Senate Health Committee Hearing

I testified at the California State Senate Health Committee hearing held in San Jose on March 13, 2009. Chaired by Sen. Alquist, there was a lot of high quality testimony at the hearing. For me the highlights were comments by Paul Tang, John Mattison, Sam Karp and Robert Miller. Speakers each had 8 minutes, and the Committee staff was efficient at promptly moving the process along.

I spoke on a panel of four HIE representatives.

• David Katz, former Executive Director of the Smart Valley Task Force


• Will Ross, Project Manager, Redwood MedNet


• Laura Landry, Executive Director, Long Beach Network for Health


• Molly Coye, MD, Chair, Board of Directors, CalRHIO

The main story I heard in the four HIE presentations was the gap between the first three presenters and CalRHIO. The first three presenters focused on their three HIE road maps, with narratives rooted in what worked (myself and Laura) and what didn't work (Dave). In contrast, Molly's presentation was a pitch for funding. To briefly compare and contrast the four presentations, I'll list an outline of the CalRHIO narrative, followed by observations drawn from the other three presentations.

Molly opened with the three important characteristics of CalRHIO.

1. It is sustainable


2. It is secure


3. It will be self-financing over time

Next, Molly presented five opportunities for the State of California.

1. Rapid deployment of HIE across the state


2. Providing the state with a plan to enable California to move to the front of the line for drawdown of federal funds


3. Offering the State the opportunity to recognize a broad public private partnership, designate an organization, and apply for federal funds


4. An additional opportunity to maximize federal stimulus funds based on meaningful use of HIE


5. Establish a public private partnership that provides a core technology for HIE

Briefly comparing these remarks to the other HIE presentation to the committee, the following contrasts are apparent.

• Smart Valley presented a detailed and practical analysis of the fiscal disincentives facing the launch and operation of an HIE service. The analysis did not spare state or federal health IT leadership with regard to incubating and enabling viable business models for HIE services. I find it hard to overstate the importance of Smart Valley's experience, which included a thorough and realistic vetting of hard boiled financial projections. In contrast, CalRHIO presented a financial model with massive HIE revenue generation, but I am unaware of any substantial public vetting of the CalRHIO revenue model.


• Redwood MedNet presented a methodical, chronological and incremental narrative showing steady progress through planning stages to the launch of an operating HIE, with practical details for integration of HIE services into the work flow of local clinical practices. In contrast, CalRHIO, an organization still in the HIE planning stage, presented a high level plan to rapidly deploy full HIE services statewide, with no recognition of the nuts and bolts of deployment or of actual integration with clinical practices.


• Long Beach Network for Health explained why they are creating HIE services, how they are building it, how far along they are as one of nine successful NHIE's funded by the federal government. Laura also emphasized shared community trust and a focus on supporting and collaborating with safety net and public health stakeholders, and how the Long Beach core infrastructure is installed and is scalable up to millions of lives. In contrast, CalRHIO asked the state to bypass any of the six HIEs that are already functioning in California by suggesting that the CalRHIO plan, which has never been tested, has the greatest likelihood of quickly deploying across the state.

In addition, both Laura and I announced the creation of the California eHealth Collaborative, an open and inclusive organization, where no HIE is excluded and all are invited. In the next post, I'll detail the Collaborative's call for a truly open statewide process to help all HIE efforts move forward in a public private partnership. And I'll explain why CalRHIO cannot fairly represent local HIEs at the state level.