The early results of a county-wide clinical information interoperability project in California are promising, but local and regional data exchange networks need plenty of help from Washington in order to succeed, according to a report to be released next week.
Saying that "ambiguity in federal rules that affect health information exchange is a barrier" to connectivity, the California HealthCare Foundation spells out a wish list of federal policy changes in its interim report on the 5-year-old Santa Barbara County Care Data Exchange, a public-private network available to any healthcare provider in the seaside California county.
"Potential policy initiatives include financial incentives for regional exchange of health information, clear safe harbors in federal healthcare regulations, operating standards for health exchange organizations" and other measures to promote interoperability over wide geographical areas, says the report, a copy of which was provided to Modern Physician this week.
However, local experiences suggest the exchange has been a positive development for Santa Barbara County. A 2002 Institute of Medicine report referred to the project as "perhaps the best-known example of a data exchange platform for patient information."
The data exchange effort started in 1998, though the organizational and operational model was launched early last year and the technical model now is in the final phase of testing.
"To date, the SBCCDE has shown that secure patient-specific health information exchange is legally, organizationally and technologically feasible," the report says. It also says the project is sustainable because it increases operational efficiency and cash flow for physicians, medical facilities and payers alike.
"The SBCCDE has shown that there is a moderate-to-strong business case for health information exchange," the report says, but it notes that it is just one of many means of financial improvement that healthcare organizations are contemplating.
The research team says healthcare organizations in the county have embraced the data exchange because of its potential to simply physician workflow.
However, researchers, led by informaticist David Brailer, M.D., are still trying to determine what sort of care-quality improvement the network brings. They are looking at the extent to which data sharing can prevent medical errors, hospital readmissions and redundant testing and note that most U.S. patients--called consumers in the report--have limited or no access to their own clinical histories.
Brailer, who recently joined the not-for-profit Health Technology Center in San Francisco, was a consultant to the project in his former role as chairman and CEO of CareScience, a Philadelphia-based care management technology company.
The California HealthCare Foundation provided a $10 million grant to start the exchange and is in the process of transitioning full financial responsibility for the network to Santa Barbara County healthcare organizations.