Broad Adoption, Small Success Stories or Both?

Should state-level health IT leaders primarily work on increasing EHR adoption rates and creating the infrastructure for statewide data exchange?
Or should they focus on small victories with pilot projects that target chronic disease management to both help alleviate the crushing costs of Medicaid payments and help prove the value of exchanging data? Or can states do both at the same time?
We’ve read about intriguing state-level success stories such as the Delaware Health Information Network, but many states are closer to starting from scratch than they are to having a statewide exchange up and running. Facing all the traditional problems involving business models and governance issues, where should they start? Federal funding will kick-start HIE development, but it probably won’t pay to sustain it long-term.
Mark Danis, vice president in charge of public sector health for information technology services company Keane, told me recently that he believes broader EHR usage and data exchange shouldn’t be goals in themselves. Rather, state governments and public/private HIEs should work on identifying specific quality improvement projects and then make technology investments to achieve those goals.
“My concern is that a lot of energy may be expended to push for wider adoption, the network effect, when I think there should be more focus on desired outcomes from the beginning,” Danis said.
Many states have received Medicaid Transformation Grants from CMS to work on pilot projects that involve technology investments targeting Medicaid patients.
Some states have started to build systems to work with chronic disease populations, and if successful those efforts may become building blocks for broader health data exchange.
“One state we have been talking to wants to address patients who are males over the age of 47 who have diabetes,” Danis explained. By using public health databases, the state can identify that population and see if by expanding broadband access in rural areas and pushing widespread EHR and PHR usage, it can have an impact on patient empowerment both in terms of access to information, and patients taking control of their own health, he said.
Like many others, Danis believes the broader definition of “meaningful use” of health IT will ultimately have to include patient empowerment.
Last year I wrote an article about health record banks under development in the states of Oregon and Washington. Those efforts both envision putting the patient in the center of the equation. This week I am checking in with the project managers in those states, and next week I will report on their progress. Stay tuned.