California is developing a long-sought statewide health information exchange for providers and payers to deliver better care for patients.
The health information exchange, or HIE, has received little public attention. But it would cover 40 million people in California’s 58 counties, and would in part quickly inform emergency room doctors and nurses of a patient’s medical history, e.g., a preexisting condition, before her care.
It marks the first time California has begun putting together such an exchange. The data exchanges in the past have often been fragmented and limited to the local or regional levels, experts say. A statewide network does not yet exist in California, leaving a gap in the provision of services.
The law establishing HIE, AB 133 authored by Assemblymember Jim Wood (D-Eureka), was signed by Gov. Gavin Newsom as a budget trailer bill in July 2021
A framework for the data-exchange program is supposed to be completed by this July by the California Health and Human Services Agency, which will also set up an advisory group, which plans to meet this week.
John Ohanian is chief data officer for the CHHS and director of the Center for Data Insights and Innovation. “We know that to succeed,” he told Capitol Weekly, “providers will need to be able to share their patients’ health information with each other and with critical safety-net programs. These data will need to be usable, accessible, timely, and secure for the organizations providing care as well as individual Californians who will need to be able to use them to improve their lives and well-being.”
There are many moving parts in developing California’s HIE. Currently, there is a coalition, Connecting for Better Health that in part is a clearinghouse for current developments, legislative background and future scenarios. Launched on March 1, the coalition aims to facilitate improved patient outcomes in the Golden State.
In diverse California, realizing such an outcome is a challenge on several levels. Abner Mason is founder and CEO of SameSky Health, a health equity firm. His company helps health plans engage all their members, with a special focus on assisting low income, minority and multicultural patients who might have low health literacy.
“Being able to measure health disparities at the statewide level,” Mason told Capitol Weekly, “then targeting those individuals to address those disparities and measuring the effectiveness of those interventions are three steps to making our health system more equitable. A statewide health information exchange is how we make taking these steps possible.”
SameSky Health engages 2.8 million health members and has 11 health plan clients. When the HIE is up and running, Mason’s metric-heavy approach to closing the health disparity gap would apply to all Californians across all counties.
Beth Goodman is the executive director of palliative care services at Charter Health Care Group based in Southern California. “Ask any healthcare professional or provider,” according to her at Physicians Practice, “and they’ll tell you: to take care of the patients and communities they serve, they need comprehensive health data to deliver the best care.” she said.
“They’ll also tell you that in California, it can be very difficult to do that across different healthcare providers and systems. As I’ve seen firsthand, HIE networks allow nurses, doctors, and other healthcare professionals to provide better-informed care—especially in an emergency—because we have real-time access to a patient’s vital health information.”
One might call Michael Lighty a skeptic. He is a leader of the Healthy California NOW coalition, formed to support Medicare for All in California, and the former healthcare constituency director for Vermont’s Independent Senator Bernie Sanders’ presidential campaign in 2020.
“It appears that the private sector, mostly for-profit insurers, are creating a voluntary version of a necessary service that would be all-inclusive and more efficient if done through a single public program,” Lighty told Capitol Weekly. “Given the push in California for such a program in a system of “unified financing,” the plans are attempting to address the fragmented, wasteful and inefficient model they’ve created to forestall reform and the inevitable reckoning over their failures.”
A recent bid for a single public program of health care was Assembly Bill 1400, set for a vote by the California Assembly on Jan. 31. However, the author, Assemblymember Ash Kalra (D-San Jose), judged it did not have the 41 votes to pass, and he pulled the measure back, thereby saving it from defeat in a recorded vote.
Returning to California’s HIE, its development has the benefit of several states: Michigan, North Carolina and New York have established health data exchange models. The Michigan and North Carolina approaches feature mandates (legislative and rule-making) and a governance mechanism.
The development of an HIE in the Golden State has multiple supporters. They range from Anthem, Inc. to Blue Shield of California, Riverside University Health System and the Service Employees International Union California.
When up and running, California’s HIE will replace the state’s current health information sharing system.
Previous governors have recognized the need for such a statewide system. For example, Gov. Arnold Schwarzenegger in 2007 issued an executive order for “100% electronic health data exchange” by 2017. Easier ordered than done?
Meanwhile, keeping state lawmakers apprised of the developing HIE is on tap. “In April 2022,” Ohanian said, “we will update the legislature on our progress, and by this summer, we plan to finalize the policies and procedures that will allow health information to flow where and when it’s needed.”