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California Dreamin'

August 17, 2009
by David Raths
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After the flurry of activity earlier this year, it may seem like there is an August 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 & 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 recent phone interview. Draw a line down the middle of the state, she noted, and the two parts are quite different. The providers south of the line are fiercely independent, while north of the line there is much more managed care.

"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."

But California does have several things going for it, including eight functioning HIEs and four groups with experience participating in NHIN demonstrations. What California has been missing, Landry said, is better collaboration between groups working on eHealth. "There have been several ongoing efforts, but all of us have been working on our own sites in informational silos."

To help break down those barriers, CAeHC has put on a series of webinars and held town hall meetings across the state. The Health & Human Services Agency also convened workgroups that had more than 200 people working on topics related to the stimulus package.

Although there may be a competition under way to determine which group will govern statewide HIE efforts, Landry said that once a decision is made, all the players would come together. "It is crystal clear to all of us that this is our one chance to get this right," she said. "All the groups have slightly different philosophies, but whichever strategy the state chooses, we will follow."

I'd love feedback from any California-based readers about the state's eHealth challenges and the steps the state government is taking to address them.

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