More on State Health IT Initiatives
An October 26, 2006 iHealthBeat item made reference to a Modern Healthcare article on the diverse health IT activities within states. More interesting than the content, perhaps, were the titles. The iHealthBeat item was entitled: "State Health IT Groups Not Tracked" and the Modern Healthcare article was entitled: "State Health IT Groups Proliferate." One can imply from these titles that a lack of systematic study is problematic and that "proliferation" is a symptom of disorder rather than experimentation in the early, unformed states of social change. It is, one can claim, important to understand a problem by tracking but to avoid premature solutions.
The article cites are real desire among states to understand what others are doing. It mentions but possibly understates some of the state-resources already extant through HIMSS, AHIMA, NCSL, and eHI. It speaks of "standards" and "model laws" - very good ideas.
Still one wonders at the right mechanism and pace for coordination. One can argue that several federal approaches over the past year have been incomplete, premature, or somewhat rushed. One can argue that it is too soon to really provide much systematic guidance - all the more reason to emphasize tracking and observing.
The initiative to which the articles refer was originally termed "SHADES" (State Healthcare Alliance for Data Exchange Solutions) and describes a two-year sole-source contract from ONC to the National Governors Association.
What should be emphasized in these initiatives? Several critical elements, in this writer's mind:
The article cites are real desire among states to understand what others are doing. It mentions but possibly understates some of the state-resources already extant through HIMSS, AHIMA, NCSL, and eHI. It speaks of "standards" and "model laws" - very good ideas.
Still one wonders at the right mechanism and pace for coordination. One can argue that several federal approaches over the past year have been incomplete, premature, or somewhat rushed. One can argue that it is too soon to really provide much systematic guidance - all the more reason to emphasize tracking and observing.
The initiative to which the articles refer was originally termed "SHADES" (State Healthcare Alliance for Data Exchange Solutions) and describes a two-year sole-source contract from ONC to the National Governors Association.
What should be emphasized in these initiatives? Several critical elements, in this writer's mind:
- Simple, centrist model legislative frameworks for states and Congress
- Medicaid
- Care of the uninsured
- Financial sustainability of the entire health care system, not just any individual aspect. A "self-sustaining" state-level RHIO is not the point. A self-sustaining American health care system - at the federal, state, and local level - is the point.
- Roles for health plans as well as alternatives like health savings accounts, banks, consumer-driven care
- Confidentiality, consent, and security - focusing on policy first, not legislation.
Data exchange is a prerequisite for change, but cannot be understood in isolation.
There may be a tendency to continuing the current trajectory, focusing on legislative harmonization (and pre-emption), regulations (e.g., CLIA), and state-level RHIOS. Others would argue
States may be clamoring for help and strategies with health information technology, but if they are, one hopes they begin their discussions with how increased effort can improve and enhance state Medicaid, public health, and public-private partnerships.
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