New Leader, New Plan, New EHR Initiative for Cal eConnect

by David Gorn, California Healthline Sacramento Bureau

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Laura Landry has worked at Cal eConnect since it was formed by the state two years ago, but she looks at the organization a little differently now. After spending the last six months as interim CEO, Landry was officially named CEO on March 19.

Her new position gives her a different perspective -- the overview.

"I think we're on the verge of a breakthrough," Landry said. "People talk about making changes at the speed of trust, and we're at the point where we've engaged stakeholders ... and now we're giving them the things that they need to get things done. We're right on the cusp of making health information easier, making it easier to do health information."

Cal eConnect is a not-for-profit health information technology liaison between public and private stakeholders in California. Its task is a big one: to help integrate electronic health records into the fabric of medical practice throughout the state and to coordinate health information exchange among public agencies, providers, pharmacies, laboratories and health plans.

That's a lot of players, and getting them to agree on a single direction in the development of health information exchange technology and implementation can be pretty daunting. That's why Cal eConnect has spent considerable time laying the groundwork for that direction, Landry said -- and now the organization is ready to reap the benefit of that consensus building.

Getting everyone in the state on the same EHR interface is one of several big steps Cal eConnect and state health data exchange participants are about to take, Landry said.

"One of the things we're working on immediately is an MOU [memorandum of understanding] between Cal eConnect and EHR vendors in California," Landry said. "[It] specifies: We're going to give you these interfaces that are going to do these things. And you're going to be able to get it anywhere in the state of California."

Interface in the Crowd

The official announcement of the initial MOU is expected at the start of May, Landry said.

"We're calling it the Orderable Kit," Landry said. "We don't have a better term for it right now."

Whatever it's called, the idea of establishing a ubiquitous EHR interface has been a long time coming and would allow much more ease of operability between systems, she said.

"It's about operationalizing it, so it's easy to purchase the interfaces for your EHR system," Landry said. "We have a lot of alignment with the EHR vendors. We're aligning the vendors right now."

Cal eConnect is negotiating with about a half dozen vendors that have a sizable share of the market, Landry said. "We want to start with three [vendors]. We want to have enough market pressure to have people say, I should do this. We think it's going to be a market differentiator."

The group plans to act as the intermediary to provide the EHR interface -- something that would be a substantial aid for EHR vendors that need to spend their resources on software development, not interface work.

"It's not like it was that hard [to figure out it was necessary]," Landry said. "The vendors were saying, 'We need someone to tell us what we should do.' So in the world of HIE stakeholders, we're just giving them what they asked for."

Vendors get a deal on the health information exchange interface, and health care providers get a product they know will fit with other EHR systems in the state, according to the Cal eConnect plan. The coordination should allow providers to communicate more easily with hospitals, pharmacies, labs and state agencies.

"The providers need it, too," Landry said. "It's a very clear communication.

[Vendors] need to ship an interface, one interface, over and over and over again without having to do these custom solutions every time. So we think it's going to be, well, 'Here's your HIE connectivity.' We think it's going to be that kind of differentiator."

Once three vendors are signed up and the standard is established, it will likely be easier to provide the same EHR interface around the state, Landry said.

"This is a collaboration between us and CalHIPSO," Landry said. CalHIPSO --  California Health Information Partnership and Service Organization -- is a federally designated regional extension center tasked with helping health care providers in the state implement EHRs. "CalHIPSO needs people to be HIE-enabled. We need people to be HIE-enabled. The vendors want to be connected. So this is really the right resources at the right time to do the right thing."

Other Projects

The first CEO of Cal eConnect, Carladenise Edwards, resigned in August last year, after about 14 months on the job. She now works as a health IT consultant. After a long search, Cal eConnect announced in March that Ted Kremer, who ran a regional health information organization in Rochester, N.Y., would assume the CEO post. But Kremer changed his mind, and about two weeks after the appointment announced that he was withdrawing. Landry stepped in.

When Landry became interim CEO in August, one of her first priorities was to create an action plan, which the organization completed before the year ended. In addition to the EHR component, Cal eConnect's plan includes several other projects, including:

  • Developing model agreements and standard policies for a health information exchange;
  • Facilitating public health efforts, including immunization reports; and
  • Establishing a mechanism for an inter-HIO (health information organization) exchange.

The exchange of immunization information is high on the list, Landry said.

"We are working currently so providers can deliver immunization records, electronically, in meaningful use-qualified messages, to the state. We are helping to coordinate that effort. Immunization information needs to be moving from providers to the state, and from the state to providers," she said. "So that's a natural place where Cal eConnect can provide support."

To accomplish that, Cal eConnect brings stakeholders together and identifies what needs to happen.

"What is it that the government needs from providers, and what is it that providers need from government?" Landry said. "So we figure out how to identify that and codify it. That is squarely in the Cal eConnect role."

California Not Alone

California is pretty well-advanced in its health information exchange effort, but it is not alone. Landry said that Cal eConnect has learned a lot from New York state's effort, which started in 2003, as well as the longstanding Texas work on health data exchange systems.

"Other states have a Cal eConnect, too," Landry said. "We have watched and learned from other states, and are implementing some of those strategies, as well."

This public-private coordination model of organization is unusual, Landry said. "The role that the state coordinating entity plays is to encourage people to do what they're already doing," she said, "and then make sure we create solutions to link them together, so that we get a network effect."

Landry said coordination and discussion facilitated by Cal eConnect is vital to keep the complex implementation of health information exchange moving along. No matter how complicated the whole puzzle may be, it has an extremely simple endpoint, Landry said.

"Where we're headed with all of that is data liquidity," Landry said.


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