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HHS Press Release and Blogposium

Posted Oct 22 2008 9:32pm

Bob Coffield from Health Care Law Blog   came across this press release from HHS Secretary Mike Leavitt regarding Dr. Brailer's resignation.  Keep in mind that a successful organization or initiative does not rely solely on the efforts of one individual.  While Dr. Brailer may be the "godfather"  of the National Health Information Infrastructure (NHII), all of our collective efforts will be what drives us toward our goals!  Dr. Brailer has served as the visionary leader and convener needed to initiate a NHII in the US.

Also visit Inland Empire RHIO for Dr. Levin's response to the news!

On the Blogposium front, I've been working on some additions to the Governance Model contribution in response to feedback.  While yesterday was the end of the Blogposium to create a clinical informatics wiki, it is not the end of the wiki.   So, keep writing, reading and contributing!

Challenges:

§          General

        Lack of trust and accountability

        Politics – finding “neutral” ground

        Pride of ownership

        Fear of loss of advantage

        Maintenance of interest and buy-in

        Individual stakeholder priorities

        Costs

        Motivation

§          Business / Policy Issues

        Competition between stakeholders

        Consensus of common policies and procedures

        Consumer privacy concerns

        Transparency of process

        Uncertainties regarding liability

        Difficulty in reaching multi-enterprise agreements for exchanging information

        Decreasing debt capacity

        Return on investment

        Governance and leadership

        Sustainability

        Costs –Financial and personnel – especially for Small/Rural providers

        Physician and payer incentives

        Economic Factors

§          Technical / Security Issues

        Interoperability among multiple parties

        Standards

        Authentication

        Auditability

        Security and legal issues

§          Internal to the Institution / Network

        Competition for resources

        Dilution of Effort: Project competing against other pressing needs

        Preservation of previous investments

        Increased cost of IT (perceived or real)

§          External to the Institution / Network

        Security – Data & Physical Resources

        Rights in Data – who “owns’ the data and who can make changes (tracking changes)

        Reliability of Data – potential mismatching of patients & data corruption

        Linking Outside: Standards, reliability, controls

        Business Continuity: Destruction/Recoverability of critical resources  

        Lack of Accountability & Control (perceived or real)

Overcome Challenges

§          Don’t allow the long list of challenges overwhelm you

§          Obtain buy-in from the highest level of each participating entity

§          Engage State leadership and leaders of healthcare organizations to continue to support dialogue/education on the issue

§          View challenges as opportunities for improvement

§           Identify effective leaders and “champions”

§          Identify financial incentives and provider investments in their internal systems

§          Identify funding sources for information technology and RHIN/RHIOs

§          Identify funding assistance for rural and small providers

§          Educate and communicate with providers and the public

§          Recognize opportunities

§          Recognize improved ease of inter-institution partnering

§          Identify the value and benefits that accrues to each participant

§          Establish standards

§          Leverage the efforts of the larger health systems – collaboration not competition

§          Reduce the number of barriers posed by state and federal regulations (HIPAA, Stark, etc.)

§          Adopt common terminology

§          Address adjudication of liability

Recommendations for Success

§          Involve major players in planning – CEOs, COOs CMOs, CIOs, nurse executives, legal, risk management/compliance, etc ~ avoid “one champion” or pure tech view

§          Ensure leaders of the RHIN/RHIO are accountable to the community, not their individual interests

§          Establish a shared vision and common goals

§          Plan for governance from the beginning

§          Keep patient and security and privacy of information at front

§          Identify all stakeholders and invite everyone to the table

§          Prepare stakeholders for real collaboration

§          Establish a mission and set measurable and achievable goals

§          Address governance accountability and sustainability concerns

§          recognize that discussion dialogue and debate are part of the process

§          Build trust

§          Plan some quick “wins”

§          Demonstrate value and quality, safety, and cost benefits

§          Share stories and data of success with the reluctant and encourage them to join the collaborative

§          Secure the services of an experienced legal firm and keep them informed

§          Address and implement the agreement structure early

§          Spell out all interface & data specifications in excruciating detail, and hold everyone to them

§          Communicate expectations and hold all accountable for their obligations.

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