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The Physician Factor

May 29, 2009
by David Raths
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Discussions on policy and meaningful use should include input from small practices

The following post has been selected from David Rath's Policy Blog, which can be found at

Valuable Addition to HIT Policy Committee

Posted on: 4.9.2009 10:55:49 AM

I have read a few opinion pieces lately in which people have noted that there are no representatives of small physician offices on the federal HIT Policy Committee. I think that's a valid criticism. But one physician I think will make a valuable contribution is Arthur Davidson, M.D., director of public health informatics and preparedness for the Denver Public Health Department.

Dale sanders

Dale Sanders


His presentation at the National eHealth Collaborative March board meeting impressed me. His description of the many challenges faced by the Colorado Regional Health Information Organization (CORHIO), a five-year effort to establish a regional health information exchange for Colorado, demonstrated that he and his colleagues have valuable (and sometimes painful) experiences to share with other groups starting down that path.

In summary, Davidson told the NeHC board that although the AHRQ-funded CORHIO has been able to create a master patient index to share point-of-care information, it has not found a sustainable business model for that type of use.

“The point-of-care information has not been defined as something that will lead us to a sustainability model,” he said. But the health information exchange has seen considerable volume in clinical messaging between providers, and that has become a major focus for the board. With the AHRQ funding running out this September, the issue of sustainability is paramount in the minds of the board members.

The monetary incentives for building the query response and decision support tools for quality outcomes, which is what CORHIO told AHRQ it would do, are limited, Davidson stressed. But the volume of clinical messaging is impressive, he added. “In some ways, solving the problem of clinical messaging is much bigger and has many more transactions happening every day,” he said. “That's why CORHIO is saying let's go there and try to solve that problem instead of continuing to try to solve the problem we said we were going to try to solve with the initial AHRQ contract.”

A project started five years ago has to be able to adapt to changing conditions and to leverage what they have already built. Davidson quoted Phyllis Albritton, executive director of CORHIO, as saying the problem is: “We have where we have been and where we need to go, and those are two things in conflict at the moment.”

As Davidson put it, there are two different conversations with two different sets of issues: one about quality and one about volume and creating a sustainability model, and those things have not been thoroughly resolved in the minds of CORHIO. But, as he suggests, they have very common themes: they are all about cost, about buy-in, about return on investment, and who wants to pay for this in terms of being members of CORHIO.

By the way, Gov. Bill Ritter recently designated CORHIO as the state-level entity to receive health information technology funds available through the American Recovery and Reinvestment Act.

Comment from Dale Sanders, VP & CIO, Northwestern Medical Faculty Foundation:

Thanks very much for this post. This discussion of messaging between clinicians is very, very timely. As our hospital (Northwestern Memorial) embarks on a project to deploy eClinicalWorks in our affiliated physician faculty offices (per Stark Umbrella), we are, in essence, creating our own health information exchange especially so as we plan for future integration with Children's Memorial Hospital and the Rehabilitation Institute of Chicago. The de facto integration strategies address interoperability of EHR data and patient identifiers, but not clinical messaging. However, as we listen to our physicians, they clearly want “integration” to include faster and more efficient ways to communicate between referrals and the broader care team. I'm going to point our project management team to your blog and to CORHIO for more insight.

Again, thanks, David.


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Healthcare Informatics 2009 June;26(6):88