California needs to take a step back and address some fundamental issues with vision and governance as it continues to implement aspects of the HITECH Act, according to a new report from the California Healthcare Foundation.
The state has received up to $3 billion in federal funds, about which the report--"Are We Wired Yet? Measuring the Progress of HITECH in California"--says:
"In many respects, HITECH can be viewed as venture capital funding that seeded activities but now must be re-evaluated and restructured in light of dramatic changes in healthcare payment and delivery models due to reform."
Though the report lauds the boost to electronic health record implementation that the federal funds spurred, it notes some setbacks, including the low rate of e-prescribing adoption and the closure of Cal eConnect, the state's health information exchange governance entity, which suffered from numerous changes in leadership.
The report discusses and makes recommendations for the Medi-Cal EHR Incentive Program, Regional Extension Centers, health information exchange and telehealth.
Overall, it urges:
- Developing an overarching vision for a unified statewide approach to HITECH implementation efforts that align them with payment reform and system redesign as a result of the Affordable Care Act.
- Establishing centralized governance. The California Telehealth Network, HIE, and REC duplicate efforts, according to the authors. Streamlining and consolidating governance would reduce redundancies and facilitate program coordination.
- Retaining strong leadership. Strong leaders must be recruited and retained to run these programs, and they must be given the authority, resources and support to succeed.
Cal eConnect spent $12 million with little to show for it. It was plagued with turnover and failed to produce necessary privacy and security policy changes. Exchange of prescription and lab data remains a challenge in the state.
California leads the nation in total Medicaid EHR incentive payments--$353 million as of August 2012.
"Given the lack of tangible progress in expanding HIE capacity in California through federally funded programs ... it is unclear how meaningful the widespread adoption of EHR will be," the report says. "Electronic silos of patient data will be no more effective in enabling care delivery transformation than paper silos containing the same information.".
California is one of the states highlighted in this FierceHealthIT post about the trial-and-error going on as states implement HIEs.
For help, California and other states could look to the National eHealth Collaborative, which this week released a series of reports detailing strategies for developing and sustaining interoperable HIEs.
To learn more:
- read the report