Rebooting California’s Health Records for a Digital World
Now that it’s clear Governor Gavin Newsom will stay in office, following last month's recall election, we can be sure that momentum behind a major step for healthcare in California will continue, too. With Newsom and his cabinet -- including California Health and Human Services Secretary Dr. Mark Ghaly -- charting the course, California will continue full steam ahead towards a historic modernization of health data records in our state.
Late this summer, Governor Newsom signed AB 133, a bill that contained multiple provisions that garnered significant media attention: expanding Medi-Cal eligibility, supporting behavioral health, and extending telehealth coverage. What may have been missed was a pivotal provision calling for the modernization of California’s atrophied health information system that will positively impact every single Californian at some point in their lives. Many could see the impact as we mitigate and recover from the COVID-19 public health nightmare, which could be a years-long process.
Currently, in California, if a patient sees doctors in different health systems or hospitals, it is difficult, if not impossible at times, to ensure that their health records travel with them. This is a major fundamental failing -- as a patient’s data is, fundamentally, theirs, and they should be fully in control. When records are shared, it’s often by mail, fax, or the patients themselves carry binders filled with paper copies of their health history from doctor to doctor. Compared to health information exchange systems in other countries and across the U.S. in states like New York, Nebraska, Arizona, and Colorado, California lags behind.
However, AB 133 mandates that health care providers and plans begin sharing health data among providers anywhere in the state in real time by January 2024. By this time, the state will also need to establish a framework for the exchange of information. A stakeholder advisory group, pivotal in the early stages of this work, had its inaugural meeting in early September. The law, and all it entails, is a crucial step forward on California’s path toward creating an electronic health information exchange (HIE). But work remains to ensure patients have all of their health data when they are most in need of care, and to support public health insights at the state level.
I have seen firsthand, as the CEO of the Inland Empire Health Plan (IEHP), how invaluable robust data-sharing can be. IEHP is one of the top 10 largest Medicaid health plans, and the largest not-for-profit Medicare and Medicaid plan in the country. We serve 1.4 million members, and work with over seven thousand providers. Each of our patients deserve the highest-quality care -- which necessitates a high-quality data structure -- so that nothing, and no one, falls through the cracks.
Our Inland Empire Health Information Exchange (IEHIE) -- which later merged with Cal INDEX to create Manifest MedEx (MX) -- already developed such an information exchange infrastructure in 2012. IEHIE connected nearly every hospital in our area, compiling data into one central repository that is accessible to each patient and all of their providers. The near-universal participation in the HIE in our community was critical to its success. It has ensured that if a patient sees multiple providers or receives care at multiple hospitals in our region, their invaluable health data goes with them.
Ours is a roadmap for success, and it is incumbent upon state leaders -- especially those in the Newsom Administration and the leaders in the stakeholder advisory group -- to find a structure that works for the entire state. There are three key steps these leaders must take to reach that goal.
First, stakeholders and the State must define the data sharing mandate, and what it practically means for the organizations required to share data. At a minimum, it needs to include the data held by our health care providers and health insurers. To make an impact on health outcomes in our state, it must also include demographic information on race and ethnicity, on sexual orientation and gender identity, and also information to address Californians’ social needs like housing and food insecurity. Most importantly, we have to decide how this data will be shared and what data needs to be shared in real-time.
Next, we need a financing plan that ensures an ongoing source of funding to build out the state’s health information exchange infrastructure and support smaller provider practices with the IT resources they need. In addition to providing solid foundational funding, California has an opportunity to draw from federal funding to support this effort -- a source from which other states have drawn hundreds of millions of dollars for their statewide networks in the past.
Finally, we must ensure accountability. State leaders must make certain the stakeholder advisory group process remains transparent to the public, so that in the end, the data sharing mandate has a real impact. We need both a carrot and a stick -- financial incentives for early adopters and repercussions for organizations that fail to share data by the specified date. We must continue to convey the health care priorities for which data sharing can improve individual and population health -- a critical piece of recovering from COVID-19, in both the short and long term.
Until the recall was decided last month, California’s healthcare future was on the chopping block. Now, with the political landscape clear of this obstacle, this critical process toward statewide health data exchange can continue unabated. For the health of individual patients, and entire communities, and our state as a whole, it’s critical we seize the moment and think big. There’s no time to waste.
Jarrod McNaughton, MBA, is the CEO of the Inland Empire Health Plan, based in Rancho Cucamonga, CA.
