- Why is Jonah the "Deputy Secretary for Health Information Technology" while the committee is the "Health Information Exchange Advisory Board"? Why isn't Jonah the Deputy Secretary for HIE? Or why is the committee not named the "Health Information Technology Advisory Board"? Is the state just being careless with the terms or do these variations mean something?
- Five members of the newly appointed HIE Advisory Board are also listed as members of the CalRHIO Board of Directors. Now that they are appointed to the state board, do these five board members plan to resign from CalRHIO? And if not, will they recuse themselves in discussions which evaluate health IT issues in which CalRHIO "has a horse in the race"?
- There are 10 HIEs in California that are planning a data service, and 8 additional HIEs in California that are already exchanging data, yet none of these projects are directly represented on the so-called "HIE Advisory Board". If none of the 8 experienced HIE projects are represented on the HIE Advisory Board, then how will the committee make informed decisions regarding the operating practices of HIEs?
- If the state plan is to complete a careful baseline evaluation of HIE opportuties by the end of July, and to be prepared with a list of HIE projects to fund by October, then doesn't this mean that California is bypassing all FY 2009 HITECH funds in order to be positioned for FY 2010 HITECH funds? And what options are available to the 8 operating HIEs in California that are ready to expand their services now, during FY 2009?
Thursday, April 23, 2009
Questions for California
On Tuesday the 21st the California Health and Human Services Agency introduced Jonah Frohlich, MPH, as the new Deputy Secretary for Health IT. Several people spoke during the hour-long conference call. In addition to introducing, Jonah two important planning documents were released: the roster of the newly appointed HIE Advisory Board and the HIE Work Plan. The new action from California DHHS is a welcome addition to the team effort towards HIE services throughout the state. However, what was said and what was left unsaid leave a lot of questions unanswered. Here are four questions that occur to me.
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Will, your observations here are very astute and deserving of consideration by all components of California's healthcare community. As much as I sense sincerity in these CaHSSA efforts, I believe we are seeing one of several challenges that hinders us all: Patients prefer to move and are best served with Horizontal capabilities, while humankind keeps trying to orchestrate with highly Vertical structures. When the Horizontal velocity grows to a point, it is beyond what the Vertical methods can understand, let alone govern. It becomes at best a confusion to be ignored and, at the worst, a threat to be reduced or controlled.
ReplyDeleteWhy would I offer such a seemingly harsh comment when there is so much good to do and so much energy to move forward? A few weeks ago I was at HIMSS 2009 in Chicago watching the EVP of Minute Clinic describe how they enable HIE today with 18,000 sites in 50 states recently issuing 360,000 Visit Summary Reports deliverable electronically in the PDF-Healthcare format. That was enough. Hyatt's regional executive officer walked in, declared that the topic being presented was found offensive by HIMSS attendees and ordered that this discussion be halted and the group dispersed.
OK, this was an informal gathering. Some members of HIMSS had previously critiqued PDF-Healthcare as unqualified for use since it carries XML within as ASTM standard, not an HL7 standard. Unfortunately, it was not possible to have an open dialog and share that what Minute Clinic delivers nationally in volume for sneaker net delivery by Patients to their Physicians (and is consumed by NextGen among others) now wraps XML in BOTH the ASTM and HL7 flavors.
Here too, I think we see the speed and ease of broad Horizontal deployment emerging as "out of the box" and "confusing" relative to the comfortable Vertical approach to governance and control. I'll go further and guess that PDF-Healthcare via sneaker net, while effective for Patients and Physicians, may well fall short of the HITSP Use Case that a Hospital would prefer to see. But how soon will any Physician Health IT that is not Hospital-sponsored fulfill the HITSP Use Case in this scenario, one that obviously works well for patients on a very large scale?
Let's invest all we can in good Horizontal, community based HIE because it works. Let's keep working hard on understanding how Vertical governance resources can help, not hinder. Your comments get the ball rolling in a good way. We all need more dialog and need it right now, before we squander the chance to leap forward together with ARRA resources!