|Implemented in this survey?|
The Santa Barbara County Care Data Exchange (SBCCDE) project was engaged in final pilot testing. The project aims to improve care quality and efficiency by allowing hospitals, clinics, payers, laboratories, and eventually pharmacies to exchange patient care information on a universal peer-to-peer internet-based network accessible to all authorized users.
During the survey period April-October 2004, the Santa Barbara County Care Data Exchange (SBCCDE) project was engaged in final piloting and testing in preparation for an official launch by the end
of 2004. When it officially goes online the SBCCDE will allow hospitals, clinics, payers, laboratories, and eventually pharmacies to exchange patient care information on a universal
peer-to-peer internet-based network accessible to all authorized users.
The aim of the system is to increase care quality and efficiency in Santa Barbara County by reducing medical errors, duplicate tests, hospital admissions, and manual data handling time. The project is also conceived as a demonstration project for other communities looking to establish data exchanges. A data exchange, which allows data on a patient to be pooled between many competing health care facilities, is different from an electronic medical record, which tends to be held by one facility.
In the Santa Barbara model, each participating facility maintains its own records, but can use the web-based interface to easily share these records with other facilities. Authorized users (e.g. a primary care physician) can link into the system via a web-browser interface from the point of care and quickly access hospital or pharmacy records held by the relevant entities.
For participants in the data exchange, the prospect of increasing efficiency provides the financial incentive for participation in the system. Additionally, the potential of electronic data exchanges to reduce medical errors (responsible for up to 89,000 hospital deaths in 1999 in the United States) and increasing care quality is a powerful motivator for care providers and consumers to invest in the system.
For government officials and private funders, investing in the SBCCDE is highly desirable due to the SBCCDE's role as a demonstration project; investments are leveraged because the legal, financial, technical and organizational models for the exchange will give interested health officials and funders the tools and know-how to develop similar data exchange networks around the country. Further development of such networks is thought to have the potential to drastically increase quality and efficiency of health care in California and in the United States as a whole.
|Medienpräsenz||sehr gering||sehr hoch|
This was a community-based effort that has thus far taken place outside of the political system, and as such has not been directly influenced by government mandates or direction. However, a
number of factors have influenced its emergence.
First, doctors and hospitals have been under increasing pressure to improve patient safety and reduce the incidence of medical errors. According to data released by the Institute of Medicine (IOM) in 1999, Between 44,000 and 98,000 Americans die in hospitals each year because of medical errors. Medication errors alone cause nearly 7,000 of these deaths. Approximately 770,000 people are injured due to adverse drug events each year, and the IOM estimates that up to 70% of those incidents are avoidable. These medical errors represent not only major health risks, but also a major expense; Medical errors cost the U.S. an estimated $37.6 billion each year, $17 of which are associated with preventable errors.
The Bush administration has thrown itself behind IT solutions to rising health care costs and the problem of patient safety and care quality. The administration created the first national health information technology coordinator position (which reports to the Health and Human Services director). They also earmarked $50 million for electronic health records projects in 2004 and plan to make $100 million available in 2005. Although the SBCCDE project was begun before these changes, the increased interest from the federal government is significant to the SBCCDE to the extent that it generates interests among community members and engenders a more supportive funding environment.
Finally, recent modifications of regulatory policies have also facilitated the development of electronic care data exchanges. Most notably, the simplification and standardization of the federal health privacy rules under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) (See survey on the Federal Health Privacy Rule) has reduced the legal barriers to data exchanges by allowing health care providers to more easily share data while at the same time requiring privacy protections.
|Implemented in this survey?|
The project began in 1998, when leaders from the Santa Barbara County health care community approached and met with staff from the California Health Care Foundation (CHCF) about funding a proposed
health care data exchange.
The CHCF was interested, and in 1999 commissioned a feasibility study by Dr. David Brailer, a professor of health care systems at the Wharton School of Business and of Internal Medicine at the University of Pennsylvania Health System. Based on the favourable outcome of the feasibility study, and the business plan that Dr. Brailer and his team developed in collaboration with community leaders, the CHCF awarded a $10 million grant to the project.
CHCF contracted with CareScience, Inc. (an organization formed to commercialize research developments from the Wharton School of Business and the University of Pennsylvania, with a strong history of developing and providing care management services) to oversee the development and management of the legal, organizational, governance and financial aspects of the project. Later, CareScience was also asked to develop the Internet-based data exchange software.
This project builds on previous attempts at building care data exchanges. These attempts failed in large part due to insufficiently developed technology, prohibitive front-end costs, and concerns about data ownership, privacy, and other barriers. Increasing use of electronic data management in hospitals and laboratories (although IT penetration in physicians' offices remains limited) facilitates current electronic data exchange attempts, as does the more advanced technology and the potential of the Internet to enable easy exchange of data.
The project has broad based support from health care providers across Santa Barbara County, and the financial support of the California Health Care Foundation and the federal government.
Patient groups and privacy advocates have expressed concerns that the data exchange will make sensitive medical information vulnerable to confidentiality breaches. The extensive legal and collaborative technical planning that went into the project has helped to alleviate some of these concerns. Patient data will be held by the facilities that generate it, which will be individually responsible for its security. The system itself has redundant security features built in to ensure only authorized users can access the system. Physicians can only access information about their own patients. The system logs all information requests, and patients may deny physician access to their data at any time.
The project has emphasized collaboration and community participation from the beginning. Stakeholders are involved in the legal, financial, technical and organizational development and oversight, and so are able to influence the direction of the project, thus resolving many disagreements early on.
This project has not been directly associated with any legislation thus far.
Full deployment is expected by the end of 2004. The non-profit 501c3 organization that was formed to manage the project (replacing the former governance structure - a loosely organized group of health executives and stakeholders) will be in charge of implementing the project and establishing a sustainable funding mechanism.
The California Health Care Foundation funded a study evaluating the financial benefits of a care benefits system. They found that there was a "moderate to strong" business case to be made on the
basis of reduced data handling time. The report also stated that this financial advantage was only valid for medium to large health systems. Clinical efficiencies (fewer hospital
admissions, fewer medical errors, fewer duplicate tests) were not officially quantified in the report, however, CHCF opined that if they were factored in, the potential cost savings would be even
greater. This report will help to generate support for further expansion of the Data Exchange, and will help other communities use the SBCCDE as a model for their own data exchanges.
An audit was commissioned by an outside company to evaluate the security risks to the internet based system. This audit identified a number of areas of concern, which were reported to the software developers, who worked to remedy these areas. A second security audit to evaluate the success of the developers in addressing the concerns was in the process of being conducted at the time of this report.
When fully operational, the SBCCDE will provide a well-designed mechanism for care data to be exchanged between the disparate health service providers in Santa Barbara County. The success of
the exchange will probably depend ultimately on the number of physicians and consumers that can be signed on, and also on securing a steady funding stream.
Beyond Santa Barbara County, the SBCCDE is viewed as one of the model systems for other regions interested in facilitating the efficient exchange of patient care data. Mesa County, Colorado, for example, is using a $2.5 million dollar Medicaid settlement to establish a data exchange project according to the Santa Barbara model in late 2004. On a national level, the experience of the SBCCDE may help national policymakers design federal standards and policies for a health information infrastructure.
Sam Karp. "Santa Barbara County Care Data Exchange". Presentation to NHII 2004: Cornerstones for Electronic Healthcare. June 22, 2004. Available Online at:
David J. Brailer, MD, PhD, Lori M. Evans, MPH, MPP, Nick Augustinos, MBA and Sam Karp. "Moving Toward An Electronic Health Information Exchange: Interim Report on the Santa Barbara County Care Data Exchange" July 2003. Available online at http://www.chcf.org/documents/ihealth/SBCCDEInterimReport.pdf
John Morrissey. Certified and Ready for Duty; Fledgling healthcare IT commission to help determine what qualifies as a fully capable electronic medical-records system" Modern Healthcare. August 23, 2004: p. 8
California Healthcare Foundation. Ihealth Beat. http://ihealthbreat.org
California Healthcare Foundation. www.chcf.org
Care Science, Inc. www.carescience.com
Sarah Weston, Universtity of California, San Francisco, Institute for Global Health; Carol Medlin, PhD, University of California, San Francisco, Institute for Global Health