Northern California health information organizations are helping lay the groundwork for the next steps in expanding health information exchange throughout the state. Their participation in pilot programs for secure messaging, rural health information exchange and personal health records puts Northern California communities in the forefront of the campaign to increase the use of health information technology.
There are 16 community HIOs in California, half of which are operational. A new map shows health technology has reached 35 counties -- more than half of California's 58 counties.
Three Northern California HIOs -- the venerable Santa Cruz HIE, the one-year-old North Coast Health Information Network and the UC-Davis Health System -- are participating in California Health eQuality's California Trust Framework pilot. The effort started in June and runs for six months.
The trust pilot is developing a set of policies, practices and technology to create a trusted exchange environment across states and organizations, said Robert Cothren, technical director for CHeQ, which has provided $360,000 in funding for the pilot.
He expects the collaboration to produce a scalable solution.
"It will probably take a year, however, to develop the infrastructure because the technical standards are not quite there yet," Cothren said. The results of the pilot will inform the California Association of HIEs, which is responsible for advancing safe and secure exchange throughout the state.
CHeQ falls under the auspices of the UC-Davis Institute for Population and Health Improvement and oversees the state's HIE implementation.
CHeQ is behind another current initiative, the California Health eQuality 2013 Rural HIE Incentive Program, started April 1, 2013, and runs for eight months.
For the program, CHeQ selected five HIE organizations, two of which are in Northern California -- Santa Cruz HIE and Redwood MedNet -- to develop a package of services for rural communities.
Rural health care providers have a choice of services, including records, delivery of lab results, alerts and notifications, care summaries and immunization reports, from as many of the five vendors as meet their needs.
CHeQ provided $1.2 million to defray the cost of connectivity for service providers; end users will pick up the rest of the tab.
Santa Cruz HIE Has Years of Experience
Starting in 1996, Santa Cruz was one of the first HIEs in the country, founded well before the HITECH Act of 2009.
"The impetus behind the HIE was the multiple hospitals, clinics and other facilities in our community using different technology systems," said Bill Beighe, chief information officer for Santa Cruz HIE. "This situation gave us the opportunity to provide coordinated, high-quality patient care on a local level."
The key players in the original initiative were Dominican Hospital, Physicians Medical Group of Santa Cruz County, reference labs and imaging providers.
Since then, the HIE has added Watsonville Community Hospital, 100 provider locations, the Santa Cruz County Health Services Agency, 10 safety-net clinics, and more labs and radiology imaging sites.
The organizations are able to exchange information -- including patient referrals, test results, laboratory and radiology reports, patient hospital discharges, orders, prescription and refill requests, and inpatient and emergency department outcomes -- representing 1.2 million web transactions monthly and more than 120,000 clinical documents.
Santa Cruz HIE depends on funding from three primary health care entities in the organization, along with membership user fees, most of which go toward operations. Less than 1% of funds come from the state or federal government; however, Santa Cruz HIE received a $200,000 grant in 2013 from CHeQ to help physicians defray costs.
Getting Patients Involved
Besides the two CHeQ pilots, Santa Cruz HIE is one of three organizations chosen by the California Office of Health Information Integrity to participate in an electronic personal health record demonstration project. The other two organizations are Humetrix in Del Mar, Calif., and the UC-San Diego Department of Emergency Medicine in Southern California.
Cassie McTaggart, chief of health information policy at CalOHII,
said the three organizations were chosen because they already exchanged health care information and had physicians willing to interact with their patients electronically.
She expects the pilot will outline policies, governance and technical issues for a PHR, identify barriers to data exchange and improve access. CalOHII awarded Santa Cruz HIE $102,500 for its pilot participation.
Because PHRs are owned and controlled by patients, patients choose with whom they want to share information. They would have the ability to send and receive secure messages. Their information goes with them despite a change in providers or insurers.
"The PHR delivers data in one place and is portable," Beighe said.
Beighe expects all three pilots will better prepare organizations to accomplish stage 2 of meaningful use. Under the 2009 federal economic stimulus package, health care providers who demonstrate meaningful use of certified EHR systems can qualify for Medicaid and Medicare incentive payments.
Federal guidelines for achieving meaningful use include secure messaging. In order to receive incentive payments, providers must demonstrate the use of a secure messaging system as a primary transport mechanism, while also incorporating lab results, electronically transmitting patient care summaries across multiple settings and providing more patient-controlled data.
MedNet: A 'Hybrid' HIE
Redwood MedNet, another well-established HIO, is a "hybrid," according to Will Ross, project manager. He said Redwood MedNet leverages open service software rather than purchasing it from a vendor.
MedNet developed its own security appliance, a small box that plugs into a local network and encrypts clinical messages. For small facilities, it increases security over a firewall.
The HIO was established in 2005, with basically no support for the idea from the local health care community, according to Ross.
He said information exchange is difficult in a health care environment whose model is hostile to the concept. "Our system integrates with an organization's workflow," he said.
A Year off the Ground
Although established HIOs might be running the show, newcomer North Coast Health Information Network is already participating in CHeQ's trust framework initiative.
Serving Humboldt and Del Norte counties, NCHIN is the successor organization to a community collaborative hosted by the Humboldt-Del Norte Independent Practice Association and Humboldt-Del Norte Foundation for Medical Care.
CEO Martin Love said it was a natural transition leveraging the two organizations' community care improvement projects and experience in technology, the latter enabling NCHIN to handle most of the system requirements in-house.
The network connects 22 local physician practices, two hospital systems, the county health system, local and commercial labs, the California Immunization Registry, a diabetes registry and the Nationwide Heath Information Network.
Love said creating a perfect system is not as important as learning from experience. He warned against overdesigning an HIE. "It is best to avoid the bells and whistles and stick with the tried and true," he said.
An Emerging HIO
Half of the state's HIOs are still listed under "emerging" status -- still in embryonic stages of development. One such HIO, SacValley MedShare is expected to go live in March 2014, connecting 30 physician offices, four labs, three acute care hospitals, critical access hospitals and clinics, and public health organizations.
It has not received any funding from the state but is expected to receive a grant from CHeQ to cover 50% to 65% of the cost of implementation and software.
Jim Hauenstein, chair of the HIO, said the effort has coalesced quickly because of the cooperation and commitment among the parties who will be served by the HIE. "It takes more than just the involvement of IT people to make it work," he said.
"It takes organizational will, a good champion in the medical system, cooperation, capital and a business plan. Lack of short-term savings and higher quality health care are potential barriers to adoption," he said.