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Battleground States

September 28, 2009
by David Raths
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With HITECH dollars forthcoming, the pressure is on for states to develop organizations that represent both public and private interests

The postings below have been edited due to spacing concerns. To read all of David Raths' blogs in their entirety, please visit /contributors/david-raths.

Has Your State Designated an Entity to Coordinate HIE?

Lynn Dierker

Lynn Dierker

Posted on: 8.11.2009

How ready is the government in your state to take the reins in overseeing health IT efforts? Are your state governor and CIO engaged? Is there already a healthy ecosystem of public and private players working out health IT policy details?

Lynn Dierker, R.N., project director for the State-Level HIE Consensus Project, has noted that when it comes to HIE sophistication, states basically fall into “three buckets.” One group is advanced and implementation-ready. Another group is almost there, but may need to revise its strategy on planning and deployments in the wake of the HITECH Act. A third group is really scrambling right now because they have no established governance and it isn't clear who is going to deal with funding, including applying for and managing grant funds. An important part of that task will be establishing accountability measures for the health IT strategy.

As states prepare to handle their share of stimulus money to work on interoperable EHRs, many are undergoing internal debates about whether a department of the state government should oversee the implementation of health IT efforts or whether a nonprofit, public-private partnership should be given a contract to tackle the job.

Clearly the implementation of the HITECH Act will expand the role of state government, including managing the Medicaid incentive payments. Currently, nine state governments host state-level HIE efforts from within state government. But from their own experience, many State-Level HIE Consensus Project participants perceive that it would be better for a state-level HIE entity to be a structure that sits outside of state government, so it won't be subject to the same financial turmoil state governments are facing, and won't have to follow the same stringent procurement rules.

A good example of a public-private partnership would be the New York eHealth Collaborative (NYeC), which is facilitating a statewide collaboration process involving the New York State Department of Health, RHIOs that have received state contracts, and other stakeholders.

California Dreamin'

Posted on: 8.17.2009

After the flurry of activity earlier this year, it may seem like there is a lull on the healthcare IT policy front. But at the state level, many people are scrambling to meet deadlines to develop cohesive organizations that will be responsible for distributing and monitoring federal funds to promote health information exchange.

Perhaps nowhere is the scope of the challenge greater than in California, which should get about 10 percent of the $36 billion spent on eHealth over the next few years.

The California Health and Human Services Agency is expected to decide next month whether one or more public/private partnership organizations should be the state's health information exchange governance entity. Both CalRHIO, an organization that has been around for several years, and the California eHealth Collaborative (CAeHC), formed in February 2009, have expressed interest in playing that role.

The Golden State's size alone makes communication and governance much more complex than in smaller states. California has a population of 36.8 million. It has 90,000 physicians, 400 hospitals, 890 community clinic sites, 28 critical access hospitals and 62 public health departments.

“There's a perfect storm of reasons why things shouldn't work in California,” said Laura Landry, executive director of the Long Beach Network for Health and a member of CAeHC's steering committee. “At every turn there is a challenge,” Landry said in a phone interview. “We can't take Delaware or Utah as a role model,” Landry said. “New York may be the closest, but they started this process five years ago, like we should have.”

Healthcare Informatics 2009 October;26(10):51

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