California Regional HIE Meeting

The meeting was held two weeks ago in Los Angeles. As an event, it was a strange brew of scripted posturing from CalRHIO and abrupt intrusions of reality due to many inconvenient questions posed by attendees who represented operational HIEs. From my perspective there were no revelations at the meeting. CalRHIO continued their Quixotic quest to impose a misunderstanding of eHealth technology on the state, while the meeting held a room full of HIEs who knew too much to simply accept the self-serving inaccuracies that litter CalRHIO's common narrative in presentations, press releases and in meetings like this one. For example:

• The typical CalRHIO narrative claims that when they build an HIE service, at some future point, it will be a first for California. Over the past two months CAeHC has developed a definitive inventory of HIE efforts within California. When CAeHC launched in February, the inventory showed 4 operating HIEs. Now, two months later, the inventory shows 8 known operating HIEs in California, none of which are CalRHIO.
  


• The recent press release from CalRHIO about new HIE services in Orange County conveniently omits any mention that there already is an operating HIE service connecting the emergency rooms in Orange County. The press release says the planned launch by CalRHIO of a small portal in Orange County this summer will be the first county-wide HIE service, when in fact if it launches in July (as promised) the new service from CalRHIO will be the second county wide HIE service in Orange County, and it will join several other county wide HIE services already in operation in other counties in California. The Orange County press release is typical of inaccuracies in CalRHIO's narrative.


• CalRHIO continues to misunderstand the NHIN gateway architecture by asserting incorrectly that the CalRHIO web service from Medicity will be needed for all small HIEs in the state to connect to the NHIN. This assertion by CalRHIO is directly contradicted by the current federal architecture for the NHIN, in which any HIE in California that operates an NHIN gateway will connect directly to the NHIN without CalRHIO.


• CalRHIO said that if they cannot be the official statewide HIE, then they will close their doors, which is silly, because there is still a role for CalRHIO even if they don't yet understand the NHIN gateway architecture

So the short version of the meeting is that CalRHIO found itself in a room full of its peers, and instead of taking the opportunity to communicate openly, CalRHIO maintained its imperial, top down approach towards HIEs across the state that are already delivering clinical data (unlike CalRHIO). Here's the list:

1. Redwood MedNet
2. Virtual Clinical Network of Partnership HealthPlan
3. ACCEL
4. Santa Cruz
5. EKCITA
6. Long Beach Network for Health
7. Kaiser Permanente
8. Orange County MSI

In the end, the meeting was another missed opportunity for CalRHIO to harmonize their message with the eight HIE projects in the state that are already operational. Instead, rather than openly collaborate with other HIEs in the state, in this meeting CalRHIO described a clearly inaccurate version of events. When called on these inaccuracies by participants at the meeting, CalRHIO sought to talk them away. People I spoke with after the meeting were disappointed by the continued stonewalling from CalRHIO.

As the next phase in the NHIN unfolds this year, fueled by HITECH funds, and as the 8 operating HIEs in California are joined by the 10 planning HIEs, and as even more HIE projects in this huge state emerge, CalRHIO will find a robust community of peers available to collaborate on improving health care for all. This is not a question of if but rather is only a question of when CalRHIO will drop their mistaken assumptions that (1) they are in charge of the state or (2) are in any way essential to the NHIN, when in fact they are just one HIE among many.

Call To Action
In the next post I'll detail the Call to Action that was published earlier this week (on Monday) by the California eHealth Collaborative, which asks all communities in the state to articulate the actual, known, on-the-ground eHealth activities. Far more than the inconclusive regional meeting hosted by CalRHIO in Los Angeles, the CAeHC statewide survey will show how many communities are hard at work developing an eHealth infrastructure for California.

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.

Hello World.

Welcome to the Minformatics Blog. "Minformatics" is an amusing concatenation of the name of my technology consulting business, Mendocino Informatics. It is also a pun drawn from a personal focus on minimally invasive technology. My broad goal for starting this blog is to leverage this verbal venue to advocate for technology solutions that enhance our humanity, protect our privacy, conserve our resources, and accelerate our collective ability to create peaceful and productive communities for ourselves and for all inhabitants of the planet. The narrow focus of my comments will be the theory and practice of health informatics, with specific attention towards the ability of small rural communities to participate in the emerging eHealth agenda. Occasionally I will lapse into commentary on art exhibits, musical performances, sustainable technology, horticulture, raising children and other peripheral topics; however my primary discussion will consider how to make electronic health data agile across the community in an affordable way while maintaining appropriate privacy, security and access controls.

The next post will drill down into recent public claims made by CalRHIO, including their general barrage of press releases; CalRHIO doesn't actually operate a health information exchange (HIE), they merely issue press releases about planning to operate one. Specifically, I will analyze the public testimony by Dr. Molly Coye, Chair of the CalRHIO Board, at the California State Senate Health Committee hearing in San Jose on March 13, 2009. I will compare and contrast the assertions in her testimony to other testimony at the same hearing.