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Building Blocks

July 21, 2009
by David Raths
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Postings have been edited due to spacing concerns. To read David Raths' blogs in their entirety, please visit

Broad Adoption, Small Success Stories, or Both?

Posted on: 6.10.2009 1:28:11 PM

Should state-level health IT leaders primarily work on increasing EHR adoption rates and creating the infrastructure for statewide data exchange? Or should they focus on small victories with pilot projects that target chronic disease management to both help alleviate the crushing costs of Medicaid payments and help prove the value of exchanging data? Or can states do both at the same time?

We've read about intriguing state-level success stories such as the Delaware Health Information Network, but many states are closer to starting from scratch than they are to having a statewide exchange up and running. Facing all the traditional problems involving business models and governance issues, where should they start? Federal funding will kick-start HIE development, but it probably won't pay to sustain it long-term.

Mark Danis, vice president in charge of public sector health for information technology services company Keane, told me recently that he believes broader EHR usage and data exchange shouldn't be goals in themselves. Rather, state governments and public/private HIEs should work on identifying specific quality improvement projects and then make technology investments to achieve those goals. “My concern is that a lot of energy may be expended to push for wider adoption, the network effect, when I think there should be more focus on desired outcomes from the beginning,” Danis said.

Many states have received Medicaid Transformation Grants from CMS to work on pilot projects that involve technology investments targeting Medicaid patients. Some states have started to build systems to work with chronic disease populations, and if successful those efforts may become building blocks for broader health data exchange.

Clearing Technical Hurdles, Washington Tries Health Record Banks

Posted on: 6.18.2009 10:24:18 AM

Earlier, I wrote about a health record bank (HRB) project being planned in Oregon. But north of the border, there are four HRB pilots already underway in the state of Washington. Three are state-funded and one (Madigan Army Medical Center in Tacoma) is funded through a federal appropriation.

Last year, Juan Alaniz, manager of the Health Record Banking Project for the Washington State Health Care Authority, told me that the state wanted to try something different than the traditional efforts that involve building interfaces between provider data silos. “We think the real change will come from consumers having control over their healthcare information and sharing it with whomever they want to. The health record bank could be the disruptive technology to change the paradigm,” he said.

Alaniz recently updated me on the three regional state-funded efforts. He noted that the projects all experienced unexpected technical issues that caused launch delays. It turned out that some of the interfaces between the personal health record software and Microsoft Health Record Vault and Google Health (the platforms the pilots are using) were more challenging than anticipated to develop. Alaniz said that Microsoft dedicated full-time staff to work through issues with the pilots.

He added that the pilots are now working to enroll consumers and are expected to showcase their models at state meetings. They will propose next-phase options that may include hardening of the technical infrastructure, creating interfaces to more data silos, increasing enrollment, sharing infrastructure, and possibly a common account locator service or virtual master patient index (to assure that the records are accurately matched). They will also begin business model planning to work toward self-sufficiency.

The Washington State Health Care Authority also has created an organization,, to support the concept of online personal health records in the state. Its activities may grow to include playing an ombudsman role for consumers. It may also provide advice and recommendations to communities and the industry on best practices for engaging consumers and providers.

Healthcare Informatics 2009 August;26(8):29

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