Helping Physicians Achieve Meaningful Use in California: CalHIPSO’s Sustainability Strategy

Well, it’s the job we’ve been given. We’re the largest state in the nation, so we have the largest REC in the nation. And we recognize that adoption and meaningful use are a bit challenging, so we’re starting the year with big goals. At the same time, we’ve been given the charge by the ONC of developing sustainability beyond the grant. We received $35 million; that goes a ways, but given that there are 35 million Californians, in that context, it’s not that large. The ONC created a formula with a per-provider cap, around $5,000. So the more providers you have, the more money you get. And part of our responsibility has been, for the past three years, to manage that money well. But everything we’ve been told by the ONC is, do not expect an extension, this is stimulus funding.

And, given the environment in Washington, the chance of getting more money are probably small, correct?

Probably. But there has been a tendency to look back at the meaningful use program and say, the standards aren’t enough, or the accomplishments aren’t high enough; but my response to that, as someone who’s living and breathing this every day, is, you have to meet the doctors where they are.

Meaningful use really has been a success, in that sense.

Yes, it has created a tipping point. It created the critical mass; five years ago, you were still talking to physicians who were doubting whether they would ever get an EHR. Now it’s not whether, it’s when. Or they’ll retire. But no one is believing that they’ll be able to practice medicine in a non-electronic environment. And I say when folks come to work at CalHIPSO, you know what? The goals are very, very clear here. I call the success measures breathtakingly direct, we know based on the numbers.

And many of our readers will be executives in those “aggregator” organizations you discussed, like hospital systems.

Yes, and it’s interesting, because I believe California is one of three states (I believe the others are Texas and New York) that still forbid direct physician employment. And the center of our universe is the physician or provider; and we’re enabling their choice. If they want to be able to affiliate and build their capacity, that’s their choice as well.

So what lessons are you learning?

One of the things we’re increasingly observing, per the future, is, from the provider perspective, the ideal universe is that when patients get care in their office or another physician’s office, or at a hospital, regardless of where the patient receives care, the clinical information is put in a place where providers can use that appropriately. What we’re seeing in our marketplace is that the business rationale is not quite there yet to support that. But who’s buying the HIE [health information exchange] companies? It’s the payers! Every time I turn around, there’s another payer buying an HIE company. Why? Because they want that information. And we are interested in working with payers. But what I’m seeing is that the leverage is moving to the payer community, and they’re buying HIEs to basically manage the flow of information that they need to do their jobs. So the industry’s not quite there yet, and that makes our jobs a little bit harder. But we’ll be moving forward.