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From the Health Plan Perspective, a Skeptical View of HIE Progress

February 19, 2014
by Mark Hagland
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L.A. Care’s Mary Franz sees slow progress towards achieving true health information exchange

How quickly is health information exchange (HIE) really moving these days, when it comes to connecting physicians in practice with health plans? The answer is, not as quickly as anyone would like, as Mary Franz sees it. Franz is executive director, health information technology, for L.A. Care Health Plan (Local Initiative Health Authority of Los Angeles County), a public entity and community-accountable health plan serving residents of Los Angeles County, California, through a variety of available plans, and covering more than 1.5 million covered lives in L.A. County.

Franz will be participating as a panelist on a panel entitled “Enabling Data Exchange with New Models for Interoperability,” during the Health IT Summit in San Francisco, sponsored by the Institute for Health Technology Transformation (iHT2), and taking place March 25-26. The Institute became a part of Vendome Group, LLC, Healthcare Informatics’ parent company, in December 2013.

L.A. Care has been the recipient of a regional extension center (REC) grant for $16 million, and has functioned as a REC since it was awarded the grant in April 2010. Like most of the 62 RECs nationwide, L.A. Care is expecting an extension of that status through to April 2015, after its status expires this April. In that capacity, L.A. Care has worked very extensively with area physicians, supporting more than 5,000 doctors in implementing electronic health records (EHRs) and connecting with fellow clinicians.

Franz spoke recently with HCI Editor-in-Chief Mark Hagland regarding her perspectives on HIE and healthcare IT in the current policy and operating environment. Below are excerpts from that interview.

What will be the benefit of having the REC designation extended to L.A. Care for another year?

The benefit will be that we get to continue to provide service to the providers; and most of the 62 RECs will be getting extensions, from what we’ve heard from the ONC [Office of the National Coordinator for Health IT]. We’ve already worked with 5,000 physicians, and we will probably be able to work with an additional 500, if we’re extended through to April 2015.

What have been your organization’s most important learnings to date, from having served in this function?

The most important learning for me so far is this: that it’s going to be a long process [towards optimization of the use of healthcare IT, and robust data exchange], and it’s going to be iterative. And this is not new to the information technology adoption curve in any other industry; but in healthcare, the IT adoption curve is not a very well understood model. The healthcare industry somehow expects that you sort of use technology, and then you’re done forever. But in every other industry that exists, everyone knows that you have to constantly modify software and upgrade functionality, and that that is a long-term proposition.

Physicians have been off the grid in terms of understanding what happens in other industries, right?

Yes, they have. And their expectations are very high, perhaps partly because their adoption of tablets, smartphones, and apps, has been very high. But that adoption doesn’t translate into core information systems adoption or readiness. But the biggest learning is that we don’t have coordinated care in this country, and our payment models aren’t set up for that, so there’s a huge pushback around that. And so to get someone to share and exchange data, as with doctors, is a monumental effort.

In fact, I’m not sure that the HIE framework, as it exists right now, is viable; it’s a very, very difficult topology to have to navigate, with hundreds and hundreds of different interfaces. And it’s not simple, like the ATM model in banking. And no one has simplified the data transfer models. And I see it happening over and over again that when someone is trying to connect with another, unless they are owned by another, it’s extremely difficult, not just from the technological standpoint, but also from the contracting standpoint. And I’ve been in technology all my life, and have been in healthcare since 1989, and I just continue to be blown away by how difficult this is. And I’ve been involved with a lot of different HIEs; and you hear lots of great stories, but when you dig deeper, you find that a lot of these entities have been around for a while, and yet they’re still not breaking even.

So I think there’s a different way to think about this: California isn’t that consolidated a market. But the more you have integrated delivery systems that are owned by an entity, the better chance you have to successfully exchange data. And that just begs for national, single-payer healthcare. When I look at the health systems here, the one model that seems to apply here is the Kaiser model, where they own the hospitals and doctors.

So, in the end, the sets of issues around connectivity is just a conundrum in my mind. What I believe is that health information exchange has got to become as easy as an applet; a doctor’s got to be able to download an app and immediately exchange data. With ATMs, you can download anywhere and start processing transactions, but then again, it’s transactional, and it’s tiny bits of data.

Then again, when you look at the longitudinal medical record, you have to ask what’s really relevant. And I think that’s where it’s sort of got to get; what do you need in real time? But we’re exchanging years of history or transporting something in its complete form, and it’s deep but not wide. And I see a lot of HIEs transporting lab results, and that’s one thing, but it’s not enough. And you only need labs from the last few days. And I think the HIEs right now are much more technology-centric right now than they are information-driven.