In a small office tucked away in the Arizona Medical Association's Phoenix headquarters, Brad Tritle is in startup mode. Just last week, Tritle assumed his new job as the first executive director of Arizona Health-e Connection, the state's ambitious private-public partnership on health information technology and electronic health-records exchange.
The not-for-profit, formed in January, evolved from Gov. Janet Napolitano's 2005 executive order to develop a statewide e-health infrastructure and EHRs for every Arizonan by 2010. That timeline would put Arizona far ahead of the Bush administration's goal of implementing EHRs nationally by 2014.
With just three years left to complete the project, Arizona is undertaking a massive effort to communicate the importance of data exchange to providers, most of whom work in small two- or three-practice offices, and facilitate stable funding mechanisms to ensure long-term adoption.
Tritle, 39, who is temporarily using a card table as a desk and configuring his own computer system, is Arizona Health-e Connection's sole employee.
But that doesn't mean he's alone in the effort.
Arizona's broad group of stakeholders, involving more than 100 people at the outset in virtually every aspect of healthcare, has garnered the state praise in the way it is moving forward with the arduous task of health information exchange.
"Arizona gets it," Robert Kolodner, the head of HHS' Office of the National Coordinator for Health Information Technology, told stakeholders at an Arizona summit in March. "You have in fact embodied that idea of fostering collaborations and bringing to the table a wide spectrum of stakeholders, all of whom have to be involved."
At a time when the federal government aims to convert the American Health Information Community into a private group, and other states are embarking on their own e-health initiatives, the Arizona private-public model is being closely watched.
And as several more regional health information organizations fold or go on hiatus, Arizona's experience could be instructive if it succeeds.
"There's a big hope that we could jump ahead and our template could be used in other states or even nationally," said David Landrith, vice president of the Arizona Medical Association and chairman of Arizona Health-e Connection's board. "I don't see many downsides in trying to do it."
How others are doing it
State efforts are important to moving health information exchange along, said Scott Wallace, president and chief executive officer of the National Alliance for Health Information Technology.
"Our federal government right now is comprised of federalists who don't believe there is a strong role for the federal government in this," Wallace said. "And the needs in Arizona are probably going to be different than those in Pennsylvania or Alaska."
States are taking different approaches to implementing health information exchange. Several others, including Florida and Delaware, are taking an approach similar to Arizona's by forming not-for-profit organizations to help develop a statewide health information infrastructure.
The foundation of Arizona Health-e Connection is outlined in a road map unveiled in April 2006, with buy-in from hospitals, physicians, health plans, consumer groups, policymakers, researchers and other stakeholders. The 80-page document lays out the priorities and goals: that the not-for-profit group will serve as a facilitator for health information data integration by providing incentives and guidance, while working to remove barriers.
"Our goal is to be a lean and flexible organization," Tritle said.
The group's strategic direction falls into three categories: serving as an information clearinghouse on health information exchange; leading development of standards; and supporting infrastructure as it develops around the state.
Since the road map was created more than a year ago, the state has identified privacy and security roadblocks to health information sharing, under a $350,000 federal grant. These barriers included state statutes that could slow data sharing, and liability issues facing participating providers.
"We need to create a good perimeter around information exchange for it to move forward," Tritle said. "We have to give everyone a comfort zone."
Arizona Health-e Connection is not a regional health information organization, or RHIO, and it's not nestled inside a state agency. As a hybrid of sorts, the group has autonomy and yet sits on an influential perch, Tritle said.