It all comes down to an experiment. Can a collection of providers, payers and employers with sometimes competing interests work toward a better information services deal than any of them could pull off separately?
Principals of the Santa Barbara County Care Data Exchange will test an interlocking technical and business structure designed to balance consensus and latitude, common standards and individual preferences, financial risk and collective clout.
Guided by a huge not-for-profit community foundation and an information company with academic research ties, the project is envisioned as "an investigation that will build intellectual property and services," says David Brailer, M.D., who heads Care Management Science Corp.
If successful, the validated approach will be marketed to other communities by Care Management, which Brailer describes as an "investigative science company" that converts projects of the University of Pennsylvania's Wharton School of Business into products.
If the plan doesn't pan out, it won't be the first time for healthcare.
Previous ventures into this terrain by so-called community health information networks collapsed under the weight of the baggage they were carrying, and the data exchange seeks to avoid the same mistakes, Brailer says.
Much of the crushing weight of CHINs was financial. The expense of essentially building a proprietary communications network from scratch required a substantial commitment from participating organizations to cover the costs. Even then, the costs were out of line. "It was simply unaffordable," says Brailer. "There was no formula that could make this not just cost-effective but merely affordable."
The advent of Internet technology removes that burden, but CHINs would have faced an unstable business foundation even if they could have gotten past the technology gap, Brailer says. To get the initiatives going, a small high-level group often made decisions on behalf of all participants. Those decisions included thorny problems of confidentiality, determinations about which transactions and functions to include, and the business rules governing how and when data exchanges took place.
The new approach starts with a central governing body, the Santa Barbara Care Data Exchange Council, to deal with business rules and technical standards on which all participants must agree. But the responsibility for planning and implementing the end products is in the hands of four "care data alliances" formed around common business transaction needs and existing trading-partner relationships.
"We've put a year's worth of time into understanding the desires of the Santa Barbara community to do something like this," says Sam Karp, chief information officer of the California HealthCare Foundation.
Each alliance is built around an "anchor" organization that is contractually responsible for ensuring the group's goals. Grant money from the foundation, totaling $10 million, will be funneled through the anchors to alliance partners based on their internal agreements.
The four alliances came up with their own project priorities, without much overlap (See chart). That means the overall effort can tackle 25 to 30 pilot projects at once, Brailer says.
When alliances are working on the same objective, such as results reporting, they must support standards-based technology but otherwise can select different ways of achieving it with any number of certified vendors, he says.
Although physician groups in Santa Barbara County admit patients to multiple hospitals, three of four hospital organizations in the county each chose one alliance in which to participate:
* Cottage Health System is participating in the Sansum Santa Barbara Medical Foundation Clinic's alliance. The health system has facilities in Goleta, Santa Barbara and Santa Ynez.
* Lompoc (Calif.) Hospital District is participating in the Lompoc Valley alliance.
* Marian Medical Center, Santa Maria, is participating in the Midcoast Care alliance.
St. Francis Medical Center of Santa Barbara is not directly involved in an alliance but is associated through Marian Medical Center. Both are part of San Francisco-based Catholic Healthcare West.
The Santa Barbara Regional Health Authority, a Medi-Cal HMO, has formed its own alliance including county health clinics and the county medical society. But it also lists the Lompoc Valley and Sansum alliances among its members.
Also in the fold are major employers and government installations, including Vandenberg Air Force Base, University of California at Santa Barbara and a federal prison in Lompoc.
Unilab Corp. is participating in two alliances that aim to automate exchanges of lab orders and results.