer and all HIE meeting attendees,

I look forward to the HIE meeting in Los Angeles on Wednesday March 25th. Thank you for all the work you have done to coordinate this meeting. To be clear, I plan to introduce three ideas during the
meeting:

1. CalRHIO is in the planning stages of HIE while six other HIEs in California are already in operation

2. It does not seem rational for a planned HIE to speak on behalf of functioning HIEs at the state level

3. CalRHIO should join with all other HIEs as a peer by working with the California eHealth Collaborative to form a truly open and statewide public private partnership

I believe these are public issues that are best discussed in the open, so I am cross posting these comments to my health IT blog (www.minformatics.blogspot.com) and to the California eHealth Collaborative blog (www.caehc.org/blog).

Here is a brief discussion of my three ideas.

CalRHIO suggests that they have a statewide solution, but CalRHIO doesn't actually operate an HIE service, while six other HIE services are now in operation in California. I support giving CalRHIO a grant to implement a modest technology plan, but not a statewide plan. It is too risky to propose that CalRHIO's undemonstrated technology plan qualifies for statewide funding. The HIEs in California that qualify for aggressive expansion funding are the six operating HIEs: Santa Cruz, Redwood MedNet, Long Beach Network for Health, Kaiser Permanente, ACCEL, and EKCITA.

As a planned HIE, CalRHIO cannot fairly "represent" local HIEs at the state level because CalRHIO's business plan relies on providing services "statewide" -- including the areas that the other HIEs are already operating in. This isn't an inclusive statewide plan, it is competing with the local HIEs. California HIEs should plan and collaborate on a statewide basis as equal HIE peers.

I have personally invited CalRHIO to participate in the Collaborative, an invitation that will remain open, because the Collaborative is at root an open public process. If any organization is going to "represent" the HIEs, it is the California eHealth Collaborative, which was recently launched by four of the six operating HIEs. The Collaborative is by design an open networking process. It is neutral, it works on behalf of all HIEs, it does not advance one HIE over another, and it does not compete against individual HIEs. The Collaborative is the logical entity to build a public private partnership with the State of California. No HIE is excluded from the Collaborative, and all are invited.

On Wednesday most of the HIEs in California will meet in Los Angeles. The agenda that CalRHIO released for the meeting (attached) shows that the other HIEs are intended to rubber stamp a proposal to have CalRHIO be declared the lead HIE for the State. I have canvassed most of the HIEs who plan to attend the meeting. I have found that a large number intend to oppose the designation of CalRHIO as the "lead HIE." So, in the interest of having a productive meeting rather than a family feud, I suggest that the current agenda needs to be scrapped in favor of a truly open discussion.

Shortly I will post this to my blog, and I will call for a new public draft agenda for the meeting.

With best regards,

Will Ross
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After the Letter and Before the Regional HIE Meeting
Several people contacted me after the letter and expressed their support for the issues I raised. A common theme in these was concern that CalRHIO was not the appropriate entity to coordinate statewide collaboration among HIEs.

Arriving at the regional meeting on Wednesday March 25th, the final agenda for the meeting handed out to attendees replaced the four goals in the draft agenda with two entirely different goals.

1. Exchange information and answer questions
2. Emerge with ideas of where there is potential collaboration and mutual support and where there is remaining difference of opinions or approaches

These new goals represent a substantial change in tone and approach. I hope my open letter was helpful in moving the agenda. Now the meeting is underway. As the conversation unfolds, I'll post more details later.