The third speaker was Lori Evans, formerly of the Office of the National Coordinator for Health Information Technology. Evans left ONCHIT to join the law and consulting firm of Manatt, Phelps & Phillips. Evans was in charge of regional health information organization development at ONCHIT and earlier this year was named deputy commissioner of the New York State Health Department and head of its Office of Health Information Technology Transformation. If Weems was dour and Perlin optimistic, Evans was effervescent.
I can see interoperability from my window, Evans exclaimed, riffing somewhat on Republican vice presidential candidate Sarah Palins foreign policy claim that Alaska is in sight of Russia.
At least 35 states have issued gubernatorial directives or legislative directives to boost health IT adoption, Evans said. Minnesota passed a law requiring all healthcare providers to have an electronic, interoperable healthcare record system by 2018. The California Regional Health Information Organization, or CalRHIO, was recently endorsed by that states giant pension and healthcare benefits fund, the California Public Employees' Retirement System, or CalPERS. Also, Rhode Island, by law, created a framework for a statewide network, designating the Rhode Island Quality Institute to oversee it.
Evans attributed the slow pace of creating interoperable health information to two distinct types of market failure, the failure to find a sustainable business model for healthcare information exchange organization infrastructure and the still low adoption rates of electronic health-record systems by providers.
Exchanges will provide a public service and, therefore, they not only need some government funding to get them off the ground, but also it is a proper function of government to provide some of those funds, according to Evans. Both are views that, had they been publicly expressed when she was still with ONCHIT, where the magic of the market reigned supreme, would have been out of sync with administration orthodoxy. Evans acknowledged as much.
Weve been told since 2004 we have to spend private-sector money on this, Evans said, but, in New York, and she was beaming when she said this, we are investing up to $200 million in our infrastructure and in November we are publishing a comprehensive set of health information policies.
We have to think about this infrastructure as a public good, Evans said. In fact, she said, it is a classic public good, likening it to the highway system. The search now, she said, is to find a funding source for IT analogous to the gasoline tax, the main funding source for the interstate highway system, and that may change with a new administration in the White House and a new Congress.
We need this gas tax to advance the information highway, Evans said, one that will provide a continuing stream of support for healthcare information interoperability.
Reimbursements also are needed to pay for provider EHRs to correct a second type of market failure, where the costs of buying the systems are borne by the providers, but the benefits of the investment in IT are reaped by the payers, the employers and, ultimately, the patients.
I know our institutions are capital-starved, Evans said. Those reimbursement payments for provider investment in IT will likely come from payers, she said.
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