Under the radar -- and all but forgotten in the combined cacophony of polarization in Washington, D.C., and the launch of the state's new benefit exchange -- a significant milestone was reached in California on Oct. 1.
The Department of Public Health launched its Health Information Exchange Gateway, a single point of entry for submitting data for many state and public health programs. The gateway is an expansion -- a wider opening, to follow the metaphor -- of the department's Immunization Portal.
The first new stream of information flowing through the gateway is infectious disease laboratory reports. Eventually, other public health programs, including the California Cancer Registry and Childhood Lead Poisoning Prevention Program, will use the gateway.
Ultimately, this will be a two-way gate. For now, information is only flowing in, but eventually the collection and manipulation of all this data has the potential to profoundly change the state's health care delivery system. Proponents of "big data" predict that gathering and analyzing health information on a large scale will lead to better medical outcomes at lower costs through evidence-based decision-making.
"In the long run, this will make a very big difference in people's lives," said Jonah Frohlich, managing director of Manatt Health Solutions and former deputy secretary of health information technology at the state HHS.
"This should be more widely recognized. This is the beginning of really excellent work that needs to be further invested in," Frohlich said.
Ron Chapman, DPH director and state health officer for California, said the gateway is an example of his department's focus on the future.
"CDPH is pleased with the launch of the HIE gateway," Chapman said. "As technology changes, CDPH will continue to seek progressive solutions, encouraging innovation and creativity. We often say that we work in the present and focus on the future, and the HIE Gateway is a fine example of that," Chapman said.
From Portal to Gateway
The public health department's first effort toward electronic information exchange -- the state Immunization Portal, which launched in July -- replaced a manual process for registering, testing and submitting electronic immunization data. Medicare and Medi-Cal providers participating in an electronic health record incentive program are required to submit immunization data electronically to the state's immunization registry.
Using both the Immunization Portal and the new gateway can help California health providers meet the requirements of the federal meaningful use program, which rewards providers for adopting certified electronic health records.
In the first week of operation, the new gateway logged 209 visits to its home page and 72 registrants. The number of providers who used the gateway in the first week is probably larger than 72, according to DPH officials.
"It's important to note that some of these registrants may represent provider groups, so the total number of providers may be greater than 72," said DPH spokesperson Matt Conens.
Two recent news events illustrate the importance of gathering and analyzing public health data:
- An outbreak of salmonella traced to three California poultry-processing plants sickened 278 people in 17 states. USDA officials said the Foster Farms facilities in Fresno and Livingston can stay open for now, after making "immediate and substantive changes to their slaughter and processing."
- Because of the federal government shutdown, officials from CDC are not on the job, just at the start of flu season. To help fill the void, an electronic health record company is offering to share its data to track the spread of influenza and other infectious diseases. Athenahealth, whose EHR systems are installed in 44,000 physician offices and hospitals across the country, will monitor about 300,000 patients visiting primary care physicians weekly reports. The company plans to post data on its website to help providers understand and react to flu outbreaks in different parts of the country.
Funding, Policies Need Coordination
"Both of those examples are exactly the sort of things that these sentinel services can do, but we have just the basics in place," Frohlich said. "We need to get serious about our long-term support and coordination," Frohlich said.
"The federal government really needs to commit to long-term fiscal and policy support for these efforts," Frohlich said. "The government needs to align its data-driven policies at ONC (Office of the National Coordinator for Health Information Technology), CDC and CMS.
"Stimulus funding was a good way to get things started, but what happens next? The funding and long-term policies for all these agencies need to be thought about," Frohlich said.
'How Simple and Convenient It Could Be'
While big data has the potential to improve care and reduce costs on a large scale, electronic collection and storage of data -- an effort the health care industry is slower to adopt than many other industries -- also will have an impact on individual care. Formerly filed separately in multiple folders in multiple physician offices and available only to those physicians, patient records eventually will be kept in one electronic file and will be accessible by anyone given the authority to look at it.
California's Immunization Portal and now the Information Exchange Gateway will help the industry move in that direction.
"When I think about the immunization registry in particular, I harken back to my own relationship with the system and my three children -- how simple and convenient it could be for school, family, county to all have secure access to records to allow them to enroll kids in school," Frohlich said.
Frohlich said both aspects of data collection -- the public health advantages of "big data," as well as the improved care and convenience for individual patients and families -- should get more policy attention and funding.
"We're moving in the right direction, but what we're doing now is just not good enough for the long haul," Frohlich said.
While much attention is paid to political wrangling and getting the uninsured covered, in the long run less-heralded changes in information technology could play a more profound role in the evolution of health care than the Affordable Care Act.
"There needs to be more attention paid to these efforts," Frohlich said.