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Santa Barbara County Care Data Exchange, Inc.
DWT is pleased to feature Santa Barbara County Care Data Exchange,
Inc. (the “Exchange”) as our Health Information
Technology Regional Health Information Organization (RHIO) in
the Spotlight. The Exchange is not only a technological innovator,
enabling users to share clinical data at the point of care,
but has also developed an organizational and operational structure
to effectively attract and retain participants. With a large
number of leading health care providers in Santa Barbara County
participating, the Exchange is close to reaching the critical
mass essential to its success.
The Technology
The Exchange technology allows authorized hospitals, clinics,
payers and laboratories to access clinical information using
a central, peer-to-peer networking system that is web-based.
The peer-to-peer system negates any need to place all shared
files on a central database or server. Instead, members of the
peer-to-peer network pull files off of each other’s individual
computers and access them through the Internet. Information
is updated as soon as a physician types it in – no need
to enter data into a central file. As a result, up-to-date lab
results, radiology images, transcription reports, clinical notes
and medical, hospital and pharmacy claims information are all
available to network users at the point of care.
While the concept of sharing information is not new, the system
developed by the Exchange is novel. Designed to eliminate mistakes
that occur when data must be entered in a centralized system,
this web-based, peer-to-peer technology is intended to reduce
medical errors, cut down on paperwork and costs and create better
health care through easier access to records. Now in its final
stages of testing, the Exchange expects to be fully operable
by the spring of 2005. Ultimately, the Exchange hopes to make
the system accessible to individual patients as well.
Organization and Operation
The Exchange developed as a result of a six-month feasibility
study, conducted by David J. Brailer, M.D., Ph.D., and funded
by the California HealthCare Foundation (the “Foundation”)
to evaluate the potential for regional data sharing. The study
concluded that financial returns from a system such as the Exchange
were possible and health care costs could be reduced by lowering
the volume of manual data handling. Although harder to quantify,
efficiencies such as fewer hospital admissions, fewer medical
errors, and fewer duplicate tests could provide additional savings.
Based on these findings, the Foundation provided a $10 million
grant to Dr. Brailer and CareScience, Inc., the entity that
built the Exchange software, to oversee the implementation,
governance, legal and regulatory issues of building the Exchange.
Using a small grant from the Foundation, the local participants
organized the Exchange as a collaborative public-private arrangement
guided by a 501(c)(3) California nonprofit public benefit corporation.
Following are some key structural elements of the organization:
- The Care Data Exchange Council (the “Council”),
which acts as the governing body of the Exchange, meets monthly
to determine the business and operating policies of the Exchange,
set priorities for its expansion, development and communication
strategies and provide legal and business oversight.
- Any organization with a direct role in the delivery, operation
or purchase of health care services in Santa Barbara County
may become a “Participant” in the Exchange by
entering into a Care Data Exchange User Agreement with the
Council. The agreement sets forth the rights and responsibilities
of the parties, almost like a software license agreement,
without binding them together under any specific corporate
structure.
- Each of the founding health care entities participating
in the Exchange (the “Key Participants”) has one
representative, with one vote on the Council.
- Key Participants and Participants are loosely organized
into four “Care Data Alliances,” according to
mutual information technology goals. The structure is designed
to enable collaboration but allow each organization to achieve
its unique strategic priorities. Each Alliance is led by an
anchor entity, which is one of the Key Participants.
- Two advisory committees, the Technical Advisory Committee
and the Clinical Advisory Committee, composed of representatives
from each Alliance, provided guidance to the Council on technical
and advisory issues, respectively, during the development
stage.
- Under the arrangement, the role of CareScience, Inc. is
now limited to that of technical provider, pursuant to a contract
with the Exchange. Dr. Brailer resigned as senior policy adviser
to the Exchange when he was appointed the first National Health
Information Technology Coordinator by Health and Human Services
Secretary Tommy Thompson.
In addition to funding the feasibility study and project, the
Foundation also provided grants to Key Participants to enable
their early participation in the project. Because it is organized
as a 501(c)(3) organization, the Exchange may continue to receive
grant money from the Foundation as well as other funders, including
the Key Participants. The Exchange recently won a $400,000 federal
grant from the Foundation for eHealth Initiative, one of only
nine programs nationwide, and the only program in California
selected for a portion of the $2 million available funding.
The Council is now in the process of determining how to obtain
continued funding from nonprofits, the government and, ultimately,
Participants, through the imposition of a user fee.
For more information on the Exchange, please contact its Executive
Director, Mike Skinner, at Mike@ConsolidatedHIC.com
or visit: http://ccbh.ehealthinitiative.org/profiles/SBCCDE.mspx
or http://www.chcf.org/topics/view.cfm?itemID=19714&dir=ihealth.
Please note that the Exchange is funded in part through a contract
with the Foundation for eHealth Initiative (FeHI) and their
cooperative agreement with HRSA, Office for the Advancement
for Telehealth (HRSA/OAT). The contents of this article are
solely the responsibility of the authors and do not necessarily
represent the official view of HRSA/OAT or FeHI.
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