On September 1, our coalition was joined by Mark Elson, Intrepid Ascent and Dawn Gallagher, HealthTech Solutions, for twin presentations on the history of HIE, particularly in California, along with the current status of HIE in different regional markets around the state.
Mark Elson, drawing on findings from Intrepid Ascent’s recent study, “Health Information Exchange in California: Assessment of Regional Market Activity,” began by describing the differing regional profiles across California, along with the different network types that are in place in different markets.
Doing a deep dive into the Humboldt County profile, Mark welcomed Jessica Osborne-Stafsnes from North Coast Health Improvement and Information Network (NHIN) to provide her firsthand perspective on the utility of HIE in this rural, diffuse community where nearly 60% of residents are covered by Medi-Cal or Medicare.
The principal conclusions of the study, borne out in the Humboldt County example, were that regional variation in the networks matters less than ensuring a coherent user experience. That said, there are clear opportunities for alignment between data exchange networks across the state and beyond to ensure a coherent user experience for all Californians, even if they move between regions. As Mark said, when it comes to leveraging existing data sharing infrastructure in the state to improve patient outcomes, “There is more than one positive path forward.”
Dawn Gallagher then turned to her presentation, driven by her recent study, “Learning from the History of Statewide Health Data Exchange in California.”
Dawn illustrated that for all the conversation in California today around investing in HIE infrastructure across the state, the state “has been down this road before, with a failed attempt to create a statewide data exchange that ended nearly a decade ago.”
In summary, California received more than $100 million in federal funding in 2009 to build a scaled initiative but struggled due to a lack of guidance and resources at the state level along with a lack of national standards. The efforts ended after 5 years, leaving a mostly uncoordinated system of regional HIOs that we have today.
In terms of why the first go-around fell short, Dawn identified four shortcomings: first, policymakers did not provide enough direction; second, the state relied too heavily on federal guidance and standards that failed to materialize; third, the state leaders in charge of HIE did not have adequate regulatory latitude; and fourth, it relied too heavily on federal funds.
California’s previous failure to scale up a robust data exchange network provides concrete lessons about how to find success going forward: a discrete operating entity, a dedicated source of funding, and strong statewide standards. These are goals we as a coalition have long supported.
This was the second time we welcomed Mark and Dawn to our coalition meetings, and we look forward to hearing from them again soon!