FOR HEARING
THIS AFTERNOON WELCOME TO THE
ASSEMBLY HEALTH COMMITTEE
HEARING EXPLORING HEALTH
INFORMATION EXCHANGE IN
CALIFORNIA DUE TO THE CONTINUED
STAY AT HOME ORDER WE ARE
PRACTICING PHYSICAL DISTANCING
HERE IN THE HEARING ROOM AND
THROUGHOUT THE CAPITOL BUILDING
SO WE ARE ONLY ABLE TO HAVE A
LIMITED NUMBER OF PEOPLE
WATCHING OR PARTICIPATING IN
PERSON AT THE HEARING. WE'RE
ALSO REQUIRING THAT MASKS BE
WORN IN PHYSICAL DISTANCE IN BE
MAINTAINED BY ALL MEMBERS OF
THE PUBLIC TESTIFYING WHETHER
HERE OR IN VIDEO CONFERENCING
SIDE IF YOU DO NOT HAVE A MASS
WE CAN PROVIDE ONE FOR YOU. FOR
OUR WITNESSES IN THE VIDEO ROOM
AND REMOTE TESTIMONY- STATIONS-
WE REACH THE PUBLIC COMMENT
PORTION OF THE AGENDA WOULD ASK
THE ANY MEMBERS OF THE PUBLIC.
TO TESTIFY EITHER IN THE STATE
CAPITOL IN THE WITNESS VIDEO
ROOM. PLEASE MAINTAIN SOCIAL
DISTANCING AS YOU MOVE AROUND
THE ROOM. IN ADDITION WE HAVE
PANELISTS AND OTHER MEMBERS OF
THE PUBLIC MAKING USE OF OUR
WITNESS VIDEO CONFERENCING
ROOMS HERE IN THE CAPITAL AND A
FEW OTHER LOCATIONS THROUGHOUT
THE STATE. WAS WITNESSES WILL
APPEAR ON THE SCREEN SO MEMBERS
CAN WATCH THEIR TESTIMONY LIVE
FROM OUTSIDE OF THE HEARING
ROOM. AND ALSO ASK THEM
QUESTIONS. FOR DIALING
WITNESSES- AND MEMBERS OF THE
PUBLIC CALLING IN WE WILL ALSO
BE USING A MODERATED TELEPHONE
SERVICE THROUGH THE WHICH ANY
MEMBER THE PUBLIC CAN PROVIDE
COMMENTARY WHEN WE GET TO THAT
POINT IN THE AGENDA. ANALYSTS
HAVE BEEN PROVIDED A CALL IN
NUMBER PRIOR TO THIS HEARING.
THE CALL IN NUMBER FOR PUBLIC
COMMENT- FOR THIS HEARING. IS.
EIGHT SEVEN SEVEN SIX NINE TWO.
EIGHT NINE FIVE SEVEN IN THE
ACCESS CODE IS SEVEN THREE TWO
SIX TWO FOUR TWO. READ THAT
AGAIN. EIGHT SEVEN SEVEN SIX
NINE TWO. EIGHT NINE FIVE SEVEN
AND THE ACCESS CODE IS SEVEN
THREE TWO. SIX TWO FOUR TWO.
YOU CAN ALSO FIND THIS NUMBER
ON THE ASSEMBLY HEALTH
COMMITTEE'S WEBSITE AND YOUR
TELEVISION SCREEN AS WELL. WILL
THIS WILL COME UP AGAIN AS WE
GET CLOSER TO PUBLIC COMMENT.
THE OPERATOR ON THE LINE WILL
GIVE YOU INSTRUCTIONS ON HOW TO
BE PLACED IN THE QUEUE- TO
ROGER PUBLIC COMMENT YOU'RE
CALLING IN PLEASE LIMIT
ELIMINATE ALL BACKGROUND NOISE
THIS INCLUDES MUTING YOUR LIVE
STREAM BROADCAST. AND YOUR
SMART DEVICES TO REDUCE THE
SOUND DISTORTION. WAS YOUR
PLACE IN THE QUEUE YOU WILL
ALSO NEED TO MUTE YOURSELF
UNTIL CALLED UPON TO SPEAK.
HAVING ANY PROBLEMS WITH THE%
MODERATOR PHONE SERVICE YOU CAN
CALL THE COMMITTEE AT NINE ONE
SIX. THREE ONE NINE. TWO ZERO
NINE SEVEN AND MY STAFF WILL BE
THERE TO TRY TO HELP. ALSO IN A
NOTE THAT WE ARE ACCEPTING
WRITTEN PUBLIC COMMENT THROUGH
THESE HEALTH COMMITTEES PUBLIC
EMAIL. THAT EMAIL ADDRESSES A.
H. P. A. DOT COMMITTEE.
ASSEMBLY DOT C. A. DOT G. O. V.
WHICH CAN ALSO BE FOUND ON OUR
WEBSITE WE MAY NEED TO LIMIT
HOW LONG EACH PERSON HAS TO
PROVIDE PUBLIC COMMENT. AND WE
THANK YOU FOR YOUR PATIENCE. I
WANT TO THANK ALL THE SPEAKERS
FOR ACCOMMODATING REQUESTS
PRESENT AT THIS HEARING- DURING
THE ERA OF THE PANDEMIC. HEALTH
INFORMATION EXCHANGE IS AN
IMPORTANT AND COMPLEX TOPIC.
YOU CAN IMPROVE THE QUALITY OF
CARE PEOPLE RECEIVE AND REDUCE
THE COST OF THAT CARE BY
REDUCING DUPLICATIVE TESTS AND
PROCEDURES. TODAY'S HEARING
WILL TOUCH ON FIVE AREAS FIRST
HE WILL PROVIDE AN OVERVIEW. OF
WHERE WE ARE TODAY WITH A
PRESENTATION ON WHAT HEALTH
INFORMATION EXCHANGE MEANS WHY
IT'S IMPORTANT AND THE EXISTING
HEALTH AND HEALTH INFORMATION
EXCHANGE ARRANGEMENTS IN
CALIFORNIA. SECOND WE WILL HEAR
WHAT HAS BEEN DONE DATE DONE TO
DATE BY THE STATE OR FEDERAL
GOVERNMENT BY EXAMINING RECENT
STATE AND FEDERAL EFFORTS. TO
ENCOURAGE H. I. E. THAT'S
HEALTH INFORMATION EXCHANGE
THROUGH FINANCING THE TO THE
ADOPTION. AND USE OF ELECTRONIC
HEALTH RECORDS AND CONNECT
PROVIDERS TO REGIONAL HEALTH
INFORMATION ORGANIZATIONS.
THIRD WILL HEAR ON THE
FORTHCOMING FEDERAL
REQUIREMENTS RELATED TO H. I.
E. FOURTH WE WILL HEAR FROM THE
CEO OF MARYLAND HEALTH
INFORMATION EXCHANGE
ORGANIZATION- ARE KNOWN BY THE
ACRONYM CHRIS- AND ON ON WHAT
OTHER STATES HAVE DONE RELATED
TO HEALTH INFORMATION EXCHANGE.
AND FIFTH WE WILL CONCLUDE WITH
A PRESENTATION ON POLICY
OPTIONS- TO INCREASE HEALTH
INFORMATION EXCHANGE IS MY GOAL
THE TODAY'S HEALTH
INFORMATIONAL HEARING WILL
PROVIDE OF FOUNDATIONAL BASIS
OF INFORMATION ON THE ISSUE IN
ANTICIPATION OF FURTHER
DISCUSSIONS ON THE ISSUE IN THE
NEXT LEGISLATIVE SESSION- WE DO
HAVE SOME. OTHER MEMBERS
ATTENDING TODAY WE HAVE ONE AND
ONE IN THE CHAMBER AND OTHERS
ATTENDING REMOTELY IF ANYBODY
WOULD LIKE TO MAKE ME OPEN
REMARKS- MISS AGUIAR-CURRY
WHICH I HAVING ANYTHING TO SAY.
OKAY ANY OF OUR- MEMBERS WHO
ARE ATTENDING REMOTELY IS THERE
ANYONE WHO WOULD LIKE TO- HAVE
ANY OPEN REMARKS. I'M NOT SURE
WHICH SCREEN TO LOOK AT OKAY.
NOPE CURRENTLY NOT OKAY. SO
WE'RE GONNA GO AHEAD OF FROM.
WITH OUR FIRST SPEAKER OUR
FIRST SPEAKER IS- WHAT DR
WALTER- SO JANSKY- IS A
PRESIDENT WHO JANSKY
ASSOCIATION ASSOCIATES EXCUSE
ME THE AUTHOR OF PROMISE AND
PITFALLS A LOOK AT CALIFORNIA'S
REGIONAL HEALTH INFORMATION
ORGANIZATIONS. SO WITH THAT AND
I WANT TO THANK A DOCTOR
SUGGESTS THE FROM WHOSE
TESTIFYING FOR MARK AND ARE
OAKLAND REMOTE TESTIMONY SITE
THANK YOU FOR BEING WILLING TO
GO THERE SO- WITHOUT ANY
FURTHER DO DOCTORS SUGGEST SKI.
THANK YOU VERY MUCH- I HOPE YOU
ALL CAN HEAR ME GOOD AFTERNOON.
I'D LIKE TO THANK THE COMMITTEE
FIRST OF ALL FOR INVITING ME
HERE TO PROVIDE AN OVERVIEW. OF
THE HEALTH INFORMATION EXCHANGE
LANDSCAPE IN CALIFORNIA. AND I
HOPE MY REMARKS TODAY WILL BE.
HELPFUL TO THE COMMITTEE AND
THE PUBLIC AT LARGE. NICK'S
FIRST SLIDE PLEASE. JUST A NOTE
I CANNOT SEE THIS LIGHT SO I'M
HOPING THEY'RE COMING UP. CAN I
GET AN AFFIRMATIVE FOR MARIA
YEAH. YES FIRST FIGHT IS UP.
FIRST LIGHT IS UP THANK YOU
TITLE SLIDE ANYWAY SO WITH THAT
LET'S GO TO THE SECOND SLIDE.
IT'S UP. SO A QUICKLY I TO
BEGIN THINGS IN THIS HEARING
I'VE BEEN ASKED TO DISCUSS A
FEW SPECIFIC ASPECTS OF HEALTH
INFORMATION EXCHANGE OR H. I.
E. AS IT'S KNOWN- BEGINNING
WITH A DESCRIPTION OF WHAT WHAT
IT IS TO BEGIN WITH AND HOW
THAT TERM IS USED. AS FOR
BACKGROUND AND ALSO WHAT THE
IMPETUS IS FOR HEALTH
INFORMATION EXCHANGE TO BEGIN
WITH WHY WE CARE ABOUT WHY
WE'RE TALKING ABOUT IT TODAY
AND THEN GOING TO TALK ABOUT OF
THE SMALL NUMBER OF ALTERNATIVE
TECHNICAL MODELS FOR PROVIDING
IT TO THE EXTENT THAT THE
DIFFERENCE BETWEEN SOME OF
THESE BOTTLES IS RELEVANT TO
POLICY DISCUSSIONS AND
DECISIONS AND ALSO TO DISCUSS
SOME OF THE CURRENT
INFRASTRUCTURES IN THE
ORGANIZATIONS THAT ARE HAVE
IMPLEMENTED THOSE MODELS IN OUR
STATE. AT THE PRESENT TIME AND
HOW THOSE- WORK WHERE THEY WORK
THEY ARE AND HOW THEY WORK
TOGETHER AND SO FORTH AND THEN
LASTLY TO TALK ABOUT WHAT WOULD
GAPS REMAIN IN HEALTH
INFORMATION EXCHANGE IN
CALIFORNIA AND- AND WHAT WHY
THAT IS THE CASE THE SENATE UP
FOR MY COLLEAGUES WHO WILL TALK
LATER ABOUT SOME OF THE WAYS OF
ADDRESSING THOSE GAPS. NEXT
SLIDE PLEASE. SO FIRST A LITTLE
A LITTLE BIT ON TERMINOLOGY
SINCE THE TERM HA ITSELF CAN BE
AMBIGUOUS- SO. ESSENTIALLY IT'S
OFTEN USED IN TO. SOMEWHAT
DISTINCT WAYS FIRST AS H. I. E.
THE BIRD AND IN THIS SENSE
REFERS TO THE ACT OF
ELECTRONICALLY SHARING PATIENT
DATA. AMONG DESPERATE HEALTH
CARE. ORGANIZATIONS SHARING OF
THAT THE ACT OF SHARING THAT
DATA- IT DOESN'T THAT THAT USE
DOESN'T ASSUME ANY PARTICULAR
ORGANIZATION INVOLVED WITH IT
OR TYPE OF ORGANIZATION
INVOLVED WITH IT- IT'S JUST A
THE GENERAL- FACT OF.
PERFORMING THAT SHARING. IN THE
SECOND USE THAT THEN HA THE
NOUN. IN IN DISTINCTION IS
OFTEN USED TO REFER TO AN
ACTUAL SPECIFIC CENTRAL
ORGANIZATION THAT PROVIDES SOME
FORM OF TECHNOLOGY
INFRASTRUCTURE TO ENABLE.
HEALTH INFORMATION EXCHANGE IN
MOST OF THESE ORGANIZATIONS
SERVE A PARTICULAR REGION AND
OR A PARTICULAR GROUP OF.
CONSTITUENTS AND PARTICIPANTS
ACROSS EVEN ACROSS REGIONS. SO
I'M NOT A FAN OF. THIS USING
THE TERM. AS A AS A NOUN
BECAUSE IT'S CONFUSING AND
AMBIGUOUS SO MAYBE FOR PURPOSES
OF TODAY'S DISCUSSION MY
PRESENTATION TODAY TO AVOID
CONFUSION. I'LL BE USING.
HEALTH INFORMATION FOR. OR H.
I. O. WHEN REFERRING TO THE
NOUN FORM. OUR NEXT SLIDE
PLEASE. SO WHY DO WE CARE ABOUT
HIV THE FOR THE ACT OF SHARING
INFORMATION ESSENTIALLY BOILS
DOWN TO THE FACT THAT OUR OUR
HEALTHCARE DELIVERY SYSTEM
REMAINS FRAGMENTED- IN THE
SENSE THAT A SINGLE PATIENT
RECEIVING FOR A NORMAL COURSE
OF CARE ANY ANY COMPLEX COURSE
OF CARE WHATSOEVER WHATSOEVER
NEEDS TO SEE A LOT OF DIFFERENT
HEALTH CARE PROVIDERS WORKING
IN A LOT OF DISTINCT
ENTERPRISES- OR ORGANIZATIONS
FROM- THAT SAID NOT NINE
O'CLOCK IN THIS PARTICULAR
DIAGRAM STARTING WITH A PRIMARY
CARE PHYSICIAN. THAT MAY
IDENIFY A LUMP OF SOME SORT
SOMEWHERE SENDING THEM OFF TO
NUMBER TWELVE THE IMAGING
CENTER A DIFFERENT
ORGANIZATION- WHERE SCANNING IS
PERFORMED AND- PERHAPS- CANCER
FOUND A NECESSITATING A TRIP TO
AN ONCOLOGIST AT A SPECIALTY
CLINIC AT NUMBER FIVE. ON THIS
DIAGRAM AND THEN OFF TO THE
HOSPITAL FOR SURGERY NUMBER ONE
AND THEN A REHAB CENTER-
NUMBERS- NUMBER THREE FOLLOWING
THAT AND SO FORTH ALL THESE
ORGANIZATIONS MAY BE DIFFERENT
BUSINESS ENTITIES THAT MAKE
THEIR OWN HEALTH IT PURCHASING
DECISIONS AND IN FACT OF
DIFFERENT TECHNOLOGIES AND
DON'T SHARE MEDICAL RECORDS- IN
IN THEIR NATIVE FORM. SO N. AND
IN FACT A STILL TODAY THERE'S
LIMITED VERTICAL AND HORIZONTAL
INTEGRATION OF THE CLINICAL
PROCESSES AND SYSTEMS- ACROSS
THESE ORGANIZATIONS ALTHOUGH
THERE CERTAINLY- BEEN A MORE
CONSOLIDATION AMONG THESE
ORGANIZATIONS NOT LEAST BECAUSE
THE SHARING OF HEALTH
INFORMATION IS IMPORTANT AND
HAS VALUE TO ORGANIZATIONS FROM
FROM VARIOUS PARTS
PERSPECTIVES. SO THROUGHOUT
THIS CARE PROCESS WE'RE LOOKING
AT HERE. WHAT TO WHAT IS THE
USE OF H. WATER USE CASES ARE
EXAMPLES OF HOW HEALTH
INFORMATION EXCHANGE- MAY BE
VALUABLE TO PATIENTS AND HEALTH
CARE PROVIDERS NEXT SLIDE
PLEASE. SO ONE WAY OF USING
HEALTH INFORMATION EXCHANGES TO
FACILITATE TRANSFERS OF CARE SO
FOR EXAMPLE POSITION SEEING A
BRAND NEW PATIENT- IN HIS OR
HER OFFICE. WHO HAS RECEIVED A
LOT OF CARE IN THE PAST AT
OTHER HEALTHCARE PROVIDER
ORGANIZATIONS ABOUT HIS NEW TO
THIS CONDITION THAT THAT THAT
POSITION IN ORDER TO GET A FULL
PICTURE THAT PATIENTS HISTORY
REALLY WOULD NEED TO COLLECT
AND AGGREGATE DATA FROM A LOT
OF DIFFERENT ORGANIZATIONS IN
ORDER. TO BE ABLE TO- MOST
EFFECTIVELY ASSESS THE NEEDS
AND PROVIDES THE THERAPEUTIC
SERVICES SCREENING SERVICES
WERE NOT FOR THAT PATIENT.
SECONDLY A PHYSICIAN MAY REFER
THEM THAT PATIENT TO A
SPECIALIST THAT SPECIALIST'S
WOULD SIMILARLY NEED A LOT OF
DIFFERENT INFORMATION MORE THAN
THE PHYSICIAN MAY BE ABLE TO
PROVIDE JUST IN THE REFERRAL
REQUEST. ARE ALSO PATIENTS IN
EMERGENCY ROOMS WITH MANY
CHRONIC CONDITIONS OFTEN- AND
CMPLICATED CLINICAL HISTORY.
BUT WITHOUT BRINGING THEIR OWN
MEDICAL RECORDS TO THAT URGENT
SITUATION- MAIN RESUSCITATE THE
EMERGENCY ROOM BEING ABLE TO
ACCESS THEIR PAST MEDICAL
HISTORY. NORD ASCERTAIN PERHAPS
WHAT WHAT ASPECT OF THAT IS
RESPONSIBLE FOR THE CURRENT
VERSION CONDITION. AND ACCESS
TO ALL THOSE DATA WERE
IMPORTANT FOR THAT FINALLY A
PATIENT IS DISCHARGED FROM
HOSPITAL OFTEN THEY GO TO
SKILLED NURSING FACILITIES. OR
OTHER A STEP DOWN TYPE%
FACILITIES THAT ARE DIFFERENT
ORGANIZATIONS THAT NEED IN
CRITICAL INFORMATION ABOUT
THAT'S PATIENTS
HOSPITALIZATION. A RIGHT AWAY
AS SOON AS THEY ARRIVE- SO
THOSE ARE ALL IMPORTANT
TRANSFER OF CARE USE CASES. ARE
OF ANOTHER- CATEGORY OF USEFUL
HIV COVERS NOTIFICATION OF
CARE. FOR EXAMPLE POSITION
BEING NOTIFIED OF THIS PATIENT
IS BEING SEEN OR WAS SEEING
EMERGENCY DEPARTMENT WAS
ADMITTED TO THE HOSPITAL SO
THAT WHEN THEY ARE DISCHARGED.
THE POSITION CAN FOLLOW UP
EFFECTIVELY WITH THEM- TO
PROVIDE APPROPRIATE FOLLOW UP
CARE MAYBE PREVENT FUTURE
EMERGENCY ROOM VISIT OR
HOSPITALIZATION- SIMILARLY
INSURERS- BENEFIT FROM FROM
NOTIFICATION- OF
HOSPITALIZATIONS AS WELL SO
THAT THEY CAN MANAGE. A
DISCHARGE PLANNING- AND OTHER
SERVICES. AND AS WELL AS- OFTEN
BENEFIT FROM BEING NOTIFIED
WHEN IT WHAT A PATIENT THAT'S
BEEN REFERRED AS ACTUALLY
VISITED THE SPECIALIST OFTEN-
SOMETIMES PATIENTS DON'T BOTHER
TO HOLD THEIR IMPORTANT
SPECIALIST VISITS- TO
CARDIOLOGISTS FOR EXAMPLE WHICH
CAN HAVE ADVERSE EVENT. AFFECTS
ON THEIR HEALTH- AND IF THEIR
POSITION WERE AWARE THAT THEY
COULD INTERVENE AND- I THINK
COURAGE TO START THE HOLDING OF
AB VISIT- NEXT SLIDE PLEASE.
OTHER IMPORTANT USE CASES
INCLUDE COORDINATION OR
OVERSIGHT OF CARE LOOKING
ACROSS ALL PATIENT POPULATION
FOR EXAMPLE AN INSURER HAVING
ENOUGH DATA FROM MULTIPLE.
ORGANIZATIONS TO TRACK WHETHER
PATIENTS HAVE RECEIVED A NEED
OF PREVENTIVE SCREEN CARE THIS
IS ALREADY DONE BY MANY
INSURERS TODAY BUT THEY RELY ON
CLAIMS DATA LARGELY WHICH IS
OUT OF DATE AND OFTEN
INCOMPLETE. AND SO THE THEIR
PICTURE OF THE PATIENTS- FULL
FULL HISTORY IN THIS REGARD- IS
SUBOPTIMAL HAVING ACCESS TO
CLINICAL DATA FROM ALL THE
ORGANIZATIONS WERE PATIENT HAS
BEEN SEEN WOULD GREATLY
FACILITATE THAT- SIMILARLY
PHYSICIANS ARE INCREASINGLY
ORGANIZING IN ACCOUNTABLE CARE
ORGANIZATIONS AND OTHER- OF
PARTNERSHIPS- THAT TAKE ON
CLINICAL RISK. IT'S IMPORTANT
FOR THEM TO- TO ALSO HAVE A
FULL PICTURE OF WHERE PATIENTS
RECEIVED VARIOUS TYPES OF
THERAPEUTIC AND UP. IN
PREVENTIVE AND SO FORTH CARE
ALSO IN FOR- OF. SAFETY NET
PATIENTS ARE SEEN IN COMMUNITY
CLINIC ENVIRONMENTS- THEY OFTEN
RECEIVE TREATMENT OUTSIDE OF
THE TRADITIONAL RECEIVE
SERVICES OUTSIDE OF THE
TRADITIONAL HEALTH CARE
ENVIRONMENT- SUCH AS AT
SUBSTANCE ABUSE CENTERS
BEHAVIORAL HEALTH HOUSING
ASSISTANCE AND SO FORTH AND
IT'S VERY HELPFUL FOR THE
COMMUNITY CLINIC HEALTH CARE
PROVIDERS. TO ALSO HAVE A
PICTURE OF THESE-
NONTRADITIONAL SERVICES THAT
HAVE A BEARING ON A PATIENT'S
MEDICAL CARE. AND A AND LASTLY
THERE THE THERE'S VALUE IN MORE
PROSAIC TYPES OF HEALTH
INFORMATION EXCHANGE JUST MORE
EFFICIENTLY COMMUNICATING
MEDICAL DATA THAT IS ALREADY
COMMUNICATED TODAY- SUCH AS LAB
RESULTS AND- IMMUNIZATION
RECORDS CASE REPORTS SO FORTH
BUT DIDN'T OFTEN IN INEFFICIENT
SLOW. AT WAYS THAT INTRODUCED
DELAY. AN EXTRA COST SO ACROSS
ALL THESE NEXT SLIDE PLEASE.
THESE VARIOUS USE CASES FOR HIV
GENERATE- SOCIAL VALUE I GUESS
YOU COULD SAY IN AT LEAST THREE
WAYS FIRST IS- JUST CLINICAL
QUALITY IMPROVEMENT THROUGH
PROMPTLY PROVIDING ALL THE
CLINICAL DATA RELATED TO A
PATIENT- THROUGH TRACKING
MAKING SURE PATIENTS RECEIVE
PREVENTIVE CARE SERVICES TO
PREVENT DISEASE. AND A POORLY
MEASURING. AND REPORTING ON
QUALITY OF CARE ACROSS
DIFFERENT PROVIDER
ORGANIZATIONS- AND THAT
REPORTING AND TRACKING UNTO
ITSELF- THERE'S EVIDENCE THAT
THAT HELPS IMPROVE QUALITY OF
CARE- BYE BYE- ENCOURAGING
PROVIDERS TO FOCUS ON IT
IMPORTANTLY IN ORDER TO DO THAT
EFFECTIVELY. FOR MORE VALUE
BASED CARE PROGRAMS ALL
ALTERNATIVE PAYMENT MECHANISMS
ONE NEEDS TO OF. RISK ADJUST
THOSE DATA APPROPRIATELY IN
ORDER TO DO THAT THE FULL
CLINICAL PICTURE OF THE
PATIENT'S SITUATION NEEDS TO BE
KNOWN ALL THE PATIENTS DATA
NEEDS TO BE FACTORED IN A
INCLUDING A SOCIAL DETERMINANT
DATA NOT JUST MEDICAL DATA- SO
THAT'S THAT'S A- DOES A WAYS IN
WHICH HEALTH INFORMATION
EXCHANGE CAN IMPROVE- CLINICAL
QUALITY. TERMS OF COST CONTROL
OBVIOUSLY ACCESS TO PRIOR
RECENT TEST RESULTS CAN-
OBVIATE THE NEED TO REDO THOSE
TESTS JUST TO BECAUSE THE
RESULTS AREN'T. DON'T HAPPEN TO
BE AVAILABLE IN THE EMERGENCY
DEPARTMENT OR A SPECIALIST THAT
THAT THEIR OBVIOUS COST SAVINGS
AND NOT ESPECIALLY FOR VERY
EXPENSIVE TYPE OF IMAGING
STUDIES AND SO FORTH- IN IN
IMPROVE QUALITY OF CARE CAN
ALSO REDUCE COSTS BY REDUCING
HOSPITALIZATIONS OR RE
HOSPITALIZATIONS WHEN BETTER
CARES PROVIDING OUTPATIENT.
SETTING AND EARLIER
INTERVENTIONS CAN BEFORE WHEN
THEY'RE WHEN THEY'RE KNOWN TO
BE NEEDED- AGAIN HAVING A FULL
PICTURE OF THE PATIENT'S
CLINICAL DATA CAN ASSIST WITH
THAT AND OF COURSE THERE'S
REDUCING THE ADMINISTRATIVE.
COSTS AND INEFFICIENT PAPER
BASED COMMUNICATIONS FINALLY
NOT NOT LEAST IMPORTANTLY THESE
DAYS THERE'S A PUBLIC VALLEY
SICK PUBLIC HEALTH VALUE IN
SHARING PATIENT DATA
AGGREGATING PATIENT DATA. TO
GET MORE COMPLETE PICTURES OF
PATIENT CARE FOR PURPOSE OF
DIZZY SURVEY. EPIDEMIOLOGY
CONTACT TRACING AND SO FORTH
FOR EXAMPLE- WHEN CASE REPORTS
ARE RECEIVED OF COCA NINETEEN
POSITIVE RESULTS- PERHAPS
PUBLIC HEALTH DEPARTMENT TO
BENEFIT FROM KNOWING WHAT OTHER
COMORBIDITIES THOSE PATIENTS
HAD. ARE WHAT SOME OF THEIR
SOCIAL DETERMINANTS OF HEALTH
WERE- IN ORDER TO PRIORITIZE
FOR EXAMPLE CONTACT TRACING OR
TO PROVIDE A NECESSARY
COMMUNICATION TO THOSE
PATIENTS. HEALTH CARE PROVIDERS
TO FOLLOW UP WITH THEM FOR
NEEDED TREATMENT. NEXT SLIDE
PLEASE. THERE IT IS- SO HOW
DOES THAT SWITCHING GEARS HOW
DOES HEALTH INFORMATION
EXCHANGE THE VERB HAPPEN- WHAT
ARE SOME OF THE TECHNICAL
METHODS I WON'T GO INTO INTO
THIS IN GREAT DETAIL OF COURSE
TODAY BUT- I THINK AT A CERTAIN
UNDERSTANDING OF IT IS HELPFUL
TO UNDERSTAND PUBLIC POLICY
DECISIONS AND CHOICES AS WELL
SO IN GENERAL FROM THE
TECHNICAL MODEL POINT OF VIEW
THERE'S A SPECTRUM BETWEEN A
CENTRALIZED. MODEL OF HEALTH
INFORMATION EXCHANGE AND- AND A
VERY DECENTRALIZED MODEL ON THE
LEFT HAND SIDE IS A DEPICTION
OF A CENTRALIZED MODEL IN WHICH
ALL OF THE HEALTH CARE
ENTERPRISES PARTICIPATING IN
PATIENTS CARE ACTUALLY
CONTRIBUTE THEIR DATA THEY A
COPY THEIR DATA INTO A CENTRAL
DATA REPOSITORY AND THERE ARE
CENTRALIZED SERVICES FOR
MANAGING THOSE DATA AND
CONTROLLING ACCESS TO THOSE
DATA AND SO FORTH IT'S VERY
CENTRALIZED PROCESS SO- JUST- A
ROUGHLY THIS IS ANALOGOUS TO A
SYSTEM LIKE FACEBOOK WHERE WE
ALL WE CAN COMMUNICATE WITH
EACH OTHER IN A SENSE. BUT ALL
OF ITS ALL BEING ORGANIZED BY
BY PARTICULAR ENTITY IN THIS
CASE THAT'S CONTROLLING THE
DATA AND CONTROLLING ACCESS TO
THE DATA AND SO FORTH WITHOUT
WHICH NONE OF IT COULD HAPPEN.
CONVERSELY ON THE RIGHT HAND
SIDE AT THE OTHER END OF THE
SPECTRUM IS A VERY
DECENTRALIZED MODEL WHERE
ORGANIZATIONS ARE ON A POINT TO
POINT BASIS JUST CONFINING AND
COMMUNICATING WITH EACH OTHER
AND SENDING INFORMATION THAT
THAT THAT- THEY EACH MAY NEED
TO CENTER MAY NEED TO ASK FOR
AND RECEIVE- AND THERE'S NO
CENTRALIZED ENTITY MANAGING AND
CONTROLLING IT ALSO THIS IS
ROUGHLY AGAIN AND NOW IT IS TO
THE EMAIL SYSTEM THAT WE'RE ALL
USED TO THERE'S NO BIG. THERE'S
NO FACEBOOK FOR EMAIL IT'S JUST
A LOT OF DIFFERENT EMAIL
SERVICE PROVIDERS AND THE
INTERNET BACKBONE THAT ENABLE
THE EXCHANGE OF EMAIL AMONG ALL
OF US AND HAD FOR A VERY LONG
TIME SO THOSE. ARE THE TWO
DIFFERENT MODELS NEXT SLIDE
PLEASE. IN PRACTICE OF COURSE
THERE'S A SPECTRUM. BETWEEN
THESE TWO MODELS VERY FEW
SYSTEMS ARE AT THE EXTREMES-
AND MANY ARE IN THE MIDDLE WITH
A PARTS PARTIALLY. PARTIALLY
DECENTRALIZED PARTIALLY
FEDERATED. MODEL NEXT SLIDE
PLEASE. SO NOMINA TALKED
BRIEFLY ABOUT. HOW THE HELL
THESE MODELS WORK. A LITTLE
BIT. WITHOUT GETTING WITHOUT
BORING YOU ALL HOPEFULLY I'LL
HAVE THE TECHNICAL DETAILS SO
THERE'S A DEPICTION OF A FULLY
CENTRALIZED AGGREGATED MODEL
THE- THE BLUE AREAS ARE THE
CENTRALIZED SERVICES. WE SEE
HERE THAT IN THIS MODEL AS I
MENTIONED DATA FROM VARIOUS
HEALTH CARE ENTERPRISES LARGE
AND SMALL ARE ACTUALLY SENT TO
A COPY TO THE CENTER CENTRAL
DATA REPOSITORY WHERE THEY ARE
AGGREGATED. ORGANIZED A
STANDARDIZED- AND NOT LEAST THE
PATIENT'S DATA IS LINKED INTO
WHAT'S CALLED A MASTER PATIENT
INDEX THIS IS VERY IMPORTANT
STEP BECAUSE DIFFERENT
HEALTHCARE ENTERPRISES USE
DIFFERENT IDENTIFIERS DIFFERENT
MEDICAL RECORD NUMBERS
DIFFERENT DEMOGRAPHICS TO
IDENTIFY THE SAME PATIENTS- SO.
IN ORDER TO HAVE A COMPLETE
RECORD OF ANY PARTICULAR
PATIENT- ALL THE DATA FROM
THOSE DIFFERENT ORGANIZATIONS
FOR THE SAME PATIENT NEED TO BE
RECOGNIZED AS BEING FOR THE
SAME PATIENT NEED TO BE-
AGGREGATED AND A MASTER PATIENT
INDEX IS A CRITICAL. TECHNICAL
COMPONENT FOR DOING THAT. NEXT
SLIDE PLEASE. SO IN THIS MODEL
WHEN A PARTICULAR HEALTH CARE
ENTERPRISE WANTS TO ACCESS
INFORMATION ABOUT A PATIENT
THEY DON'T GO TO THE OTHER
ENTERPRISES THAT GO TO THE
CENTRALIZED RESOURCE IN THIS
CASE AND SOME USER INTERFACE OR
COMPONENT THERE WHICH- WHICH-
REFERENCES THE MASTER PATIENT
INDEX MAKE SURE THIS PARTICULAR
ORGANIZATION SHOULD HAVE ACCESS
TO THE DATA. NEXT SLIDE PLEASE.
AND THEN THE DATA ARE RETRIEVED
FROM THE CONSOLIDATED CENTRAL
DATA REPOSITORY. NOW IF ENOUGH
HEALTHCARE ENTERPRISES IN A
PARTICULAR AREA OR YOU KNOW
IDEALLY ALL OF THEM THAT HAVE.
MAY HAVE- GENERATED DATA FOR
PARTICULAR PATIENT IF THEY ALL
CONTRIBUTE. THEIR DATA TO THE
CENTRALIZED DATA REPOSITORY THE
REPOSITORY CONFORMANCE WHAT'S
CALLED A LONGITUDINAL PATIENT
RECORD. FOR ONE ORMANY
PATIENTS ACROSS ALL OF THEIR-
HEALTHCARE ENTERPRISES. AND
THIS IS THIS IS VERY IMPORTANT-
WENT WHEN IT CAN BE
ACCOMPLISHED- IF IT PRESENTS AS
I MENTIONED A NICE CLEAN
ORGANIZED FOR VIEW THE DATA.
BUT ALSO SUPPORTS- ANALYTICAL
FUNCTIONS ACROSS PATIENTS AND
ACROSS PROVIDERS WHICH ARE
OTHERWISE NOT NOT POSSIBLE OR
NOT EASILY POSSIBLE- IF THE
DATA REMAINS IN SEPARATED
ACROSS THE DIFFERENT HEALTH
CARE ENTERPRISES NEXT SLIDE
PLEASE. AND WE SEE THAT IN IN
LOOKING CONVERSELY AT THE OTHER
END OF THE SPECTRUM AT A FULLY
DECENTRALIZED AND FEDERATED
MODEL OF HEALTH INFORMATION
EXCHANGE HERE IN THE MIDDLE YOU
SEE YOU DON'T SEE A PATIENT
DATA REPOSITORY THERE'S NO
CENTRALIZED STORAGE FOR THE
DATA THEY'RE THEY'RE JUST AS A
SET OF STANDARDS AND RULES- BY
WHICH THE VARIOUS HEALTH CARE
ENTERPRISES EXCHANGE DATA IN A
POINT TO POINT MATTER THEY
SUBMITTED TO EACH OTHER OR THEY
REQUESTED AND RETRIEVE IT FROM
EACH OTHER. THERE'S NO
CENTRALIZED DATA REPOSITORY
MANAGEMENT SO THERE'S NO MASTER
PATIENT INDEX HELPING TO-
JUDICATA FRIEND REPRESENTATIONS
OF THE SAME PATIENTS THERE'S NO
DIRECTORY. OF WHICH
ORGANIZATIONS OF WHICH PATIENTS
DATA- THERE COULD BE DUPLICATE
COPIES OF DATA ACROSS DIFFERENT
ORGANIZATIONS. IT'S UP TO. EACH
ORGANIZATION WHEN THEY RECEIVE
THOSE COPIES TO SORT THAT OUT-
BUT IN SOME WAYS THEIR
ADVANTAGES TO THIS MODEL AS
WELL- IN THAT. THERE'S LESS
PERCEIVED RISK IN MANY CASES BY
THE PARTICIPATING ORGANIZATIONS
BY THE HEALTHCARE FUNDS.
BECAUSE THEY DON'T HAVE TO YOU.
DON'T HAVE THIS SECURITY RISK
PRIVACY RISK FOR EXAMPLE OF. OF
SENDING ALL OF THEIR PATIENT
DATA TO A THIRD PARTY. AND
HAVING TO TRUST THAT THIRD
PARTY TO PROTECT THAT DATA
THERE'S ALSO. LESS BUSINESS
RISK PERCEIVED BUSINESS RISK IN
THAT IN THAT THEIR PATIENT DATA
IS SEEN BY MANY HEALTH CARE
ORGANIZATIONS. AS AS A
STRATEGIC ASSET AND A
COMPETITIVE ADVANTAGE TO THEM-
AND THERE'S ALSO GEN GENERAL
FOR THIS DECENTRALIZED MODEL
THEIR LOWER COST OF OPERATING
THE MODEL- BECAUSE YOU DON'T
HAVE TO MAINTAIN A MASTER
PATIENT INDEX AND SOME OF THE
OTHER CENTRALIZED.
INFRASTRUCTURE RESOURCES OF THE
CENTRALIZED MODEL. SO AS YOU
CAN SEE THE PROS AND CONS IN
THIS MODEL. NOW IN BETWEEN THE
TWO NEXT SLIDE PLEASE. AND THEN
YOU MAY HAVE SEEN UP IN THE
LEFT HAND CORNER OF THE SLIDES
ARE THERE EXAMPLES OF HEALTH
INFORMATION ORGANIZATIONS
WITHIN CALIFORNIA THAT- HAVE
IMPLEMENTED THESE VARIOUS
MODELS- SO THE ALL OF THESE
MODELS EXIST SOMEWHERE IN THE
STATE. SO THIS DOES PARTIALLY
CENTRALIZED PARTIALLY FEDERATED
MODEL AGAIN INCLUDES INTEL'S NO
CENTRALIZED PATIENT DATA
REPOSITORY EACH ORGANIZATION
CONTINUES TO STORE AND MAINTAIN
ITS THE DATA ITSELF. AND ONLY
SHARE IT ON ON DEMAND
ESSENTIALLY WITH WITH THE
HEALTH INFORMATION ORGANIZATION
BUT THERE ARE IN LIKE THAT
COMPLETELY DECENTRALIZED MODEL
THERE ARE RESOURCES SUCH AS A
MASTER PATIENT INDEX. WHAT'S
CALLED A PATIENT LOCATOR
SERVICE WITH WHICH EACH
ORGANIZATION REGISTERS ITS
PATIENT DATA THESE ARE SORT OF
INDEXES- IN AWARE DIRECTORIES.
UP TO HELP GUIDE FOR THOSE
LOOKING FOR PARTICULAR PATIENTS
DATA WHERE THAT PATIENT WHERE
WHERE THAT DATA MAY RESIDE NEXT
SLIDE PLEASE. SO AGAIN. UPON
REQUESTING INFORMATION A
PARTICULAR ORGANIZATION
CONSULTS THE CENTRALIZED
RESOURCE WHICH OUT REFERS TO
THE DIRECTORIES IN INDICES IT
HAS MAINTAINED AND SO IT KNOWS
WHERE WHICH ORGANIZATIONS TO
REQUEST DATA FROM NEXT SLIDE.
AND THEN THOSE DATA OF COURSE
ARE RETRIEVED FROM THOSE
ORGANIZATIONS AS AS NEEDED AND-
INDIVIDUALLY AND SENT BACK TO
THE REQUESTING ENTERPRISE AGAIN
AS MENTIONED- THAT THERE'S NO
CENTRALIZED DATA REPOSITORIES
ALTHOUGH IT'S EASIER TO FIND A
PATIENT'S DATA AND GET THE
RIGHT PATIENTS DATA TO THIS
MODEL. THERE IS STILL LIMITED
OPPORTUNITY TO- THE TECH DE
DUPLICATED DATA TO HAVE TO HAVE
THE DATA ALL IN ONE
STANDARDIZED FORMAT WHEN IT
WHEN IT. IS RETRIEVED ALL AND
MOST IMPORTANTLY TO ANALYZE
ACROSS PATIENTS AND ACROSS
PROVIDE ORGANIZATIONS EACH
HEALTHCARE ENTERPRISE THAT
COLLECTS DATA FROM OTHER HEALTH
CARE ENTERPRISE IN THIS MANNER
MUST STILL DO ALL THAT WORK
ITSELF OF AGGREGATING AND
ANALYZING THE DATA. NEXT SLIDE
PLEASE. SO WITH THAT- IN A
SURVEY OF THE DIFFERENT MODELS-
LET'S TURN TO TALKING ABOUT
WHAT KINDS OF EXISTING HEALTH
INFORMATION ORGANIZATIONS IN
CALIFORNIA IMPLEMENT ONE OR
MORE OF THESE MODELS AND
PROVIDE THE SERVICES AROUND THE
STATE AND THEIR THEIR- THERE IS
NO NO SMALL NUMBER OF THEM IN
FACT ALREADY OPERATING IN
CALIFORNIA THE FIRST CATEGORY
ARE WHAT WE'RE CALLING REGIONAL
HEALTH INFORMATION
ORGANIZATIONS AND THERE ARE
NINE- MAJOR ONES IN THE STATE
TODAY. N. AND THEY'RE HIGHLY
VARIABLE IN TERMS OF THEIR
SIZES AND THE SERVICES THEY
OFFER AND VARIOUS OTHER
DIMENSIONS THEY ALL PROVIDE
SOME TYPE OF ON DEMAND CLINICAL
DATA SHARING FOR INDIVIDUAL
PATIENTS AND SOME OF THEM
PROVIDE OTHER IMPORTANT
SERVICES- RELATED TO THAT THE
USE CASES THAT I MENTIONED
BEFORE SUCH AS A CENTRAL
REPOSITORY THAT SUPPORTS.
ANALYSIS OR- A POPULATION
MANAGEMENT SERVICES OR THESE
NOTIFICATION SERVICES WHEN A
PATIENT IS DISCHARGED FROM
HOSPITAL OR OR CONNECTION TO
SOCIAL SERVICE AGENCIES AT
CETERA. THE SECOND TYPE OF H.
IONE CALIFORNIA- OF THOSE THAT
ARE SPECIFIC TO INTEGRATED
DELIVERY NETWORKS OR OTHER-
AGGREGATIONS OF. HEALTHCARE
ENTERPRISES THAT ARE IN SOME
WITH EACH OTHER THAT HAS
INCENTIVIZE THEM TO SHARE DATA
AND DAY THESE ARE SOMETIMES
CALLED PRIVATE H. I. O.'S-
THEY'RE ONLY AVAILABLE TO THOSE
ORGANIZATIONS IN THIS IN THIS
CLUB AND THIS PARTNERSHIP. AND
OUR DATE DAY SHARE THE COSTS OF
THIS HEALTH INFORMATION
EXCHANGE- INFRASTRUCTURE AND
TECHNOLOGY FOR THEMSELVES. AND
THEN THE THIRD CATEGORY ARE-
HEALTH INFORMATION
ORGANIZATIONS THAT ARE- HAVE
HAVE BEEN CREATED BY OUR AND
ARE OPERATED AND GOVERNED BY-
CONSORTIA OF VENDORS OR
SOMETIMES EVEN INDIVIDUAL
VENDORS- THESE INCLUDE. ONCE
CALLED CARE QUALITY WHICH HAS A
CERTAIN NUMBER OF EHR VENDORS
THAT IT ENABLES THE SHARING A
HEALTH INFORMATION AMONG.
COMMON WELL A DIFFERENT ONE
WITH SOME OVERLAPPING IN SOME
DIFFERENT MEMBERS- THERE'S A
PROMINENT LOCAL EPIC CARE
EVERYWHERE WHICH IS SPECIFIC TO
JUST THE EPIC. EHR VENDOR- AND
THERE'S SOME SECURE MESSAGING.
INFRASTRUCTURE IN IN PLACE THAT
MOST EHRS HAVE SOME CAPABILITY
TO LEVERAGE- GENERALLY SPEAKING
HOWEVER THESE. IMPORTANT POINT
ABOUT THESE NETWORKS IS THAT
DAY PROVIDE THEIR SERVICES ARE.
GENERALLY SPEAKING AGAIN
CONSTRAINED TO JUST ON DEMAND
CLINICAL DATA SHARING IN
PARTICULAR THE SHARING OF A
PARTICULAR KIND OF
STANDARDIZED- DATA FORMATTER
DOCUMENT THAT CONTAINS A
PATIENT MEDICAL. MEDICAL RECORD
BUT I BUT THIS IS A ON A ON A
PATIENT BY PATIENT BASIS CAN BE
RETRIEVED- AGAIN THERE'S IN
THESE MODELS THERE'S NO
CENTRALIZED DATA REPOSITORY-
AND THERE'S- MOST CASES NO
NOTIFICATION MANY OF THE OTHER
SERVICES. NEXT SLIDE PLEASE.
NEXT WE'LL TURN TO THE
DISTRIBUTION OF THESE TYPES OF
H. IDEAS ACROSS CALIFORNIA.
NEXT SLIDE PLEASE FIRST AMONG
THE THOSE REGIONAL H. I. AS A
NINE REGIONAL H. IDEAS- THIS IS
A OF THE MAPPING OF THE GENERAL
DISTRIBUTIONAL REFER PEOPLE TO
THAT PROMISE AND PITFALLS
REPORTS FOR MORE DETAILS ABOUT
EACH OF THESE. BOB SO THEY THEY
TEND TO BE CLUSTERED IN IN
GEOGRAPHICAL AREAS- ALTHOUGH
THERE'S DEFINITELY SOME
OVERLAPS IN GEOGRAPHY FOR
EXAMPLE L. A. COUNTY. THERE'S A
MADE A PRIMARY- ORIGINAL H. I.
O. THERE BUT THERE'S ALSO
PARTICIPANTS IN THAT AREA IN
IN- H. I WAS OF ADJOINING
REGIONS ONE IMPORTANT POINT I
WANT TO MAKE ABOUT THIS LIGHT
IS- THIS DATA AND THIS
DEPICTION IS FROM. TWENTY
EIGHTEEN A COUPLE YEARS AGO AND
SO- THERE THE FOOTPRINT OF THE
SOME OF THESE H. I. OWES MAY
CERTAINLY HAVE CHANGED EVEN
SIGNIFICANTLY CHANGED. IN THE
LAST COUPLE YEARS- SO- THAT
THIS THIS MADE MAY NOT
NECESSARILY TO PICKED UP THE
CURRENT STATE OF THE WORLD BUT
IT IS WHAT IT IS UP ROUGHLY
ACCURATE I WOULD SAY- BASED ON
TWENTY EIGHTEEN DATA. NEXT
SLIDE PLEASE. WITH RESPECT TO
INTEGRATED DELIVERY NETWORKS.
ARE THESE ALSO EXISTS IN
VARIOUS PARTS AREAS AROUND THE
STATE ARE SPREAD AROUND THE
STATE ROOM RECALL THESE ARE-
PARTNERSHIPS OF HEALTH CARE
DISTINCT HEALTH CARE
ORGANIZATIONS- THAT HAVE A
BUSINESS INCENTIVE TO SHARE
DATA. AND YEAH INCLUDING
HOSPITAL SYSTEMS- THE SUCH AS
THE WELL KNOWN ONES AND ALSO
ACCOUNTABLE CARE ORGANIZATIONS
AND SO FORTH THEY TEND TO BE
AND- POPULATION CENTERS AROUND
THE STATE. AND ALSO THERE'S
SOME OVERLAP AS YOU CAN SEE
FROM THIS MATH VERSUS THE
PREVIOUS ONE- THAT THAT SOME
ORGANIZATIONS SOME OF THESE
IDEA AND H. I. O.'S- ARE IN THE
SAME AREAS AS REGIONAL H. I. AS
IN EFFECT SOME. SPECIFIC
HEALTHCARE ENTERPRISES WILL
WILL PARTICIPATE IN BOTH A- A
PRIVATE H. I. O. AND A REGIONAL
A CHAU. NEXT SLIDE PLEASE. OF
THE SITE SO SOME OF THOSE THE
VENDOR GOVERNED AND OPERATED
HEALTH INFORMATION EXCHANGE
ORGANIZATIONS- A- IN FUTURE
THESE IS THAT THE REALLY
AVAILABLE- THAT THEY'RE NOT
REGIONAL. THEY'RE THEY'RE
AVAILABLE IN DIFFERENT PARTS OF
THE STATE THEY'RE BASED ON
BECAUSE THEY'RE BASED ON
TECHNOLOGY CHOICES. OF
INDIVIDUAL HEALTH CARE
ENTERPRISES AND A AND- SO THAT
THE CONCENTRATION HOWEVER OF
THE MEMBERS OF THESE. H. IOS
IS- IS HIGHLY VARIABLE IN ANY
PARTICULAR CITY COUNTY OR
REGION. SO FOR EXAMPLE- TO
ENTERPRISES IN SEPARATE CORNERS
OF THE STATE'S MIGHT BE ABLE TO
EXCHANGE DATA USING THE CARE
QUALITY- NETWORK BECAUSE THEY
THEY BOTH USE EHRS THAT ARE IN
THAT NETWORK WHERE IS TO
HEALTHCARE ORGANIZATIONS ACROSS
THE STREET FROM EACH OTHER IN A
PARTICULAR CITY MAY NOT BE ABLE
TO USE THAT NETWORK BECAUSE
THAT'S NOT THE CASE. SIMILARLY
FOR ANY FOR THESE AND AGAIN
SOME ORGANIZATIONS MAY BELONG
TO MULTIPLE OF THESE SO THERE'S
A REAL MIXING AND MATCHING OF
PARTICIPATION AMONG HEALTH CARE
ENTERPRISES IN THESE VARIOUS-
HEALTH INFORMATION
ORGANIZATIONS AVAILABLE IN OUR
STATE. NEXT SLIDE PLEASE. WE'RE
GETTING NEAR THE END. SO
SERVING THE SLIDE IS UP OF. THE
AS I MENTIONED THERE'S A
VARIETY OF DIFFERENT MODELS IN
A VARIETY OF DIFFERENT. H. I.
O.'S ACROSS THE STATE A REAL
SMORGASBORD IN FACT OF CHOICES
AND EXISTING RESOURCES FOR
HEALTH INFORMATION. NEVER THE
LESS THERE REMAIN GAPS IN
HEALTH INFORMATION EXCHANGE
CAPABILITIES OF PARTICULAR
ORGANIZATIONS IN CALIFORNIA IT
MANY ORGANIZATIONS IN
CALIFORNIA FOR VARIETY OF
REASONS AT ALL THAT I'LL GO GO
OVER NOW NEXT SLIDE PLEASE. THE
FIRST TYPE OF GAP IS WHERE- IN
A REGION WHERE THERE IS A
REGIONAL HEALTH INFORMATION
ORGANIZATION UP THERE THERE MAY
STILL BE ON AND ARE. OF MANY
ORGANIZATIONS TYPICALLY
HEALTHCARE PROVIDER
ORGANIZATIONS THAT THAT CANNOT
OR DO NOT PARTICIPATE IN THAT
REGIONAL H. I. O. THEIR NUMBER
OF DIFFERENT REASONS FOR OUR
FOR THIS- SOMETIMES ARE
FINANCIAL CONSTRAINTS.
SOMETIMES THEY FEEL LIKE THEY
DON'T NEED TO PARTICIPATE AND
SO FORTH BUT THE FACT IS- THAT
THERE'S NOWHERE IS THERE
UNIVERSAL PARTICIPATION IN ANY
REGIONAL H. I. O. AND THIS IS
MORE SO- USUALLY AMONG.
AMBULATORY PROVIDERS OUTPATIENT
PROVIDERS AND HOSPITALS- NEXT
SLIDE PLEASE. HOWEVER OF THOSE
ORGANIZATIONS I DON'T
PARTICIPATE IN A REGIONAL HR
THAT DOES NOT MEAN THAT THEY
CANNOT DO ANY HEALTH
INFORMATION EXCHANGE HAVE NO
CAPABILITIES BECAUSE IN THOSE
SAME REGIONS AS SHOWN IN THESE.
OVERLAPPING LAYER DEPICTION OF
DIFFERENT HEALTH INFORMATION
ORGANIZATIONS OTHER. HEALTH
INFORMATION ORGANIZATIONS MAY
BE OPERATING THERE AND MEMBERS
ARE NOT PARTICIPATING IN THE
REGIONAL H. I. O. MAYBE
PARTICIPATING IN ONE OR MORE OF
THESE. OTHER TYPES AS WELL AS
WE CAN SEE HERE IN THIS SLIDE.
NEXT SLIDE PLEASE. AND AGAIN IN
FACT. I'M SORRY PREVIOUS SLIDE.
IN FACT AS WE CAN SEE HERE IS
THAT THE- IN THE TRUE STATE OF
THE WORLD. ORGANISE THEIR SOME
ORGANIZATIONS THAT PARTICIPATE
IN MULTIPLE OF THESE HEALTH
INFORMATION ORGANIZATIONS IN A
PARTICULAR REGION. AND SO THAT
EXPANDS THE HEALTH INFORMATION
EXCHANGE CAPABILITIES OF ANY
PARTICULAR ORGANIZATION SO WE
SEE HERE TWO OF THE MEMBERS OF
THE REGIONAL H. I. OR ALSO CARE.
MEMBERS SO DOES TWO CAN.
COMMUNICATE EXCHANGE DATA WITH
ANY OTHER CARE QUALITY MEMBERS
BUT THE OTHER REGIONAL HR
MEMBERS CANNOT AND UP IT UP AT.
THE TOP OF ONE OF THE CARE
QUALITY MEMBER PARTICIPANTS IS
ALSO AN INTEGRATED DELIVERY
NETWORK SO THAT ORGANIZATIONS
CAN EXCHANGE DATA NOT ONLY WITH
THE OTHER CARE QUALITY MEMBERS
BUT WITH. THOSE OF THE
INTEGRATED LIVER YOU KNOW. THE
OTHER IN A GREAT DELIVERY
NETWORK MEMBERS CANNOT HOWEVER
DO THAT EXCHANGE DATA WITH ANY
ANY OTHER NETWORK MEMBERS SO.
THERE'S THAT COMP COMPLEXITY
AND THE GAPS THAT ARE-
ENGENDERED BY THAT AS WELL.
NEXT SLIDE PLEASE. AND THEN THE
MOST COMMON KIND OF- GAP THAT
THAT PEOPLE TALK ABOUT HELLO
IT'S OBVIOUSLY NOT THE ONLY GAP
IS WHERE THERE'S A REGION. THAT
DOESN'T HAVE A REGIONAL H. I.
OPERATING IN THAT AREA THIS OP
IS OFTEN CALLED THE CORTICAL
WHITE SPACE- YOU SEE LITERALLY
WHITE SPACE IN THAT MAP OF
REGIONAL H. I. AS THAT I SHOWED
EARLIER. THAT HAPPENED AND
OBVIOUSLY THERE'S NO HEALTH
INFORMATION SHARING BY REGIONAL
H. I. O. IN THOSE IN THOSE
PARTS OF THE STATE. NEVER THE
LESS NEXT SLIDE PLEASE AS WE
JUST TALKED ABOUT. THERE CAN BE
N. N. OFTEN IS. ALL VERY
COMMONLY IS- OTHER MEANS OF.
ACHIEVING HEALTH INFORMATION
EXCHANGE EVEN IN THE ABSENCE OF
A REGIONAL H. I. L. A THROUGH.
H. I. IS LIKE A CARE QUALITY
NETWORK INTEGRATE DELIVERY
NETWORKS COMMONWEALTH DIRECT
MESSAGING AND SO FORTH- AS AS
MENTIONED IMPORTANTLY THOUGH.
THOSE NETWORKS OFTEN DON'T
PROVIDE THE SAME LEVEL OF
SERVICES AS A REGIONAL H. I. L.
THEY OFTEN DO NOT HAVE A
CENTRALIZED DATA REPOSITORY
THEY OFTEN. DO NOT PROVIDE
NOTIFICATION SERVICES AND SO
FORTH ESPECIALLY THE CARE
QUALITY COMMON WELL IN SECURE
MESSAGING INTEGRATE DELIVERY
NETWORKS MAY PROVIDE MORE THOSE
FEATURES. SO EVEN WHERE THEIR
ALTERNATIVES FOR HEALTH
INFORMATION EXCHANGE TO
REGIONALLY CHAU THERE STILL MAY
BE GAPS IN THE TYPES OF HEALTH
INFORMATION EXCHANGE THAT THAT
THOSE ALTERNATIVES PROVIDE.
NEXT SLIDE PLEASE WHICH IS MY
LAST SLIDE. SO SUMMING UP I BY
I HOPE I'VE COMMUNICATED TODAY
THAT HEALTH INFORMATION
EXCHANGES VALUABLE WITH RESPECT
TO IMPROVE QUALITY OF CARE AT
LOWER COSTS AND BETTER PUBLIC
HEALTH SERVICES THEY'RE
DIFFERENT TECHNICAL MODELS THAT
HAVE. IMPORTANT DIFFERENCES
BETWEEN THEM IN TERMS OF
FUNCTIONLITY AND ALSO A PUBLIC
POLICY DECISIONS AND THAT
THERE'S A WHOLE HOST OF
DIFFERENT HEALTH INFORMATION
EXCHANGE ORGANIZATIONS IN THE
STATE- THAT DAD USED USE ONE OR
MORE THESE TECHNICAL MODELS
SOME IN REGION SOME ACROSS
REGIONS- AND OFTEN MANY OF
OPERATING THE SAME REGION AT
THE SAME TIME YET DESPITE THIS.
GAPS REMAIN IN HEALTHCARE
ENTERPRISE ABILITY TO EXCHANGE
DATA AFFECTED BILLION MEET ALL
THOSE USE CASES THAT THAT WE
TALKED ABOUT AT THE OUTSET. SO
THE BOTTOM LINE IS THAT IT'S
COMPLICATED TO COMPLICATED
AREA- AND- IT WILL REQUIRE
COMPLICATED THINKING IN MY
OPINION- TO. DEVELOP PUBLIC
POLICY INITIATIVES THAT ADDRESS
THE NEEDS APPROPRIATE NEEDS-
AND THAT GAME IN SUPPORT OF THE
HEALTH CARE INDUSTRY IN THE
GENERAL POPULATION IN
CALIFORNIA. SO NEXT LAST VERY
LAST SLIDE PLEASE. AND I DON'T
KNOW FOR TAKING QUESTIONS. YES
RIGHT NOW OR AT THE END NO WE
WILL GUARANTEE AT QUESTIONS AT
THE END SO WITHOUT NO NO CLUE
NO. OR WEAK VACATE THE CHAIR
FOR THE NEXT SPEAKER. GIVE I
THOUGHT WE WERE. WHAT A
QUESTION YEAH I THINK IS DOCTOR
SUE JANSKY BEFORE YOU GO. COME
BACK. COME BACK DOCTOR
SUGGESTING. THANK YOU WE DO
WANT TO TAKE SOME QUESTIONS- IF
YOU DON'T IF YOU'RE OKAY WITH
THAT- I'M AT TURN TO MY
COLLEAGUES WHO WERE IN THE
CHAMBER OF A I WOULD WELL NO
WE'VE A SISSY AGUIAR-CURRY
ASSEMBLY MEMBER GEAR CURRY IS
HERE AND OUT OF. THIS ASSEMBLY
MEMBER AUTUMN BURKE IS HERE AS
WELL DO EITHER OF YOU HAVE
QUESTIONS. PLEASE GO AHEAD WELL
MAKE QUICK COMMENT- NO DOUBT
ABOUT IT WHEN YOU SAID THE LAST
LINE AND THERE WAS IS
COMPLICATED. THERE'S NO DOUBT
ABOUT THAT BECAUSE THERE'S A
LOT OF DIFFERENT PEOPLE THAT ON
STAKEHOLDERS THAT ARE INVOLVED
IN NOBODY WANTS TO GIVE UP
THEIR- PIECE OF THE PIE. SO WE
HAVE A LOT OF WORK TO DO TO BE
ABLE TO MAKE THIS AN INTEGRATED
SYSTEM. FOR OUR CONSTITUENTS.
THANK YOU VERY MUCH. ASSEMBLY
MEMBER. THERE ANYONE- ANY OF
OUR MEMBERS ATTENDING REMOTELY
WHO HAVE ANY QUESTIONS
DOCTORS WHO JESSE I DO HAVE I
DO HAVE SOME QUESTIONS- BECAUSE
THEY ARE THEY ARE GREAT. YOU
KNOW AND I WOULD I WOULD ECHO
WHICH ASSEMBLY MEMBER
AGUIAR-CURRY SAID THIS IS THIS
IS ABSOLUTELY- VERY COMPLICATED
AND WE'RE WE'RE ABOUT AS DEEP
IN THE WEEDS YOU GET ON
HEARING- WITH THIS AND THIS
PARTICULAR TOPIC SO- SO MY
QUESTIONS ARE GOING TO BE- A
LITTLE BIT ARE PRETTY DETAILED
SO BEAR WITH ME HERE SO. YOU
KNOW YOUR PRESENTATION YOU
DESCRIBE THE DIFFERENCES
BETWEEN A FEDERATED MODEL THE
CENTRALIZED MODEL N A HYBRID
MODEL IN TERMS OF HOW THE DATA
IS MAINTAINED- DO YOU SEE. ANY
PARTICULAR ADVANTAGES IN ANY IN
IN IN ANY OF THOSE APPROACHES I
MEAN WOULD YOU WOULD YOU WERE.
COULD YOU CONCEIVABLY RANK THEM
OR- AND THAT MAY BE A DIFFICULT
THING TO DO BUT- YOU KNOW DO
YOU SEE- WHICH YOU YOU KIND OF
HIT ON A LITTLE BIT BUT- IF. IF
YOU WERE DOES LET ME PUT IT
THIS WAY THIS WAY IF YOU WERE
TO DIE DESIGN A SYSTEM- HOW
WOULD YOU DO IT. YES THANK YOU
FOR THE QUESTION OF. DOT I
GUESS THE SHORT ANSWER IS THERE
I DON'T THINK IT'S POSSIBLE TO
RANK THE APPROACHES IN IN A
VERY PRACTICAL SENSE IN TERMS
OF WHAT'S THE BEST TARGET-
BECAUSE THERE ARE- ADVANTAGES
AND CHALLENGES TO ALL OF THEM
THEY'RE NOT THEY'RE NOT ALL
NECESSARY TECHNICAL- SO THERE
MAY BE ONE MODEL MIGHT PROVIDE
THE MOST FUNCTIONALITY FROM A
TECHNICAL POINT OF VIEW BUT IT
MIGHT COST THE MOST. OR IT
MIGHT BE IT MIGHT NOT BE
PALATABLE TO ALL OF THE HEALTH
CARE ORGANIZATION WHO YOU WANT
TO PARTICIPATE SO THAT FOR
EXAMPLE IN THE ABSENCE OF SOME
TYPE OF MANDATE- IT WOULD NOT
ACHIEVE A BROAD ENOUGH
PARTICIPATION COULD REALLY
CREATE THAT LONGITUDINAL
PATIENT RECORD IF THAT WAS YOUR
GOAL AND IT MAY BE. MORE
FEASIBLE MORE PRACTICAL TO
SHOOT FOR- MAYBE LESS DAA
SHARING FUNCTIONALITY BUT
BROADER PARTICIPATION SO
GETTING SOME DATA FROM EVERYONE
RATHER THAN- ALL DATA FROM FROM
TRYING TO GET ALL DATA FROM
FROM A LOT OF ORGANIZATIONS ARE
MANY ORGANIZATIONS SUCH AS ALL
THOSE TRADE OFFS ARE YOU KNOW.
IN IN PLAY AND THOSE ARE- YOU
KNOW GET THOSE AT THE
COMPLICATED PUBLIC POLICY
CONSIDERATIONS THAT ARE. ABOVE
MY PAY GRADE- FROM FROM THAT
PERSPECTIVE. IN TERMS OF IDEAL.
PERSONALLY I FEEL YOU KNOW I
THINK MOST PEOPLE WOULD AGREE
WITH ME THAT THE IDEAL IS
REALLY TO HAVE A CENTRAL DATA
REPOSITORY OF ALL THE PATIENTS
STATE AND HAVE A LONGITUDINAL
PATIENT. PATIENT RECORD THERE
THAT- YOU KNOW ALL ALL RELEVANT
AUTHORIZED ORGANIZATIONS AND
PROVIDERS CAN HAVE ACCESS TO
THAT'S MAINTAINED THAT'S
COMPLETE AND MAINTAIN UP TO
DATE IN A VERY TIMELY MANNER-
SO THAT THERE'S ESSENTIALLY A
SINGLE. MEDICAL RECORD FOR
EVERY PATIENT IN THE STATE AND
THEN YOU CAN DO ALL KINDS OF.
ANALYSES AGAINST THAT IT'S
NICELY ORGANIZED IT'S VERY
EFFICIENT BECAUSE YOU DON'T
HAVE MULTIPLE ORGANIZATIONS.
EACH D. DUPLICATING AN
ORGANIZING AND LINKING
PATIENTS- YOU KNOW OF A
REDUNDANTLY- SO IN SOME SENSE
THAT'S IT THAT'S A THAT'S AN
IDEAL BUT WHETHER THAT IS.
FEASIBLE FOR YOU KNOW FOR THE
REASONS OF YOU KNOW PEOPLE'S
PIECES OF THE PIE IN THE COST
OF DOING THAT AND SO FORTH. IS
OBVIOUSLY DIFFERENT QUESTION.
THANK YOU I'M CAN YOU CLARIFY-
MANIFEST MEDICS MEDICS-
CLASSIFICATION AS A REGIONAL H.
I. O. IS AS IT'S BEEN DESCRIBED
TO ME IT'S A STATE WIDE. H. I.
E. WITH PROVIDER PARTICIPANTS
IN HIRTY EIGHT OF FIFTY EIGHT
COUNTIES HELP PLANNED LIVES IN
EVERY COUNTY MORE THAN A
HUNDRED PARTICIPATING HOSPITALS
AND CURRENTLY SHARING DATA FOR
TWENTY FOUR MILLION PEOPLE SO.
CAN YOU CLARIFY HOW YOU
CLASSIFY THAT. SURE. SURE SO-
SO FIRST OF ALL AS I MENTIONED
AT THE DATA THAT I'M USING THE
CHARACTERIZATIONS THAT I'M
USING ARE FROM A COUPLE OF
YEARS AGO THINGS ARE MOVING
FAST SO- MANIFESTS MAY HAVE
ENLARGED ITS FOOTPRINT.
APPRECIABLY FROM A COUPLE OF
YEARS AGO I HAVEN'T COLLECTED
YOU KNOW DATA WE COLLECTED THE
DATA- TO MAKE THAT ASSESSMENT
TODAY I THINK ONE IN DOING SO
ONE NEEDS TO CONSIDER- NOT JUST
WHETHER A PARTICULAR H. I. O.
HAS. YOU KNOW MAY HAVE ONE
PARTICIPANT IN. JUST ONE
PARTICIPANT FOR EXAMPLE IN A
LOT OF COUNTIES- AND WHETHER
THAT GIVES IT A STATE WIDE
FOOTPRINT BUT BUT REALLY WHAT
THE CONCENTRATION OF
PARTICIPANTS AND IN THOSE
COUNTIES IS AND WHERE THAT H.
I. O. HAS A- SUBSTANTIAL
CONCENTRATION SUCH THAT ANY
PARTICULAR PARTICIPANT. CAN BE
CONFIDENT THAT THE PATIENT AT
THE NEW PATIENT FOR EXAMPLE
THAT IT'S ARRIVED IN THEIR
OFFICE THAT DAY THAT DATA FOR
THAT PATIENT IS GOING TO BE
AVAILABLE IN THE H. I. L. SO
FOR EXAMPLE IF I'M FROM UP IN.
THE NORTH STATE COUNTY AND
THERE'S ONE ORGANIZATION THERE
THAT'S PART OF AN H. I. O. FROM
SOUTHERN CALIFORNIA- BUT NO
OTHERS IN THAT REGION MOST OF
THE CARE THE PATIENTS SEEN IN
NORTHERN CALIFORNIA GOING TO BE
BY OTHER NORTHERN CALIFORNIA
PROVIDERS. SO IF THEY'RE NOT IN
THAT H. I. O. THERE'S A- MORE
LIMITED VALUE THEN THERE WOULD
BE TO PARTICIPATE IN THAT H. I.
O. FROM SOUTHERN CALIFORNIA
WHERE THERE'S MANY MANY OF THE
PART OF THE PROVIDER
ORGANIZATIONS THERE ARE
PARTICIPANTS IN THAT H. I. O.
SO THE CHANCES THAT- DATA FOR
YOU DON'T MORE COMPLETE DATA
FOR MY PATIENT WILL BE
AVAILABLE TO THAT H. I. ARE
MUCH HIGHER. SO I'M NOT I'M NOT
AGAIN I DON'T HAVE THE DATA FOR
MANIFEST MEDICS OR ANY OF THE
H. I. OWES AS OF TODAY- SO I
WOULD NEED TO LOOK AT. JUST
FROM UP. SCIENTIFIC POINT OF
VIEW IF YOU WILL WHAT WHAT IS
THE CONCENTRATION. OF MANIFESTS
OR ANY OTHER H. I. OWES-
MEMBERSHIP IN VARIOUS PARTS OF
THE STATE. AND WHAT IT WHAT IS
THE WHAT IS TYPICALLY USING ARE
THEY USING- MULTIPLE WAYS OF
IDENTIFYING PATIENTS SO. SO IT
I GUESS ONE OF THE THINGS THAT
I'VE HEARD IS THAT THERE'S A
POSSIBILITY THAT YOU KNOW YOU
DO A QUERY AND YOU END UP WITH
YOU KNOW FORTY SEVEN JOHN
SMITH'S AND SO ONLY ONE OF THEM
IS. THE REAL JOHN SMITH SO WHAT
ARE OR WERE USING MULTIPLE WAYS
OF IDENTIFYING THAT PATIENT OR
IS THERE A SINGLE ACCEPTED-
TRACTOR SOMETHING LIKE A SOCIAL
SECURITY NUMBER SOMETHING. SO
THAT YOU ACTUALLY MAKE SURE
THAT YOU'RE GETTING THE DATA
FROM THE RIGHT PATIENT. YEAH
THAT'S A GREAT POINT AND A
GREAT QUESTION AND AS YOU KNOW
IN THE US AND IN CALIFORNIA WE
HAVE NO. UNIVERSAL PATIENT ID
YOU KNOW UNIVERSAL MEDICAL ID
LIKE LIKE THERE IT THERE IS IN
OTHER COUNTRIES- SO WE RELY ON.
USING OTHER EXISTING IDEAS LIKE
SOCIAL SECURITY NUMBERS AND
NAMES AND DATES OF BIRTH. AND
OTHER DATA POINTS- THAT THAT
COULD HELP IN THAT AND THERE'S
NO THERE'S NO MAGIC BULLET FOR
THAT SOME ORGANIZATIONS DON'T.
DON'T COLLECT EVEN A SOCIAL
SECURITY NUMBER OR DON'T FEEL
COMFORTABLE USING THAT. BECAUSE
OF THE SENSITIVITY OF THAT
IDENTIFIER IN THEIR PATIENT
MATCHING ACTIVITIES- SO IT'S
SOCIAL SECURITY IS NOT A MAGIC
BULLET FOR THAT ALSO. SOME
PATIENTS DON'T HAVE SOCIAL
SECURITY NUMBERS- YOU KNOW
NEWBORN BABIES AND SMALL CHAU
INFANTS IN THE HOSPITAL MAY NOT
HAVE A SOCIAL SECURITY NUMBER-
YOU KNOW UNDOCUMENTED
IMMIGRANTS MAY NOT HAVE SO
SECURE NUMBER ETCETERA- SO.
AGAIN THERE'S NO PERFECT
SOLUTION FOR THAT DIFFERENT H.
I WAS THERE TO USING DIFFERENT
TECHNOLOGIES TO DO THIS PATIENT
MATCHING IT'S A WHOLE. FIELD OF
STUDY AND A WHOLE SUB INDUSTRY
ONTO ITSELF TOOLS. FOR HELPING
TO IDENTIFY. WHICH WHICH
PATIENTS FROM DIFFERENT
ORGANIZATIONS ARE FACT THE SAME
PEOPLE BASED ON- YOU KNOW THE
DEGREE TO WHICH THEY'RE
DIFFERENT DEMOGRAPHIC DATA FROM
THOSE ORGANIZATIONS MATCH OR DO
NOT MATCH- THERE ARE SOME MORE
ADVANCED. TECHNOLOGIES FOR
DOING THAT THAT INCORPORATE.
OTHER DATA SOURCES LIKE CREDIT
BUREAUS AND OTHER PUBLIC DATA
SOURCES- TO EXPAND INTO. THE
TYPES OF DATA THAT ARE
AVAILABLE FOR MATCHING FOR
EXAMPLE CREDIT BUREAUS MAY HAVE
INFORMATION ABOUT A PATIENT'S.
PERSONS MAIDEN NAME NOT JUST
THEIR CURRENT NAME THAT CAN BE
USED TO MATCH ACROSS TWO
ORGANIZATIONS- WHERE. THEY KNEW
IN ONE IS THE PATIENTS MAIDEN
NAME IS USING THE OTHER THEIR
MARRIED NAME IS USE SO FORTH.
SO TO LONG WINDED ANSWER BUT TO
SAY THERE'S NO THERE'S NO EASY
SOLUTION FOR THAT AND IT
REMAINS AN ISSUE. SO THAT THAT
MAKES ME WONDER THAN FROM A
PERSPECTIVE OF USEFULNESS AND
BEING ABLE TO SORT THROUGH SO
IF YOU'VE GOT SOMEONE WITH A
COMMON NAME. AND YOUR THE
PHYSICIAN TRYING TO TRACK
TRYING TO PUT TOGETHER THE
RECORD ON THIS PERSON- YOU KNOW
I DO WONDER AT SOME POINT ORG
PEOPLE DISCUSS A THE HECK WITH
IT I'M JUST GONNA DO THE MRI
ANYWAY. BECAUSE I NEED THAT I'M
IN THE R. I NEED THIS NOW YOU
KNOW MAYBE THEY HAD ONE YOU
KNOW WHAT IN THE JOINING
HOSPITAL AN HOUR AGO BUT- THIS
PATIENTS CRITICAL AND I NEED TO
GET THAT INFORMATION NOW SO. SO
I DO WONDER YOU KNOW IF YOU'RE
DOING QUERIES HERE IF YOU IF
YOU'VE GOT TO SORT THROUGH A
BUNCH OF INFORMATION AND TIME
IS OF THE ESSENCE. AND HOW DOES
THIS ACTUALLY LEAD TO COST
SAVINGS AND EFFICIENCIES. IF
THE NEW INFORMATION IS. ISN'T
ISN'T AS COHESIVE AS AS WE LIKE
TO SEE A. IT'S AN IMPORTANT
POINT- I GUESS I WOULD SAY
WE'RE WE'RE MAYBE IT'S THE
SITUATION'S NOT QUITE AS DIRE.
AS YOU'RE INDICATING BECAUSE-
EVEN JUST UP JUST BASED ON.
READILY AVAILABLE DEMOGRAPHICS
SUCH AS NAME. AND DATE OF BIRTH
AND GENDER POSSIBLY ADDRESS YOU
CAN YOU CAN DO. RELATIVELY
EFFECTIVE PATIENT MATCHING SO
MOST OF THE TIME YOU WILL NOT
GET BACK OU KNOW. IN MULTIPLE
PATIENT OR NO PATIENCE- WHEN IN
FACT YOU SHOULD YOU SHOULD FIND
JUST ONE MATCHING PATIENT MOST
OF THE TIME- IT BY MOST I MEAN
YOU KNOW. FIFTY SIXTY SEVENTY
PLUS PERCENT OF THE TIME YOU
YOU WILL GET THE YOU WILL GET.
A GOOD MATCH IT'S JUST THAT
IT'S STILL IN PERFECT- SO- YOU
KNOW PUT A 20% 30% ERROR RATE-
IS YOU KNOW IF IT IF IT CREATES
MORE WORK FOR A PROVIDER IN
THOSE CASES- IS STILL
SIGNIFICANT. BUT THAT'S NOT TO
SAY THERE'S NO VALUE TO THE
SYSTEM- BECAUSE OF THAT THAT'S
HARDLY THE CASE AT ALL I WOULD
SAY AS FAR AS PUBLIC POLICY IS
CONCERNED IN MY OPINION. YOU
KNOW A VERY IMPORTANT AREA. TO
HELP WITH HEALTH INFORMATION
EXCHANGE IN GENERAL WOULD BE TO
EXPLORE- AN ALTERNATIVE I
UNIQUE IDENTIFIERS FOR CITIZENS
OF CALIFORNIA. TO HELP WITH
WITH THIS IDENTITY MATCHING
TASK TO GET FROM THAT 7080% TO
A 100% AND MAKE THE SYSTEM THAT
MUCH BETTER. WELL THAT'S GREAT
WELL I WASN'T IMPLYING THAT
ISN'T OF VALUE I WAS JUST- WELL
I WAS JUST CURIOUS AS TO HOW
HOW OFTEN YOU YOU REALLY GOT A
CALL THROUGH A LOT OF
INFORMATION- TO GET WHAT IT IS
YOU'RE LOOKING FOR SO- SO. IT'S
IT SOUNDS LIKE AND FEELS LIKE
IF WE HAD A UNIQUE PATIENT
IDENTIFIER- FOR EVERY PERSON I
WOULD GO A LONG WAY TO
SIMPLIFYING THE SYSTEM AND
MAKING SURE THAT WE HAVE. YOU
KNOW A REALLY HIGH LEVEL OF
ACCURACY. YES I WOULD I WOULD
AGREE. YOU KNOW AGAIN THAT'S
THE THAT'S AN IDEAL BUT OF
COURSE THERE ARE. NOT EVERYONE
WOULD AGREE WITH THAT. AND
THERE MAY BE DOUBT THAT THERE
MAY BE SOME PERCEIVED DOWNSIDES
TO THAT AS WELL- THAT THAT NEED
TO BE MANAGED. FROM A TECHNICAL
AS WELL AS A PERCEPTION POINT
OF VIEW BUT I BUT I CERTAINLY
AGREE WITH YOU THAT. IN IN NET
PERSONALLY SPEAKING I THINK. IT
WOULD BE A SIGNIFICANT POSITIVE.
WELL THANK YOU VERY MUCH FOR
THE INFORMATION VERY MUCH
APPRECIATED AND- APPRECIATE YOU
MAKING THE TREK TO OAKLAND TO
DO IT. NO PROBLEM THANK YOU
VERY MUCH THANK YOU. GO AHEAD
NOW AND MOVE ON TO OUR OUR
SECOND SPEAKER. OUR SECOND
SPEAKER IS- DR LYNETTE SCOTT.
SHE IS THE CHIEF DATA OFFICER
AND DEPUTY DIRECTOR OF
ENTERPRISE DATA AND INFORMATION
MANAGEMENT WITH THE DEPARTMENT
OF HEALTH CARE SERVICES SO- DR
SCOTT YOU ARE IF YOU'RE OUT
THERE YOU'RE ON. GREAT THANK
YOU SO MUCH ARE YOU ABLE TO
HEAR ME OKAY. YES MA'AM.
WONDERFUL THANK YOU SO MUCH-
DOCTOR BUT A MEMBERS OF THE
COMMITTEE REALLY APPRECIATE THE
OPPORTUNITY TO SHARE WITH YOU
SOME OF THE WORK THAT WE'VE
BEEN DOING AT DEPARTMENT OF
HEALTH CARE SERVICES WITH OUR
PARTNERS. ACROSS THE AGENCY AND
ACROSS THE STATE RELATED TO
HEALTH INFORMATION EXCHANGE.
TODAY I'D LIKE TO SPEND A
LITTLE BIT OF TIME- SHARING
SOME BACKGROUND AND SOME
CONTACT OF OUR WORK. OF MUCH OF
OUR WORK IS VERY MUCH ROOTED IN
THE HEALTH INFORMATION
TECHNOLOGY FOR ECONOMIC AND
CLINICAL HEALTH ACT. WHICH WE
MUCH PREFER TO SAY HI TECH SO
THE HIGH TECH ACT WHICH WAS
SIGNED INTO LAW IN TWO THOUSAND
NINE. REALLY HAD A VARIETY OF
COMPONENTS AND IN PARTICULAR
HOW TO FOCUS ON HEALTH OUTCOMES
AND POLICY PRIORITIES. THAT
INCLUDEDIMPROVING QUALITY
SAFETY EFFICIENCY- OF
HEALTHCARE AND REDUCING HEALTH
DISPARITIES. ENGAGING PATIENTS
THEIR FAMILIES AND THEIR HEALTH
CARE. IMPROVING CARE
COORDINATION. IMPROVING
POPULATION PUBLIC HEALTH AND
ENSURING ADEQUATE PRIVACY AND
SECURITY PROTECTIONS FOR
PERSONAL HEALTH INFORMATION.
THESE PRIORITIES WELL
INTRODUCED IN TWO THOUSAND NINE
NOW OVER A DECADE AGO THEY
CONTINUE TO BE THE GUIDING
PRINCIPLES OF THE WORK AND OUR
PURPOSE OF THE WORK ON HEALTH
INFORMATION EXCHANGE AND THE
ADOPTION OF HEALTH INFORMATION
TECHNOLOGY. THE PROGRAMS THAT
WE HAVE IN OUR MEDICAID PROGRAM
IN CALIFORNIA MEDIC HOW. SERVE
APPROXIMATELY THIRTEEN MILLION
PEOPLE OR APPROXIMATELY ONE IN
THREE CALIFORNIANS AND A PART
OF THAT. THAT PROGRAM. WE THINK
THAT HIGH TECH A LINE WITH
ARTICLES TO FOCUS ON PATIENT
CENTERED CARE PROVIDING
INFORMATION TO PATIENTS SO THAT
THEY CAN ENGAGE MEMBERS OF
THEIR CARE TEAM. AS WELL AS THE
CORONATION OF CARE ACROSS
MULTIPLE COMPONENTS OF THE
HEALTH SYSTEM. I PARTICULARLY
FOR ON THE HEALTH DELIVERY AND
ALSO THAT THE PARTICIPANTS IS A
COMMUNITY SERVICES THAT ARE.
IMPORTANT TO THE HEALTH OF OUR
MEMBERS. I KEEP. THAT HAVE BEEN
MENTIONED. THE ROLE OF HIGH
CAN'T HAPPEN IF TRAIN. FROM A
BASED EMPIRE. TO AN ELECTRONIC
DATA FIREMEN. WITH THE
PARTICULAR ON AND CALL OF CARE.
THAT THE COURT IMPROVED VALUE
THE RECOGNIZING THAT IT'S NOT
NECESSARILY JUST THE DOLLARS
BUT ALSO THE VALUE OF THE CARE
DELIVERED BY HAVING MORE ROBUST
INFORMATION WHEN A PROVIDER
EIGHTEEN A PATIENT. THIS IS
ALSO A LINE WITH A GOAL THAT WE
HAVE OF OUR HELPING HIM WITH
AGE. WITH THE PRIORITIES WERE
SET BY DA CALLER TO LOOK AT HOW
WE CAN. SERVICES ACROSS OUR
CLINICAL FINANCIAL AND SYMPTOMS
STRUCTURES TO SUPPORT PHYSICAL
HEALTH MENTAL HEALTH SUBSTANCE
USE DISORDER SERVICES SOCIAL
SERVICES AND DEVELOPMENT
SERVICES. TO FACILITATE
SEAMLESS CARE DELIVERY. AND
TIME HAS GONE BY WITHOUT
ADDITIONAL LONG BEYOND HIGH
TECH AS MANY OF YOU ARE AWARE.
AND SOME OF THE MOST RECENT
LAWS THAT HAVE BEEN PASSED
RELATE TO SECURITY BACKED AND
THE MOST RECENT REGULATIONS
THAT WERE PASSED THE LAST.
SPRING I'M NOT SURE WHEN WE'LL
BE TALKING ABOUT THAT MORE SO I
WON'T SPEND A LOT OF TIME ON
THAT BUT CERTAINLY THE GOALS OF
INTEROPERABLE ANY IN CONNECTING
PROVIDERS AND COMMUNITIES. ARE
IN LINE WITH OUR STRATEGIC
PRIORITIES. AFTER GOING BACK IN
TIME A LITTLE BIT HI TECH- WHEN
IT WAS ORIGINALLY ESTABLISHED
HAD A NUMBER OF DIFFERENT
PROGRAMS. THERE WERE THE
ELECTRONIC HEALTH RECORD
INCENTIVE PROGRAMS TO THE
CENTERS FOR MEDICARE MEDICAID
SERVICES. THAT INCLUDED THE
MEDICARE PROGRAM AND THE
MEDICAID PROGRAM. AND THEN
THERE ARE ALSO EFFECTIVE
PROGRAMS THAT WERE. SPONSORED
BY THE OFFICE OF THE NATIONAL
COORDINATOR FOR HEALTH
INFORMATION TECHNOLOGY. OFTEN
CALLED IN. THAT INCLUDED THE
HEALTH INFORMATION EXCHANGE
COOPERATIVE AGREEMENT PROGRAM
THE REGIONAL EXTENSION CENTER
PROGRAM THAT THEY CAN POGRAM.
AND THE WORKFORCE DEVELOPMENT
GRANT. THESE PARTICULAR PROGRAM
THINK. REALLY SET THE STAGE FOR
MUCH OF THE CONVERSATION WE'RE
HAVING TODAY. PART OF THE
HEALTH INFORMATION EXCHANGE
COOPERATIVE AGREEMENT PROGRAM
WE ESTABLISHED A STRATEGIC AND
OPERATIONAL PLANS- MUCH OF THAT
WORK WITH ORIGINALLY LED BY MR
FROLIK WHO WILL BE A PANELIST
LATER TODAY- AND WE DID A LOT
OF WORK WITH THE VARIOUS TEAMS
IN PARTICULAR THE REGIONAL
EXTENSION CENTERS. THROUGHOUT
THE STATE WORKED HAND IN HAND%
WITH PROVIDERS TO SHIFTED FROM
USING PAPER TO HAVING AUTOMATED
WORKFLOWS THAT LEVERAGE LIKE
TRONIC HEALTH RECORDS. AND TO
BE ABLE TO MOVE THROUGH THAT
PROCESS. PART OF THE REASON I
MENTION IT'S PROGRAMS IS THAT
THEY HAVE CARRIED THROUGH AS WE
MOVE FORWARD THANKS TWENTY
FOURTEEN WHEN THOSE AND SEE
PROGRAMS AND THAT. ONE OF THE
THINGS I WANTED TO HIGHLIGHT AS
WELL- IS THAT OUR ELECTRONIC
HEALTH RECORD INCENTIVE PROGRAM
WHICH HAS SINCE BEEN NAMED THE
PROMOTING AN OPPORTUNITY
PROGRAM- REALLY HAVE THREE CORE
COMPONENTS. AND THESE
COMPONENTS INCLUDED THE IDEA OF
USING A CERTIFIED ELECTRONIC
HEALTH RECORD. THIS MEANT THAT
THE ELECTRONIC HEALTH RECORD
HAD KEEP FUNCTIONALITY. BEING
ABLE TO. SEND AND RECEIVE
INFORMATION TO STORE
INFORMATION STANDARDIZED WAY TO
MANAGE YOU. AND TO BE ABLE TO
SUPPORT VARIOUS SECURITY AND
PRIVACY WORLD. THE SECOND THING
WAS THAT ELECTRONIC HEALTH
RECORDS NEEDED TO RECORD AND
PROVIDERS RECEIVING AND SENATE
FINANCE RECORDS NAMES FOR YOUTH
MEASURES SO DEMONSTRATING OF
ELECTRONIC HEALTH RECORDS COULD
BE USED FOR WHAT WE NEEDED TO
BEING ABLE TO RECORD THINGS
LIKE HEIGHT AND WEIGHT
PRESCRIPTIONS IMMUNIZATIONS.
ALLERGIES AND OTHER HEALTH CARE
CONDITIONS. AND THIRD THE OTHER
KEY COMPONENT WHAT'S REPORTING
CLINICAL QUALITY MEASURES SO
UNDERSTANDING THE QUALITY OF
CARE THAT WAS BEING PROVIDED.
BY LEVERAGING THOSE ELECTRONIC
HEALTH RECORDS. AND WE HAVE
MOVED FORWARD THROUGH TIME
THESE HAVE EACH ADVANCED
SIGNIFICANTLY FOR BOTH THE
MEDICARE AND THE MEDICAID
PROGRAMS ACROSS THE COUNTRY. AS
I MENTIONED IN TWENTY EIGHTEEN
CMS THE CENTERS FOR MEDICARE
AND MEDICAID SERVICES CHANGE
THE NAME OF THE ELECTRONIC
HEALTH RECORD INCENTIVE PROGRAM
TO PROMOTING INTER OPERABILITY
PROGRAM. THIS NAME CHANGE
REALLY REPRESENTED A COMMITMENT
TO PROMOTING AND PRIORITISING
INTER OPERABILITY OF HEALTHCARE
DATA. IT MOVES BEYOND THE
EXISTING REQUIREMENTS THE
MEANINGFUL USE. AND REALLY
DROVE UP FOCUS ON INTERACTIVE
BILITY AND IMPROVING PATIENT
ACCESS TO HEALTHCARE
INFORMATION. THIS SHIFT IS
REPRESENTED NOT JUST IN THE
NAME CHANGE BUT ALSO THEN AND
WHAT WE SEE YOU AGAIN BUT THE
NEW RULES THAT WERE RELEASED
THAT BLACK BRING UNDER THE
CURES ACT- THE NEW INTER
OPERABILITY ROLLED BUT WE WILL
TALK ABOUT MORE LATER WELL. THE
MEDICARE LIKE TRY HEALTH RECORD
INCENTIVE PROGRAM WAS INITIALLY
AN INCENTIVE PROGRAM AND HAS
SENT SHIFTED TO BE. A
POTENTIALLY HAVING A PENALTY
COMPONENT IN TERMS OF A
DOWNWARD PAYMENT ADJUSTMENT FOR
PROVIDERS AND HOSPITALS THAT
PARTICIPATE. AND THIS HAS HAS
KIND OF CREATED THAT THAT SHIP
THE NOT LONG GOING NATURE OF A
MEDICARE. HEALTH RECORD
INCENTIVE PROGRAM. IN CONTRAST
THE MEDICAID ELECTRONIC HEALTH
RECORD INCENTIVE PROGRAM WHICH
RUNS THROUGH SEPTEMBER TWENTY
TWENTY ONE REMAINS AN INCENTIVE
PROGRAM THROUGHOUT. SO WE HAVE
BEEN IN THE FORTUNATE POSITION
TO BE ABLE TO CONTINUE TO
SUPPORT PROVIDERS THROUGHOUT
THIS TEN YEAR PERIOD WITH
FEDERAL INCENTIVES TO CONTINUE
TO ADVANCE OUR YOU'VE GOT
ELECTRONIC HEALTH RECORD. IN
THE BACKGROUND MATERIAL SOME OF
THE STATISTICS INCLUDED- BUT I
JUST WANTED TO HIGHLIGHT- BUT
KEY ITEMS NOW AS WELL. SO OUR
MEDIC HEALTH PROMOTING INTER
OPERABILITY PROGRAM- HAD.
BONDING THAT OCCURRED IN TWO
WAYS THE FIRST IS THE SENATE
THAT ARE PROVIDED TO PROVIDERS
AND HOSPITAL WHICH REPRESENT A
100% FEDERAL FUNDING. THE
SECOND OF THE ADMINISTRATIVE
COSTS OF THE PROGRAM WHICH IS
FUNDED 990% WITH FEDERAL FUNDS
AND 10% BUT STATE OR NON
FEDERAL FUNDS. THANK AS I
MENTIONED BEFORE THE FUNDING
FOR THE PROGRAM AND THE TEMPER
TWENTY TWENTY ONE SO WE ARE
RAPIDLY APPROACHING THAT TIME
PERIOD- IN TERMS OF THE TIME
PERIOD TO CLOSE THINGS OUT WE
HAVE UNTIL DECEMBER TWENTY
TWENTY ONE TO FINISH INSIDE OF
PAYMENTS TO PROVIDERS. AND
THEN- THERE IS- ANY ADDITIONAL
I TIME FOR A MINUTE STRAIGHT UP
CAUGHT. THREE TWENTY TWENTY TWO
AND AUDIT AN APPEAL. TWENTY
TWENTY THREE. TO DATE IN TERMS
OF OUR ELIGIBLE PROVIDER
PAYMENT WE HAVE OVER TWENTY
FIVE THOUSAND UNIQUE
PROFESSIONALS WORKING IN OVER
ONE THOUSAND UNIQUE FRIEDMAN
CLINICS. THAT HAVE RECEIVED
OVER EIGHT HUNDRED MILLION
DOLLARS IN FEDERAL FUNDING FOR
THEIR WORK WITH ELECTRONIC
HEALTH RECORDS. ADDITIONALLY WE
HAVE OVER THREE HUNDRED THIRTY
PARTICIPATING HOSPITALS THAT
RECEIVED. OVER EIGHT HUNDRED
FIFTY MILLION DOLLARS AND
SENATE. THE REPRESENTS ON ORDER
OF POINT TWO BILLION DOLLARS
FEDERAL THAT GO DIRECTLY TO OUR
PROVIDE AND HOW IN THE- OVER
THE PAST TEN YEARS. TO ADVANCE
THEIR GET ELECT HEALTH RECORD.
ONE MILLION FORWARD AT THE
POINT IN TIME. THERE THERE
REALLY IS SUCH A IN FOCUS ON
NOW THAT YOU IN A LOT. HEALTH
RECORD HOW DO WE BOTH YOU IT
AND HOW. IT SO WE HAVE THAT
INTER OPERABILITY. THAT IS
SUPPORTED HEALTH INFORMATION
EXCHANGES AND OTHER PRACTICES
THAT DOCTOR TO CHANCE HE TALKED
ABOUT. SO THERE ARE NUMBER
PROGRAM THAT WAY THAT WE HAVE
BEEN ABLE TO. ENHANCED FUNDING
BUT 90% FEDERAL FUNDS TO HELP
SUPPORT THE- WORK IT MADE
FORWARD. TWO PROGRAMS THAT WE
HAVE SPECIFICALLY MANAGED UNDER
THE DEPARTMENT OF HEALTH CARE
SERVICES. SERVICESINCLUDE THE
CALIFORNIA TECHNICAL ASSISTANCE
PROGRAM WHICH WAS VERY SIMILAR
TO THE RACIAL TENSION CENTER
THAT WORKED WITH PROVIDERS TO
ADOPT ELECTRONIC HEALTH
RECORDS. AND SHOW MOVED THROUGH
THE MEANINGFUL USE STAGE IS.
AND THEY WORKED- TO ACHIEVE
THOSE FEDERAL SENATE. FOR THE
CALIFORNIA TECHNICAL ASSISTANCE
PROGRAM RAN FROM TWENTY FIFTEEN
TO TWENTY TWENTY. AND WAS ABLE
TO WORK WITH OVER SEVENTY
APPROXIMATELY. SEVENTY FIVE
HUNDRED PROFESSIONALS ACROSS
THE STATE. THE SECOND PROGRAM
AT THE THAT WE HAVE RUNNING NOW
WHICH IS THE CALIFORNIA HEALTH
INFORMATION CHANGE ONBOARDING
PROGRAM OR CAL HOCK. AND THIS
PROGRAM IS SPECIFICALLY
FOCUSING ON- ONBOARDING
HOSPITAL PROVIDER PRACTICES TO
HEALTH INFORMATION ORGANIZATION
AND IN DOING SO HELPING TO
SUPPORT THE INTERFACES
NECESSARY FOR VARIOUS KINDS OF
ACCORDING. TO THE STATE- TO
SYSTEM SUCH AS YOURS CONTROLLED-SUBSTANCE UTILIZATION REVIEW
AND EVALUATION SYSTEM- AS WELL
AS SYSTEM SUCH AS THE CAL READY
SYSTEM FOR INFECTIOUS DISEASE
REPORTING- AND INTERACTIONS
WITH OTHERPROVIDERS THAT THEY
ARE- TRANSPORTATION BETWEEN. SO
THE CAL HARPER AGAIN VERY
APPRECIATE A FIVE MILLION AND
EIGHT THAT WAS. BUDGETED THE
WHERE YOU'RE A TO MATCH WITH
FORTY FIVE MILLION IN BETTER
FUNDING. AND THAT WE WILL BE
WORKING WITH- CURRENTLY SEVEN
AND WE ARE WORKING WITH SEVEN
QUALIFIED HEALTH INFORMATION
ORGANIZATION- THAT ARE WORKING
ACROSS THE STATE. TO ADVANCE
THE- AN OPPORTUNITY IN THE
CONNECTIONS BETWEEN ELECTRONIC
HEALTH RECORDS THAT ARE BEING
USED BY PROVIDERS AS WELL AS
WITH- OTHER REPORTING ENTITIES
THAT THEY ARE WORKING WITH. IN
ADDITION TO THE TO PROTEST TO
PROGRAMS THAT HAD BEEN
ADMINISTERED DIRECTLY BY HEALTH
CARE SERVICES WE'VE ALSO WORKED
WITH OUR OUR FUTURE DEPARTMENT
TO PROVIDE SIMILAR KINDS OF
PROGRAMS IN OTHER WAYS. WE HAVE
BEEN WORKING WITH LIMITED
MARKETING MEDICAL SERVICES
ACCORDING TO IMPLEMENT THE
HEALTH INFORMATION TECHNOLOGY
FOR ECONOMIC I FIFTY FOR
EMERGENCY MEDICAL SERVICES ARE
HIGH TOWN. AND THIS IS A
PROGRAM THAT IS SPECIFICALLY A
FIFTEEN THE CONNECTIVITY
BETWEEN EMERGENCY MEDICAL
SERVICE PROVIDERS AND HOSPITAL-
INTERWORKING WITH HEALTH
INFORMATION EXCHANGES. AND
THEY'VE ALSO PARTICULARLY
WORKED WITH THE PATIENT UNIFIED
LOOKUP SYSTEM FOR EMERGENCIES
OR PAUL. WHICH ALLOWS FOR
PATIENT RECORD CRANE DURING
EMERGENCIES AND DISASTERS- THE
PULSE SYSTEM HAD BEEN ACTIVATED
DURING SEVERAL OF THE FIRES.
THAT HAVE HAPPENED IN RECENT
YEARS. WE HAVE ALL BEEN WORKING
WITH THE OF PUBLIC HEALTH AND
OF FUNDING. THAT HAD BEEN ABLE
TO HELP SUPPORT UPDATE THE
CALIFORNIA STATION REGISTRY AS
WELL AS ON BOARDING PROVIDERS
TO THE- CALIFORNIA RECORDABLE
DISEASE INFORMATION EXCHANGE
ACCOUNT READY TO FACILITATE
ELECTRONIC THE BEACH ACCORDING.
AND FINALLY WE HAVE BEEN
WORKING ALSO WITH OUR CALGARY
OFFICE HEALTH INFORMATION
TECHNOLOGY TO SUPPORT THE
DEVELOPMENT AND ADVANCEMENT OF
THE STATE'S HEALTH INFORMATION
GUIDANCE. WOULD HELP ADDRESS
THE POLICY AND LEGAL ISSUES
THAT PEOPLE RUN INTO AND WHEN
EXCHANGING DATA THAT THE- THAT
NATURE. WE HAVE WORK TO WITH
THE DIFFERENT PARTS AND
DIFFERENT PARTNERS THROUGHOUT
THE IN THE PAST NOW OVER TEN
YEARS. CALIFORNIA HAS ATTRACTED
PROJECTED THAT HAD OF VERY
DIVERSE LANDSCAPE OF HEALTH
INFORMATION EXCHANGE ACROSS THE
STATE WE REALLY ARE A NETWORK
OF NETWORK- THAT SUPPORT THE
INTER OPERABILITY AND THE
ADVANCEMENT OF HEALTH
INFORMATION EXCHANGE. PART OF
OUR APPROACH AS WE HAVE DONE
THIS- WE INITIALLY LOOKED AT
OPTIONS AROUND HAVING STATEWIDE
OR STATE LEVEL OUR SERVICES AS
PART OF OUR H. I. A COOPERATIVE
AGREEMENT BACK IN THE TWENTY
ELEVEN TWENTY TWELVE TIME
FRAME. AT THAT POINT IN TIME NO
WE- DECIDED NOT TO MOVE
FORWARD- AND INSTEAD PROVIDED
FUNDING AND SUPPORT TO DEVELOPSHARED PROPERTIES FOR
EXCHANGING DATA IN CALIFORNIA.
TO PARTICULAR- ITEMS THAT
EMERGED FROM THAT AND HAVE
CONTINUED ARE THE CHARACTERS
OVER THE CALIFORNIA DATA USE
AND RECIPROCAL SUPPORT
AGREEMENT. SOMETHING OF A
MOUTHFUL- BUT THE COUNTER STUFF
IS THE AND BASICALLY MULTIPARTY
DATA SHARING AGREEMENT SO IT'S
WHICH IS COMMON POLICIES AND
PRACTICES FOR TRUSTED STATEWIDE
HEALTH INFORMATION EXCHANGE. IT
IS THE DATA SHARING AGREEMENT
BUT THAT IS THE COMPANY BY THE
TENER CALIFORNIA TRAFFIC CHANGE
NETWORK WHICH REALLY FOCUSES ON
THOSE POLICIES AND PROCEDURES
FOR EXCHANGING DATA BETWEEN
ORGANISATIONS. AND HEALTH
INFORMATION ORGANIZATION. IN
TURN OF THE CHARACTER AND THE
TEN BASED OKAY OF DOC. IN A
PAIR PROPERTIES THAT GUY. DATA
EXCHANGE AND OUR SUPPORT BY THE
BUT OF INFORMATION EXCHANGE
OKAY HI AND THOSE YOUTH OF
THOSE HAVE REQUIRE TO PART OF
THE CALIFORNIA TECHNICAL
ASSISTANCE PROGRAM AND THE
CALVET PROGRAMS THAT THE AGENCY
HAS ADMINISTERED. AND WE ARE
CAN TO WORK WITH OUR VARIOUS
HEALTH INFORMATION EXCHANGES
AND THAT THE QUALIFIED H. I.
OWES. ONE OF THE THINGS THAT
WERE ACTIVE IS. WHAT ARE THE
SOME OF THE POLICY DRIVERS THAT
HELP. AND SUPPORT THE NEED FOR
HEALTH INFORMATION EXCHANGE AND
SOME OF THE INITIATIVES THAT WE
HAVE- BEEN MOVING FORWARD IN
THE DEPARTMENT OF HEALTH CARE
SERVICES. INCLUDE VARIOUS-
PROGRAMS TO DRIVE INTEGRATION
ACROSS DIFFERENT- DIFFERENT
COMPONENTS OF THE HEALTHCARE
ENVIRONMENT. SO SOME OF OUR
SOME OF THOSE EXAMPLES INCLUDE
PUBLIC HEALTH IF YOU CAN THE
PUBLIC HOSPITAL REDESIGN AND
SEVEN MEDIC CAL OR PRIME
PROGRAM. WORKING WITH OUR-
PUBLIC HOSPITALS THE WHOLE
PERSON CARE- THERE'S BOTH THE
CLINICAL DATA EXCHANGE WITH THE
COURT THAT THE CARE SYSTEM
WAIVER AND WHICH WERE DIRECTLY
ON FOURTEEN TO HELP INFORMATION
ORGANIZATION TO BE ABLE TO
KOREAN EXCHANGE DATA. AND THE
CALIFORNIA ADVANCED INVADING
MEDIC HOW- BALL AND THAT. PARTY
IT REALLY REPRESENTS THE MANY
WAYS IN WHICH WE'RE LOOKING TO
INTEGRATE SERVICES ACROSS THE
STATE AND TO SUPPORT QUALITY.
OUTCOMES FOR MEDIC CAL MEMBERS.
REMOVE FORWARD WILL BE. ON IN
PARTICULAR ARTICLE. OF
ACTIVITIES RELATED TO THE
TWENTY FIRST CENTURY CURES ACT
AND THEY INTERPRET THE RULES.
AGAIN MISTER WHEN WE'LL BE
TALKING ABOUT THAT FURTHER BUT
JUST TO HIGHLIGHT SOME OF THE
ITEMS THAT CAME OUT IN THE
WORLD TAT BLOCK NAY- THAT
PARTICULARLY APPLIES FOR
MEDICAID PROGRAM. THOSE INCLUDE
FOCUSING ON BEING ABLE TO
IMPLEMENTED A STANDARDS BASED
HAITIAN ACTOR ACT API OR
APPLICATION PROGRAMMING
INTERFACE SUPPORTING AND
MONITORING ACTIVITIES RELATED
TO TEAR PAYER HERE TO CATER
GIVE ME PAYER TO PAYER DATA
EXCHANGE- WHICH REALLY USES
STANDARD- AND FOCUSES ON THE U.
S. COURT DATA FOR INTER
OPERABILITY STANDARD AS A WAY
TO EXCHANGE DATA AND HELP
CREATE MORE CONSISTENCY. ALSO
IN TERMS OF MAKING INFORMATION
AVAILABLE ABOUT PROVIDER
NETWORKS USING SPECIFICALLY
YEAH FIREBASE- API FIRE IN THIS
CASE STANDS FOR FAST HEALTHCARE
IN OUR FACILITY REPORT. AND
THEN ADDITIONALLY I. THE
EXPERIENCE FOR DOING ELIGIBLE
INDIVIDUALS BY THE EXCHANGE
TREATMENT WITH OUR STATE
PARTNER. WE ALSO WILL BE
LOOKING CLOSE AT THE TWENTY
THIRD CENTURY BACK BY A LOW
FROM UP OUT OF CORE THAT
AFFECTED ON PUBLIC. INFORMATION
BLOCKING INDEFINITE RELATE TO
HELP NETWORK. SO IN TERMS OF
OUR NEXT STEP OVER THE YEAR WE
ARE PARTICULARLY FOCUSED ON THE
DELIVERY OF THE CAL POLY
PROGRAM AND WORKING WITH OUR
QUALIFIED AGE I OWN. OUR HEALTH
INFORMATION ORGANIZATION TO
REALLY SEE WHAT WE CAN DO TO
HELP DECREASE THAT WHITE SPACE
THE DOCTORS THE CHANCE TO TALK
ABOUT. FOCUSING ON ONBOARDING
CONNECTING YOUR PROVIDERS AS
WELL IT'S PRETTY MORE
CONNECTIVITY FOR PROVIDERS THAT
ARE ALREADY PARTICIPATING IN
HEALTH INFORMATION EXCHANGES.
WILL BE WERE ON. REQUIRED AS
PART OF THE TWENTY FIRST
CENTURY CURES ACT. AND THEN WE
WILL ALSO BE SHIFTING HERE TO
WORK ON- UPDATING OUR STATE
MEDICAID HEALTH INFORMATION
TECHNOLOGY PLAN. THIS PLAN IS
SOMETHING THAT WAS ESTABLISHED
INITIALLY OVER TEN YEARS AGO A
PART OF THE INPUT. I REALLY
IMPLEMENTATION OF OUR
ELECTRONIC HEALTH RECORD
INCENTIVE PROGRAM. AND IT'S
PART OF THE CLOSE OUT OF THE
PROGRAM NOW TEN YEARS LATER.
ONE OF THE REQUIREMENTS AS FAR
AS TO UPDATE THE PROGRAM WITH
THE LANDSCAPE ASSESSMENT OF THE
CURRENT ACTIVITIES RELATED TO
HEALTH INFORMATION TECHNOLOGY
AND HEALTH INFORMATION
EXCHANGE. AS WELL AS THE
DEVELOPER TO BE PLANNED FOR THE
NEXT FIVE YEARS. THIS I DUE TO
THE CENTERS FOR MEDICARE AND
MEDICAID SERVICES IN MARCH OF
TWENTY TWENTY TWO. SO THIS IS
SOMETHING WE WILL BE FOCUSED ON
DURING TWENTY TWENTY ONE
WORKING WITH OUR PARTNERS- TO
HELP SUPPORT THAT IF IT IS A
VERY ROBUST- DOCUMENTED ROBUST.
PLANNED ADDITIONALLY IF WE
FORWARD WHERE WE'RE LOOKING HOW
WE CAN LIVE HEALTH INFORMATION
POLICY TECHNOLOGY HELP ME CHECK
SHE CHURCH ARE VERY PROGRAMS.
GOALS INCLUDE PAGE ENGAGEMENT
AND ACCESS TO THEIR HEALTH
INFORMATION. BUT SHE MEAN HIGH
QUALITY CARE AND PATIENT
OUTCOMES AND SUPPORTING THE
INTEGRATION WITH SERVICES THAT
PUT PEOPLE AT THE CENTER OF
THEIR HEALTHCARE AND THEIR
SOCIAL NEEDS. SO I WILL STOP
THERE AND THANK YOU VERY MUCH
FOR THE TIME TO SHARE THE WORK
THAT WE'VE BEEN DOING- WE ARE
VERY EXCITED TO BE ABLE TO BE
PART OF THIS CONVERSATION. AND
I LOOK FORWARD TO YOUR
QUESTIONS. THANK YOU. THANK YOU
VERY MUCH DR SCOTT- QUESTIONS-
MISS AGUIAR-CURRY. THANK YOU
VERY MUCH- AGAIN COMPLEX ISSUE-
I'M JUST GONNA I THINK YOU MAY
HAVE ANSWERED ANSWER THIS
QUESTION BUT IT IS DIFFICULT TO
HEAR YOU- THE CALIFORNIA HEALTH
INFORMATION EXCHANGE OUT
BOARDING PROGRAM WAS APPROVED
BY THE LEGISLATURE OVER TWO
YEARS AGO IN THE EIGHTEEN
NINETEEN STATE BUDGET. IT WAS
SUPPOSED TO BRING IN FORTY FIVE
MILLION A FEDERAL DOLLARS AND I
BELIEVE IT'S X. GOING TO EXPIRE
THIS NEXT YEAR- WHY DID IT TAKE
SO LONG FOR CALVET UP AND
RUNNING AND IS THERE ANY PLAN
TO CONTINUE THE PROGRAM I THINK
YOU SAID IT WAS BUT I COULDN'T
HEAR YOU. I APOLOGIZE- THANK
YOU SO MUCH FOR YOUR QUESTION-
SO IN TERMS OF THE TIME IT TOOK
TO GET THINGS. STARTED A LOT OF
THAT TIME I WASN'T. INVOLVED IN
WORKING WITH OUR OUR PARTNERS
TO ESTABLISH THE GUARDRAILS FOR
THE PROGRAM- AS WELL AS TO WORK
WITH OUR PARTNERS AT THE
AMERICAN TERMS OF HAVING THE
PROVED- AND- AS WE WORK ON
DELIVERING THE FUNDS TO THE-
THAT QUALIFIED HEALTH
INFORMATION ORGANIZATIONS- WE
HAVE- MODEL BACK PROGRAM AFTER.
OTHER PROGRAMS SUCH AS THE
RETENTION CENTER FOR THE
CALIFORNIA TECHNICAL ASSISTANCE
PROGRAM- WE DID RECEIVE A
APPROVAL FOR THE PROGRAM FROM
CMS. BLOCKED OF FEBRUARY- AND
WE HAVE- NOW EXECUTED
CONTRACTS- WITH THE DIFFERENT
QUALIFIED HEALTH INFORMATION
ORGANIZATION. AND ARE WORKING
ON- RECEIVING A PROCESSING
INVOICES FROM THEM FOR THE
INITIAL WORK THAT THEY HAVE
DONE- WE DO- CONTINUE TO EXPECT
TO BE ABLE TO EXPAND THE FIFTY
MILLION DOLLARS- OVER THE- NEXT
YEAR- BUT UNFORTUNATELY IT
DOESN'T IN SEPTEMBER TWENTY
TWENTY ONE BUT WE HAVE VERY
MUCH ABOUT THE URGENCY TO BE
ABLE TO MAKE SURE THAT WE
SUPPORT. THAT. DOES WORK ACROSS
THE STATE. I THINK WHAT THE
FIRST THAT I HAVE AND I'M SURE
THAT YOU HAVE A IT ALL
TECHNICAL CHANGES INNOVATION
CHANGES ALL THE TIME
REQUIREMENTS THAT WE AS A
LEGISLATURE ASK YOU TO DO AND
CHANGE. MAKE SURE JOB REALLY
DIFFICULT. AND IT DOES TAKE A
LOT OF TIME I'M CONCERNED THAT
WE DON'T TO BE BEHIND THE EIGHT
BALL AS OTHER AGENCIES THAT WE
KNOW. NEAR AND DEAR TO OUR
HEARTS EDV WERE BEHIND THE
EIGHT BALL ON THAT WE DIDN'T
GET OUR- SOFTWARE UPGRADED AND
DO THAT. YOUR DUE DILIGENCE AND
SO I DON'T WANT TO LET THE VIEW
HIGH AND DRY SO- THANK YOU FOR
YOUR- INFORMATION TODAY. THANK
YOU SO MUCH FOR YOUR COMMENT.
IN ANY OTHER QUESTIONS FROM
HERE ANY QUESTIONS FROM OUR
MEMBERS REMOTELY NOT NINE SO
OKAY I'VE GOT A COUPLE- AND
PERSONAL THANK YOU VERY MUCH
FOR YOUR PRESENTATION AND YOUR
WORK ON THIS ISSUE- OBVIOUSLY
OVER THE LAST DECADE WE SPENT A
LOT OF RESOURCES- HERE. HOW ARE
WE DOING I MEAN. FROM YOUR
PERSPECTIVE AS FAR AS THE
UPTAKE- AND- AND THE PROGRESS
JUST A GENERAL STATEMENT YOU
KNOW GOOD FAIR. POOR I MEAN HOW
HOW DO YOU HOW DO OVERALL
ASSESS WHERE WE ARE IN THE
PROCESS. AT THE RISK OF BEING-
HALF FULL PERSPECTIVE. I
ACTUALLY THINK WE'RE DOING
REALLY WELL YOU KNOW THE
TRANSFORMATION OF THE HEALTH
CARE INDUSTRY IS A CHALLENGING
THING IT IS NOT SIMPLE- REALLY
I THINK THE FIRST FIVE YEARS OF
THE HIGH TECH PROGRAM. IT
REALLY TOOK THAT TIME TO GET
THE ADOPTION OF A LIKE HOT LIKE
CHRONIC HEALTH RECORDS TO THE
POINT THAT WE COULD HIT
SOMETHING OF A TIPPING POINT
AROUND HEALTH INFORMATION
EXCHANGE AND ROBERT BILITY. ONE
OF THE THINGS THAT MANY OF US-
NOTICED AT THE CONCLUSION OF
THE HIGH TECH PROGRAM THROUGH
THE ONC THAT ENDED IN TWENTY
FOURTEEN TWENTY FIFTEEN- MANY
OF US THOUGHT THE THOUGHT
WOULDN'T IT HAVE BEEN GREAT IF
THE HIV COOPERATIVE AGREEMENT
STARTED NOW NOW THAT WE HAVE
ADOPTION OF ELECTRONIC HEALTH
RECORDS- BUT UNFORTUNATELY THAT
WASN'T THE WAY THE TIMING
WORKED- EVEN THOUGH WE HAVE
SEEN SIGNIFICANT ADVANCEMENTS-
IN TERMS OF CONNECTIVITY AND
INTER OPERABILITY. AND SO YES
WE STILL HAVE A WITH NOT QUITE
A WAYS TO GO BUT WE'VE ACTUALLY
MADE INCREDIBLE STRIDES- I
REMEMBER THE POINT IN TIME THAT
SOMEBODY SAID YOU KNOW WE HAVE
THE FIRST PERSON GOING TO
MEDICAL SCHOOL THAT NEVER
TOUCHED A PIECE OF PAPER- YOU
KNOW FOR THAT TO BE AN
ACHIEVEMENT IT'S NOT SURPRISING
THAT IT'S TAKING UP TIME TO
REALLY CHANGE IN ADVANCE. HOW
WE INTEGRATE CARE WITH- INTER
OPERABILITY AND HELP
INFORMATION CHANGE THAT BEING
SAID- I THINK THERE HAS BEEN A
VERY STRONG COMMITMENT FROM THE
FEDERAL SIDE AND THE NEW INTER
OPERABILITY ROLES THAT WERE
ISSUED THE BOX MARKED ME-
REALLY ECHO THAT. WHEN WE WHEN
WE WERE HEARING THE
CONVERSATION ABOUT THE DROPPED-
PROPOSED RULE- ONE OF THE
THINGS THAT WE HEARD FROM BOTH
OUR CMS AND OUR OWN THE
PARTNERS WHAT THAT DOES THIS IS
NOT THE END OF THE RULES COMING
TO YOU ABOUT INTER OPERABILITY
THIS IS THE BEGINNING THEY SAW
THIS AT THE BEGINNING OF A REAL
PUSH OVER THE NEXT SEVERAL
YEARS TO REALLY INCREASE THOSE
REQUIREMENTS. SO THAT WE CAN
SEE THE BENEFITS THAT WE
ORIGINALLY STARTED OUT TO WORK
ON YOU KNOW TEN YEARS AGO- SO I
THINK I THINK WHERE WE'RE
MOVING FORWARD WE'RE DEFINITELY
MOVING IN THE RIGHT DIRECTION-
BUT THERE'S WORK AHEAD OF US AS-
YOU TALKED ABOUT WITH. TODAY
THINGS LIKE THE- THAT. IDENTIFY
HOW DO THAT. HOW WE DO THAT
OCCUR THE NUMBER AND THAT WERE.
IS A KEY ISSUE AS WELL AS BEING
ABLE TO. I YOU KNOW HOW THAT
STANDARD BASED COME. THAT
REALLY AGAIN IT'S CONTINUE TO
ADVANCE- THROUGH THE VARIOUS
FEDERAL ROLES AS WELL. THANK
YOU AND YOU KNOW WHAT YOU FROM
YOUR PERSPECTIVE- YOU KNOW TO
WHAT EXTENT SHOULD WE BE
THINKING ABOUT EXPANDING THESE
HEALTH INFORMATION EXCHANGE TO
INVOLVE SOME BY WHAT I CONSIDER
NONTRADITIONAL PROVIDERS THINGS
LIKE- FOOD BANKS OR HOUSING
AGENCIES TO ADDRESS SOCIAL
DETERMINANTS OF HEALTH. I MEAN
THERE IS CERTAINLY YOU COULD
YOU THEY COULD HAVE LIMITED
ACCESS TO SOME OF THE
INFORMATION BUT BUT THE
INTEGRATION OF HEALTH SERVICES
IS A CENTRAL FOCUS OF THE NEW
CALLIN PROGRAM SO. DO YOU HAVE
ANY THOUGHTS ON ON HOW THAT
MIGHT. PLAY INTO THE HEALTH
INFORMATION EXCHANGE- COMPONENT.
YES I'M CERTAINLY THAT THAT IS
A KEY PIECE- AND ONE OF THE
THINGS THAT WE'VE SEEN OVER THE
LAST- SEVERAL YEARS BOTH WITH
THINGS LIKE ACCOUNTABLE CARE
ORGANIZATIONS AS WELL AS OTHER
EXAMPLES ACROSS THE COUNTRY-
GENTLY AS PART OF OUR- WHOLE
WHOLE PERSON CARE- PILOT AS
WELL- IT REALLY HITS ON THAT
NEED TO EXCHANGE DATA NOT NOT
JUST BETWEEN PERHAPS YOUR
TRADITIONAL HEALTHCARE
PROVIDERS. ACROSS THE SPECTRUM
SUPPORTING THE HEALTH OF
INDIVIDUALS THAT INCLUDES NOT
JUST- MEDICAL PROFESSIONALS BUT
HOUSING- SOCIAL SUPPORT AND
OTHER OTHER SUPPORT AND SO ONE
OF THE THINGS ABOUT THE STATE
HEALTH INFORMATION GUIDANCE
THAT I MENTIONED- THE SHEIK.
THAT WAS PUT TOGETHER BY THE
OFFICE HEALTH INFORMATION
INTEGRITY ONE OF THE EXAMPLES
THERE WAS ACTUALLY THAT'S
EXACTLY THE KIND OF ISSUE IN
TERMS OF HOW DO WE DO MORE
INTEGRATION ACROSS- DIFFERENT.
PARTNERS THAT ARE SUPPORTING
INDIVIDUAL. RIGHT WELL THANK
YOU VERY MUCH AND YOU FOR
PARTICIPATING WITH US AND- WE
LOOK FORWARD TO- MORE PROGRESS
OBVIOUSLY SO THANK YOU SO MUCH
AND- AT WHAT RATE THANK YOU.
COURSE WE'RE GONNA MOVE NECK
ONTO OUR NEXT SPEAKER- ON A
SPEAKERS. QUAL WHEN- FROM
OAKLAND- MISTER WHEN IS- THE
CEO FOR CAYENNE CONSULTING. THE
AUTHOR OF UNDERSTANDING THE NEW
FEDERAL DATA INTEROP INTER
OPERABILITY REQUIREMENTS SO.
MISTER NGUYEN. THANK YOU FOR
JOINING US. HI THANK YOU FOR
HAVING ME- SO I'M HERE TO.
SPEAK A LITTLE BIT ABOUT HOW
THE NEW- FEDERAL REQUIREMENTS
RELATED TO DATA. SHARING CAN
HELP INFORM SOME OF THE
CALIFORNIA DISCUSSIONS TODAY SO
NEXT LIKE. IN MARCH OF THIS
YEAR- TO FEDERAL AGENCIES- THE
SENATE FOR MEDICARE MEDICAID
SERVICES CMS AND THE OFFICE OF
THE NATIONAL COORDINATOR FOR
HEALTH INFORMATION TECHNOLOGY
ONC BIG THEY RELEASED CHIU
REGULATIONS- TOGETHER- AND IF
YOU HEARD FROM DOCTORS GOD
SOMETIMES THEY'RE CALLED. THE
INNER ROCK THE DAILY RULE A
TWENTY FIRST CENTURY CURES ACT
SORT OF TOGETHER THEIR RESEARCH
THE RELEASE ON THE SAME DAY AND
THEY HAVE OVERLAPPING AND SORT
OF COMPLEMENTARY- REQUIREMENTS
BUT THAT THE MAIN GOAL OF THE
THESE REGULATIONS ARE TO MAKE
TO MAKE IT EASIER FOR PATIENTS-
PROVIDERS AND HEALTH PLANS. TO
ACCESS. EXCHANGE AND USE
ELECTRONIC HEALTH INFORMATION.
NOW THE REGULATIONS WHEN THEY
CAME OUT ARE TWO THOUSAND
PAGES. AND NEARLY SIXTEEN
HUNDRED COUNT PUBLIC COMMENTS
WERE SUBMITTED SO THERE ARE A
LOT OF REQUIREMENTS AND I'M
GONNA USE MY FIFTEEN MINUTES
HERE JUST TO HIGHLIGHT A FEW I
THINK THAT ARE MOST RELEVANT TO
THE PURPOSE OF THIS HEARING. SO
I'M NOT GOING TO COVER ALL OF
THEM. BUT THEY ARE PRETTY
SIGNIFICANT AND- IMPACT A BIG
PORTION OF THE HEALTHCARE
INDUSTRY NEXT SLIDE. SO BEFORE
I GET TO THE REQUIREMENTS AND
WHAT THE IMPLICATIONS ARE TO
CALIFORNIA- EDGE I DO WANT TO
SPEND EQUIPMENT ON YOU KNOW
WHO'S IMPACTED AND WHO HAS
OVERSIGHT OF SOME OF THESE
REGULATIONS. SO FOR CMS- THESE
REGULATIONS GOING TO BE
IMPACTING A LOT OF HEALTH
PLANS. PROVIDERS IN STATES.
OPTICALLY THOSE THAT
PARTICIPATE IN CMS PROGRAMS-
WHICH ON MEDICAID. MEDICARE AND
THE INDIVIDUAL- EXCHANGE MARKET
PLACE. FOR ONC THEY HAVE
OVERSIGHT- OVER HEALTH I. T.
THEY CERTIFY- I. T. SYSTEMS
ESSENTIAL EHRS THAT PROVIDERS
USE TO STORE THEIR CLINICAL
DATA. SO ESSENTIALLY BY A SORT
OF AN INDIRECT RELATIONSHIP ONC
HAS IS SORT OF IMPACTS OF
PROVIDERS BECAUSE PROVIDERS ARE
INCENTIVIZED TO USE CERTIFIED
IT SYSTEMS IN ORDER TO BE
ELIGIBLE FOR CERTAIN SENTENCE
IN THE MEDICARE MEDICAID
PROGRAM. SO A LOT OF THE
REGULATIONS THAT ARE IN BOTH
THE CMS RULE IN THE ONC RULE
REALLY GETTING AT A COMBINATION
OF STAKEHOLDERS IN THE
HEALTHCARE INDUSTRY NEXT LIKE.
SO WHAT WHAT DO THE REGULATIONS
DUE TO MAKE IT EASIER FOR
PATIENTS PROVIDERS HEALTH PLANS
TO SHARE ACCESS SHARE AND USE
HEALTHCARE DATA. THE
REGULATIONS AGAIN THERE'S A LOT
OF AND I CAN I'M NOT GOING TO
COVER ALL OF THEM BUT I THINK
THE THREE MAIN ONES TEND TO
KNOW ABOUT AND BE AWARE OF AS
THE STATE SO CONTEMPLATES
THESE- YOU KNOW. HEALTH DATA
EXCHANGE OPTIONS IS THREE THAT
THAT ARE COVERED IN IN THE
REGULATION THE SUN'S LIGHT FOR
THAT THE THREE ARE. ONE DATA
EXCHANGE THEY ARE REQUIRING
VERY SPECIFIC- ENTITIES TO
SHARE DATA CERTAIN DATA WITH.
EACH OTHER UNDER CERTAIN
CIRCUMSTANCES THEY ARE ALSO
WHEN DATA IS BEING EXCHANGED-
THEY ARE PUTTING IN PLACE
REQUIREMENTS SO THAT THOSE TWO
ENTITIES THE ORGANIZATION THAT
IS SENDING THE DATA AND THE
ORGANIZATION THAT'S RECEIVING
THE DATA THEY CAN DO THAT IN A
VERY SEAMLESS WAY. ON SO THAT
WITHOUT A LOT OF EFFORT AND
CURRENT STATE SOMETIMES YOU
KNOW GETTING DATA FROM ANOTHER
SYSTEM CAN TAKE MONTHS OF JUST
IMPLEMENTATION WORK. THE THIRD
ONE WHICH I'M NOT GONNA SPEND
TOO MUCH TIME ON BUT IS A BIG.
PART OF THE REGULATION IS-
RELATING TO INFORMATION
BLOCKING WHERE. CMS AND ONC ARE
ESSENTIALLY PREVENTING. OUR
PROVIDERS AND VENDORS OF HEALTH
SYSTEMS- TO- NOT BLOCK- PATIENT
OR PROVIDER REQUESTS FOR
HEALTHCARE INFORMATION SO
THERE'S A NUMBER OF DEFINITIONS
AND EXEMPTIONS. TO IT BUT A SAN
IF THERE IS A DATA EXCHANGE AND
ANIONS BEING REQUESTED THAT
THEY CAN BE SUPPORTED. SOMEONE
SPEND MY TIME ON THE NOTION OF
DATA EXCHANGE AND AN
IMPROBABILITY WHERE IT'S EASY
FOR TWO SYSTEMS WHO DON'T KNOW
EACH OTHER. MY PRIOR EXPERIENCE
TO CONNECT AND SHARE THAT DATA.
SO THERE'S FIVE TEAMS I KIND OF
COME OUT AND I AND I THINK FOR
THE TAKE AWAY FOR. AND
LEGISLATOR AND THE AUDIENCE- I
THINK AS YOU APPROACH THIS
DISCUSSION IS THE APPROACH THAT
THE FEDERAL GOVERNMENT HAS
USED. WHICH. THE CONSUMERS
ACTUALLY AT THE CENTER OF THIS
HEALTH INFORMATION EXCHANGE.
THEY ARE MANDATING
PARTICIPATION FROM THE
STAKEHOLDERS THAT THEY CAN
REGULATE SO IT'S NOT VOLUNTARY.
ANDFOR DATA IN A ROCKET BILITY
THEY ARE IDENTIFYING SPECIFIC
COMMON STANDARDS AND THE USE OF
A CERTAIN TECHNOLOGIES SOMEONE
OF EACH OF THOSE NEXT. SO NEXT
LIGHT SO AND I THINK AN EASY
WAY TO HELP EXPLAIN WHAT. IS
THIS IN A RAPIDLY RULE IS TO GO
OVER USE CASE AND TAKE IT FROM
THE USER PERSPECTIVE. SO IF I
ASKED YOU- IF YOU WENT TO YOUR
PROVIDER YOUR HEALTH PLAN AND
ASK THEM. I'D LIKE A COPY OF MY
HEALTH RECORD HEALTH
INFORMATION THAT YOU HAVE ON.
THE RESPONSE YOU TYPICALLY WILL
GET TODAY IS THE MAY GIVE YOU A
PRINT OUT. THAT IS PRETTY
DIFFICULT TO UNDERSTAND OR PDF
VERSION OF THAT PRINT OUT THEY
MAY GIVE YOU EVEN A CD OR USB
DRIVE WITH ALL THAT
INFORMATION. AND IN SOME CASES
THEY WILL- DIRECT YOU TO AN
ONLINE PORTAL THAT THEY HAD
THAT YOU CAN SIGN INTO AND HAS
A COLLECTION OF ALL YOUR HEALTH
INFORMATION BUT THAT PROVIDER
WHAT WITH THAT HEALTH PLAN.
WHAT THE REGULATION IS ACTUALLY
GETTING OUT IS ENABLING THE
ABILITY SO THE FOR THE FUTURE
IS THAT ANY CONSUMER PATIENT
HAS THE BILL TO ACCESS ALL
THEIR HEALTH INFORMATION IN ONE
PLACE. IN THAT ONE PLACE IS
ESSENTIALLY THE SMARTPHONE. IT
IS A MOBILE PHONE. N. THAT
MEANS PROVIDERS AND OR HEALTH
PLANS WE HAVE INFORMATION ON A
CONSUMER PATIENT. IF THAT
CONSUMER DOWNLOAD AN APP ON
THEIR PHONE TELLS THAT APT. TO
REQUEST THAT INFORMATION FROM
THE HEALTH PLAN OR HEALTH CARE
PROVIDER. THAT REQUEST AFTER
CONSENT IS CONFIRMED THAT THOSE
OLD HEALTHCARE ORGANIZATIONS
WILL SEND THAT INFORMATION. TO
THAT THIRD PARTY APPS IN THE
CONSUMER THEN ESSENTIALLY THE
USE CASE THAT IS THAT IS BEING
OFFERED IS THEY WILL GOAL TO
THEIR PROVIDER OR DOCTOR DOING
IT IS IT. PULL OUT THE PHONE
AND SHOW THEM HERE MY
MEDICATIONS FOR MY PROCEDURES
HERE ARE YOU KNOW THINGS THAT
MY CONDITIONS FOR MY PREVIOUS
HEALTH CARE VISITS SO THAT IS
THE SPECIFIC USE CASE. THAT IS
BEING SUPPORTED BY THE FEDERAL
REGULATIONS. AND THAT'S BOTH A
HOLISTIC VIEW FROM ANY PROVIDER
ANY HEALTH HAZARDS LIKE GNOSTIC
AND HAS ALLOWED ME TO NO RECORD
SO IT'S SOMETHING THAT THEY CAN
HAVE OVER MANY YEARS YOU KNOW
AS PEOPLE CHANGE HEALTH PLANS
THEY THEY GO VISIT MULTIPLE
PROVIDERS. IT'S ALL CENTRALIZED
IN ONE PLACE AND THAT'S. REALLY
THE TARGET IS ON THE SMARTPHONE.
I NEXT PLEASE. SO BECAUSE IT'S
CONSUMER DIRECTED IF YOU
REMEMBER ANYTHING ABOUT THE
FEATHER IN ABOUT THE DELAYED A
RULE A BIG PORTION OF IT IS
ESSENTIALLY A CONSUMER.
DIRECTED DATA EXCHANGE I THINK
DUCT SUE JANSKY YOU KNOW
HIGHLIGHTS DIFFERENT MY- OF A
HEALTH KNOW INFORMATION
EXCHANGE IN THE FEDERAL RULE
IT'S THE PERSON IN THE MOBILE
PHONE THAT'S THE CENTER OF THE
MODEL WHERE ALL THE DATA
SOURCES ARE COULD BE FROM A
PAYER PROVIDER COULD BE FROM A
WEARABLE DEVICE LIKE A FITBIT.
THAT COULD BE FROM A PHARMACY
OR LAB. IT COMES TO THE
CONSUMER AT THEIR DIRECTION.
THEY CAN USE IT HOWEVER THEY
WANT AND THEY CAN SHARE IT. YOU
KNOW TO THE RIGHT SIDE OF THIS
TO ANY OTHER ENTITY COULD BE
ANOTHER PROVIDER KNOW THEHEALTH PLAN. HOWEVER THEY
CHOOSE A COULD BE- TO YOU KNOW
OFF OUR BIOTECH COMPANY FOR
RESEARCH PURPOSES. SO THAT THAT
THE CORE OF IT IS THAT THE
INDIVIDUAL. AND THEIR PHONE
WILL BE BACK STANCHION IS. THE
DATA EXCHANGE MODEL. SO WHAT
I'D LIKE TO DO NOW NEXT SLIDE
IS MAYBE JUST TO COVER A COUPLE
MORE THE USE CASES AND JUST A
LITTLE BIT MORE ABOUT WHAT SOME
OF THE REQUIREMENTS. SO HERE
WHAT I HAVE INDIVIDUAL IS- FOUR
OF THESE CASES THE MIDDLE
COLUMN. IS A SOME OF THE DATA
REQUIREMENT THAT'S BEING
EXCHANGED AS PART OF THAT THAT
FROM THE SENDER TO THE RECEIVER.
AND THEN WHETHER THAT REQUIRES
CONSUMER CONSENT OR NOT. SO THE
FIRST ONE TO AS UNDER THAT SAME
BUCKET I JUST DESCRIBED WHERE A
PATIENT YOU KNOW HROUGH THEIR
APP CAN REQUEST THEIR
HEALTHCARE INFORMATION IT CAN
BE DOWNLOADED ESSENTIALLY
WITHIN SECONDS. AND THAT DATA
BUNDLE YOU KNOW INCLUDE ALL
CLAIMS ENCOUNTERS CLINICAL
DATA. YOU FROM THE HEALTH PLAN
IT'S ALSO THERE FOR MILITARY
CAMP PROVIDER NETWORK SO THE
PHYSICIANS AND PHARMACIES THAT
ARE AVAILABLE IN THEIR HEALTH
PLAN. THE OTHER TWO IF I CAN
JUST REALLY BRIEFLY THE- THE
ADDITIONAL USE CASES THAT ARE
PROMINENT IN THE REGULATION-
NUMBER THREE HERE THAT'S LISTED
IS- I CARE TRANSITION WHEN A
PERSON INVOLVED IN A NEW HEALTH
PLAN. SO AT MY NOW IF YOU GO TO
ENROLL IN A NEW HEALTH PLAN
THAT NEW HEALTH PLAN
ESSENTIALLY DOESN'T GET ANY
DATA FROM ALL YOUR PRIOR
HISTORY FROM YOUR PREVIOUS
HEALTH PLAN. IN YOUR TREATED AS
A PERSON AS PRETTY MUCH NO
HISTORY AND THEY DON'T KNOW
ANYTHING ABOUT YOU UNTIL THEY
SEE CLAIMS AN ACCOUNT IS- YOU
KNOW FROM PROVIDERS. AND IN
THIS NEW RULE THE CONSUMER CAN
REQUEST THE OLD HELPING THAT
THE COMING FROM. ST TO THE NEW
HEALTH PLAN. THURMOND THEY ARE
HEALTHCARE INFORMATION BEHALF
SO THAT NEW HEALTH. CARE PLAN
INSTEAD OF JUST WAITING FOR
SOMETHING BAD TO HAPPEN- THEY
CAN IDENTIFY- YOUR YOUR CURRENT
AUTHORIZED SERVICES THE
MEDICATIONS YOU'RE TAKING SO
ESSENTIALLY CHORE COTTON WE
KISS IN THIS NO GAPS. BUT THEY
CAN ALSO IDENTIFY- ANY KIND OF
RESOURCES AND HOW TO SUPPORT
INDIVIDUAL YES I SIGNED A ONE
WHAT DISEASES- OR CONDITIONS
MAY HAVE BEEN YOU KNOW COULD BE
HEALTH EDUCATION OR ANY
PROGRAMS THAT THEY'RE ELIGIBLE
FOR. SO THAT THAT'S A VERY
SPECIFIC USE CASE- THE FOURTH
ONE IS ONE THAT REALLY TARGETS
HOSPITALS- IN THIS ONE IS AND
SUCH DOCTORS THE CHANTING
OTHERS HAVE MENTIONED THIS.
WHERE A CONSUMER. WHO OUR
PATIENT AND GO TO HOSPITAL. THE
HOSPITAL THAN NOTIFY PCPS AND
OTHER FACILITIES IN THE
COMMUNITY. OF AN ER VISIT- IF
THERE'S AN ADMISSION TO THE
HOSPITAL- THAT PATIENT HAS BEEN
DISCHARGED THE COMMUNITY. OR
TRANSFER TO ANOTHER FACILITY SO
THIS IS A LOT OF HOSPITALS DO
THIS TODAY- BUT THIS WILL
REQUIRE OF ALL HOSPITALS IN
THIS WILL BE A REQUIREMENT OF
MEDICARE PARTICIPATION SO THAT
ENSURES ESSENTIALLY MORE ALMOST
ALL. HOSPITALS ARE
PARTICIPATING THIS. SO THAT
THAT COVERS THE USE CASES IN
THE IN THE- REGULATION SOME OF
THE DATA THAT'S BEING.
TRANSFERRED BETWEEN ENTITIES
AND BY THE CONSENT IS REQUIRED
OR NOT. OUR NEXT FLIGHT. I JUST
WANT TO COVER VERY BRIEFLY SO
TO TECHNICAL COMPONENTS THAT
GET THIS NOTION OF INTEROP AND
W. WHERE TWO SYSTEMS CAN DO
THIS VERY EASILY- ONE IS- THE
CORE DATA THAT IS BEING THE
MINIMUM DATA THAT IS BEING
SUPPORTED IN MAKING AVAILABLE
IS DATA THAT FITS INTO WHAT'S
CALLED THE U. S. CPI DATA
CLASSIFICATION AGAIN THAT'S U.
S. COURT DATE IN A LOP ABILITY
VERSION ONE. AND ALL YOU REALLY
NEED TO KNOW IS THAT IT'S
SIXTEEN DATA CLASSES IN FIFTEEN
TO DATA ELEMENTS AND I KIND OF
JUST LIFTED IT LISTED HERE THE
VISUAL IF YOU CAN SEE IT THAT'S
GOT SOME STANDARD INFORMATION
LIKE PATIENT DEMOGRAPHIC
INFORMATION BUT ALSO INCLUDES
IMMUNIZATIONS LABS MEDICATIONS
AND CLINICAL COMPONENTS SUCH AS
YOU KNOW DIFFERENT VITAL SIGNS-
ALLERGIES AND SO FORTH. SO THIS
IS THE MINIMUM THAT WE KNOW
HEALTH PLANS AND PROVIDERS IF
THEY HAVE IT IN THEIR SYSTEM IN
A IN A PATIENT REQUESTED. THEY
MUST MAKE OUT OF TO ANY THIRD
PARTY OUT THAT THAT THE
CONSUMER CHOOSES. NOW THERE'S
CONSISTENCY IN A MINIMUM FLOOR
THIS IS NOT ALL DATA THAT'S
AVAILABLE IN CLINICAL SYSTEMS
BUT THIS IS THE MINIMUM THAT
EVERYONE IS BUILDING
INFRASTRUCTURE TO SUPPORT. I
NEXT LIGHT. SO IN ADDITION TO
THIS THIS FOUNDATION FOR DATA I
JUST WANT TO HIGHLIGHT HERE IS
JUST REALLY BRIEFLY- THREE
OTHER TECHNICAL STANDARDS- THAT
IT BECOMES THE BASIS THAT NOW
AGAIN NOW PLANS PROVIDERS IN
THESE HEALTH IT SYSTEMS WILL BE
BUILDING SUPPORT FOR AND
SOMETHING THAT THE STATE AS WE
THINK THROUGH A LITTLE BIT OF
THE HOW. AT TO GET PAST SOME OF
THE USE CASES IS THAT A BIG
PORTION OF OUR HEALTHCARE
INDUSTRY NOW WILL BE SUPPORTING
EMBARRASSED DATA FORMAT AND A
SPECIFIC WAY TO COMMUNICATE
THROUGH- TO ORGANIZATIONS NOW
FOR MENISCAL FIRE A VERSION
FOR- AND THEN IN ADDITION TO
THIS TO FOUNDATIONS FOR
EXCHANGING INFORMATION THAT
PROTECTS YOUR PRIVACY AND
SECURITY I AROUND CONSUMER
DEDICATION AND- ACCESSING- FOR
THIRD PARTY APPLICATIONS. SO AS
THE STATE THINKS ABOUT THEIR
OWN OPTIONS THESE ARE YOU KNOW
KIND OF FOUNDATION THAT MANY IN
THE INDUSTRY WILL BE SUPPORTING
AS WELL SOMETHING THAT YOU
COULD EITHER BUILD OFF OF AND
NOT EASILY REPLICATE FOR
FILLING SOME GAPS AND- THAT IS
STILL. OUT THERE FROM THE OF
THE FEDERAL. OUR NEXT LINE. SO
WHO'S IMPACTED THIS THIS NEW
SORT OF DATA SHARING CONSUMER
ORIENTED DATA EXCHANGE. CMS AND
ONC ESSENTIALLY FOR THIS HEALTH
PLAN PAYER SIDE THEY ARE
MANDATING PARTICIPATION AND
THAT INCLUDES THREE HUNDRED AND
FORTY FIVE UNIQUE CMS PAYERS
ACROSS THE COUNTRY. AND I'M
GONNA HIGHLIGHT REALLY WHICH
ONE RELATES CALIFORNIA SO THE
THREE PROGRAMS IN MEDICAID THAT
INVOLVES ALL MEDICARE BUT
MEDICAID BENEFICIARIES ALL
ROUGHLY THIRTEEN MILLION IN
CALIFORNIA- BECAUSE THE STATE
STILL HAS A SMALL PORTION OF
PEOPLE SERVICE THE STATE HAS
DROPPED OUT DR SCOTT HAD
MENTIONED. THE STATE HAS TO
SUPPORT THAT CAPABILITY FOR
MEDIC MEDIC CAL BENEFITS REASON
PEOPLE SERVICE ALL MEDICAID
MANAGED MEDICAL MANAGED CARE
PLANS WHERE THE MAJORITY OF
MEDIKAL- BENEFICIARIES ACCESS
OR A MEMBERS. HAVE SUPPORTED.
AS WELL AS ENTITIES ARE DEFINED
AS PREPAID INPATIENT IN PREPAID
ASSEMBLY TORY HEALTH PLANS. IN
CALIFORNIA WHAT THAT MEANS IS
THAT INCLUDES ALL FIFTY EIGHT
COUNTY MENTAL HEALTH PLANS. ALL
THE NINETEEN DRUG MEDI CAL- YES
PLANTS ALSO HAVE TO AGAIN MAKE
THEIR DATA AVAILABLE. CLAIMS
AND ACCOUNTS CLINICAL DATA
FORMALLY PROVIDER NETWORK. AND
MAKE IT AVAILABLE TO THIRD
PARTY APPS IF CONSUMERS
REQUESTED. SO THAT THAT THIS IS
A PRETTY BIG LEFT- FOR ALL
pTHIS TODAY ON THERE'S A LOT OF
WORK TO BE DONE AND THIS
IMPACTS OR IS NOW GOING TO BE
AVAILABLE TO- AT THIRTEEN
MILLION CALIFORNIA MEDICARE
BENEFICIARIES. IN MEDICARE.
IT'S ALSO REQUIRED OF ALL-
PLANS THAT PARTICIPATE MEDICAID
AND MEDICARE ADVANTAGE- AND
THAT INCLUDES- IN CALIFORNIA
THAT THE SPECIAL DEMONSTRATION
PLANS WOULD DO ALSO ELIGIBLE
FOR BOTH MEDICARE ONLY MEDICARE
SO THAT'S ROUGHLY YOU KNOW
APPROXIMATELY TWO POINT SIX
MILLION. CALIFORNIA SENIORS ARE
ENROLLED IN A MEDICARE
ADVANTAGE. AND LASTLY ARE OF
IT'S ALSO REQUIRED FOR HEALTH
PLANS THAT ARE IN THE FEDERALLY
FACILITATED EXCHANGE. IT'S AN
OPTION FOR. STATE RUN EXCHANGES
FOR IN CALIFORNIA IT'S COVERED
CALIFORNIA. I'M NOT AWARE OF
ANY OFFICIAL ANNOUNCEMENT IF
THEY INTEND TO MAKE THAT A
REQUIREMENT OR NOT BUT THAT
THAT STATE OPTION. AND THEN IF
I CAN CONCLUDE HERE OUR NEXT
SLIDE. WHEN IS THIS ALL- DO YOU
WANT TO SOME OF THE DEADLINES
AND YOU KNOW IN A LOT OF OTHER
REQUIREMENTS IN REGULATION BUT
THE ONE THAT I'M FOCUSED ON ON
THESE FOR USE CASES. THE FIRST
ONE WITH THIS PATIENT ACCESS
AND THIRD PARTY AT. THAT IS
COMING UP. IN REGIONALLY WITH
JANUARY BUT GOT DELAYED BECAUSE
CODED SO IT'S NOW. ONE IN A POX
SEVEN. THE THAT HEALTH. NEW AND
ROMAN. DATA EXCHANGE THE STILL
CHEN ONE OF. TWENTY TWO AND
THEN THE HOSPITAL BED
NOTIFICATION THAT'S COMING ON
THE SIMILAR TIME FRAME. AGAIN
WITH THE ORIGINALLY WAS A
COUPLE WEEKS AGO. AS A RECENT
ANNOUNCEMENTS DELAY- AND NOW
IT'S ON MAY ONE OF NEXT YEAR.
THOSE ARE THE MAJOR SORT OF
DEADLINES. AND I CAN CONCLUDE
TO SOME KEY TAKEAWAYS THAT
HOPEFULLY I ALREADY MENTIONED
DURING MY PRESENTATION IT'S A
PRETTY BIG LEAGUE FORD FORD-
DATA AVAILABILITY DATA SHARING
AND IT'S REALLY IT'S CONSUMER.
ORIENTED SO HOPEFULLY THAT THAT
WILL DRIVE CONSUMER ENGAGEMENT
BUT WILL SUPPORT CLINICAL CARE
COORDINATION. BUT THESE ARE
THESE ARE JUST MINIMUM
REQUIREMENTS SO THAT IT REALLY
JUST SETS THE FLOOR NOT THE C.
AND ACTUAL LIFE OPPORTUNITIES
BECAUSE THEY'RE COMMON
STANDARDS AND- YOU KNOW MORE
AND WITH HEALTH PLANS HEALTH IT
PROVIDERS ALL PARTICIPATING
THESE REQUIREMENTS. ZACKS
OPPORTUNITIES FOR A MORE
COORDINATION. AND JUST A
CALIFORNIA PERSPECTIVE YOU KNOW
IN IN THIS DISCUSSIONS THAT ARE
COMING FORWARD- YOU KNOW MY
RECOMMENDATION IS THAT THERE'S
A SOLID FOUNDATION THAT'S BEEN
DEALT THROUGH THE FEDERAL
APPROACH AND THAT IS SOMETHING
THAT THE STATE CAN. CAN
LEVERAGE AND LEASING FORMS AND
THE OPTIONS ARE AVAILABLE
SPECIFICALLY THE USE CASES. ARE
MANDATING PARTICIPATION AND-
SOME OF THE COMMON STANDARDS
AND TECHNOLOGIES THAT ARE READY
SORT OF THE FOUNDATION OF THE
FEDERAL REGULATIONS. THAT'S ALL
I HAD FOR MINE- ARE THERE ANY
QUESTIONS. WHILE THANK YOU VERY
THAT'S THE AND IT'S KINDA SHEDS
A WHOLE NEW LIGHT ON THE ON THE
WAY THIS IS INTO TO OPERATE SO.
ASSEMBLY MEMBER AGUIAR-CURRY A
QUESTIONS. DO YOU HAVE ANY
QUESTIONS FROM THE REMOTE. NO
QUESTIONS FROM REMOTE SO I HAVE
A COUPLE QUESTIONS AND SO-
FIRST WHY I APPRECIATE THE
REALLY DO APPRECIATE YOUR YOUR
PRESENTATION AND LIKE I SAID IT
DOES SHED A DIFFERENT LIGHT ON
THINGS- THAT I THAT I WAS NOT
AWARE OF SO- ARE THERE YOU KNOW
WHAT ARE OR THEY'RE GONNA BE
DIFFERENCES IN WHAT ARE. YOU
KNOW THE ART WITH DCS AND
MEDICARE MANAGED CARE PLANS ARE
GOING TO BE REQUIRED TO DO
DIFFERENTLY- OF IT AND MADE
OTHER SIGNIFICANT DIFFERENCES.
PROBABLY MORE SIMILARITIES AND
DIFFERENCES AND GETTING INTO A
LOT OF THE NEW ONES BUT- THE
MAIN IS THE SIMILARITY OF-
ACCESS. I JUST THIRD PARTY
APPS- BASED ON CONSUMER CONSENT
THAT ONE IS THE SAME- THE END.
THE PROVIDER DIRECTORY
INFORMATION. THE DIFFERENCE IS
THAT ON THAT PAID A PAY DATA
EXCHANGE WHERE MEMBERS INVOLVED
IN A NEW PLAN THAT'S ONLY
REQUIRED OF- MANAGED CARE
ORGANIZATIONS IT IS NOT
REQUIRED IN THE STATE. AGAIN
THAT'S THE FLOOR THAT DOESN'T
MEAN THROUGH STATE POLICY AND
DISCUSSIONS THAT. AND NUMBER
WHO MOVES FROM STATE PEOPLE
SERVICE INTO A MEDIC CAL
MANAGED CARE PLAN THAT THAT
COULD BE. WEIGHED UP MAYBE
CLOSE A LITTLE BIT OF A GAP
THAT'S IN THE REQUIREMENTS- I
KNOW OUR- HEALTH PLANS AND IN
THE STATE YOU KNOW THAT'S OPEN
FOR DISCUSSION BUT THAT'S
TECHNICALLY NOT REQUIRED OF. PH
CS TO SUPPORT THAT. GREAT N.
YOU KNOW OBVIOUSLY WITH THIS
BEING. AN ANIMATOR DIFFERENCES.
OKAY OBVIOUSLY WITH THIS BEING
YOU KNOW CONSUMER DIRECT GO
HEAD. WITH ABSENT WITH AN APP
HOW HOW DOES THIS IS HOW HOW WE
HOW DO WE DRESS LIKE OLDER
PATIENTS WHO MAY NOT BE TECH
TECHNOLOGY SAVVY- IN IN MY
DISTRICT I GET MISS
AGUIAR-CURRY IS DISTRICT WE
LACKED IN MANY AREAS WE LACKS
CELL PHONE SERVICE WE LACK
BROADBAND AND SO. HELP ME
UNDERSTAND HOW THAT HELPS OUR
OUR RURAL COMMUNITIES WHO HAVE
HAVE THESE KINDS OF
INFRASTRUCTURE CHALLENGES. YES
TWO QUESTIONS THERE IS- SORT OF
TECH SAVVY AND I THINK THAT IS
ONE ISSUES THAT WITH THAT WILL
COME UP OF. HOW WELL DO WE
THINK THE ADOPTION WILL BE. N.
I WILL SAY THOUGH THAT THE THIS
REGULATION ABOUT ACCESS TO
THIRD PARTY APPS AND CONSUMER
ENGAGEMENT IT'S BUILT ACTUALLY
OFF OF WHAT CMS HAS DONE FOR
MANY YEARS FOR MEDICARE FEE FOR
SERVICE AND THEY HAVE FIFTY
FIVE APPS ACTUALLY IN
PRODUCTION THAT ACTUALLY ARE
READY SUPPORTING THIS KIND OF
FUNCTIONALITY. THEY DON'T HAVE-
A LOT FROM WHAT I CAN TELL AND
TALKING TO SOME OF THE APPS
THAT ARE AVAILABLE- HIGH USAGE
I THINK SOME ADDITION FROM
AWARENESS. BUT I THINK THERE IS
AN ASSUMPTION THAT PEOPLE STILL
RELY ON THE PHONE AND IF IT'S
NOT THEM THEMSELVES. A BIG
BENEFIT OF THIS OPPORTUNITIES
ACTUALLY NOT THE INDIVIDUAL
CONSUMER BUT IN MANY CASES IS
ACTUALLY THE FAMILY AND IN THE
CARE GIVER WHO CAN HAVE ACCESS
TO THIS INFORMATION AGAIN IF WE
LOOK AT THE USE CASE BEFORE AND
AFTER MANY TIMES. IT'S PAPER
DRIVEN FOR ITS INCOMPLETE
HEALTH INFORMATION ABOUT ON THE
ONE THAT THEY'RE CARING FOR AND
THIS CASE- IT BE CENTRALIZED IN
THE PHONE AND EVEN THE CARE
GIVER. BECAUSE IT COULD BE
GRANTED ACCESS. CAN HAVE ALL
THAT INFORMATION ON THE PHONE.
SO IT'S NOT JUST IN THE
CONSUMER THEY CAN GRANT ACCESS
TO A PROXY- THE TO SOMEONE ELSE.
THAT'S ASSUMING THEY HAVE SELF
RICH. THE LACK OF CELL PHONE
BROADBAND AND I THINK THAT
THAT'S GONNA BE A COMMON
CHALLENGE AS WELL FOR SOME
CONSUMERS- BUT- AND AGAIN I
THINK THAT'S SOMETHING YOU CAN
BE PLAN HOW CAN WE MAKE SURE
THAT THAT CAN BE DONE. IN AN
EXAMPLE I GIVE PEOPLE IS THERE
IS AN AL ON APPLE APPLE HEALTH
APP THAT ESSENTIALLY DOES IS
NOW YOU CAN LOOK AT. PROVIDERS
WHO ARE PARTICIPATING WITH
APPLE YOU CAN DOWNLOAD YOUR
HISTORY I DOWNLOAD MY SUTTER.
HISTORY AND STANFORD IN A
DOWNLOADING FIFTEEN SECONDS-
AND I THINK THAT'S THE BEAUTY
OF USING SOME OF THE MODERN
TECHNOLOGIES THAT THEY'RE
REQUIRING. IT'S THAT IT'S
REALLY A SMALL PACKET OF DATA.
AND IT'S AT THE CONSUMER LEVEL.
AND THAT'S THE THEORY BEHIND IT
IS THAT IT WOULD BE MORE
ACCESSIBLE- IT DOESN'T TAKE.
LIKE STRONG SO YOU KNOW SELL
WERE BROADBAND- POWER TO. TO
GET THAT INFORMATION INTO YOUR
CELL PHONE. SO I MEAN THIS IS A
KIND OF A NUTS AND BOLTS
QUESTION SO I'M JUST TRYING TO-
JUST TO TRY TO UNDERSTAND SO AS
THE CONSUMER. WHO'S GOING TO
ACCESS THIS APP. SOMEWHERE OUT
THERE IN IN THE WORLD OF DATA.
THERE'S A HEALTH INFORMATION-
EXCHANGE THAT RECOGNIZES THAT
PATIENT AND THEN AND THEN
SUPPLIES THE DATA IS THAT A
FAIR ASSUMPTION. WAGEWORKS
WOULD BE- THE CONSUMER
DOWNLOADS THE APT THE APP THEN
WOULD HAVE TO MAKE DIFFERENT
CONNECTIONS TO PROVIDERS AND
HEALTH PLANS SO THEY HAVE
ACCESS AND IF THE WORD E. TO
REQUEST. DATA SO THAT THAT AB
IS ACTUALLY TALKING DIRECTLY TO
A HEALTH PLAN FOR A HEALTH CARE
HEALTH PROVIDERS EHR SYSTEMS.
AND THEN WHEN THEY MAKE THAT
REQUEST THEY'RE SAYING HEY. I'M
MAKING REQUEST ON BEHALF OF
THIS PERSON. THE H. R. SYSTEMS
HOW PLAN SYSTEMS OR SAY YES
THAT'S A MEMBER THAT SOME WE
HAVE DATA ON AND THEN THEY
WOULD SEND THAT ACROSS. IT'S
NOT NECESSARILY DIRECTED AT
EACH AYE HE'S LIKE AN H. I.
LIKE ORGANIZATION IT'S REALLY
DIRECTLY AT HEALTH PLANS AND
PROVIDERS AND AGAIN THAT'S TO.
CMS AND ONC HAS AUTHORITY TO
REGULATE. RIGHT WOW THANK YOU
VERY MUCH. THANK YOU VERY VERY
MUCH FOR YOUR INFORMATION AND
WE VERY MUCH APPRECIATE IT ALSO
THANKS FOR. MAKING THE TRIP TO
OAKLAND FOR. THE TESTIMONY AND-
VERY MUCH APPRECIATED THANK YOU.
WITH THAT WE'RE GOING TO MOVE
ON TO OUR NEXT SPEAKER- AN XP
FOR SPEAKER IS DAVID HORROCKS
WHO IS THE PRESIDENT OF THE
CHESAPEAKE REGIONAL INFORMATION
SYSTEM FOR OUR PATIENTS. AND
WE'LL JUST CALL IT CHRIS- AS
BASICALLY HE'S THE CEO OF THE
MARYLAND H. I. E. AND HE'S
GONNA BE ON THE PHONE LINE. AND
SO- MISTER WORK- THE FLOOR IS
YOURS. THANK YOU THIRDS MAKE
SURE CAN ALL HEAR. YES RIGHT
YEAH SO- HAD FADED- MY NAME IS
DAVID HORROCKS MY RUN- AND H.
I. O. ON THE EAST COAST THANK
YOU THANK YOU H. ID BUT I'LL
TRY TO STICK WITH A DOCTOR THE
ECONOMIC TODAY. AND MY NAME AT
THIS YEAR FROM AROUND THE
COUNTRY ABOUT THE H. I. O. I'LL
DESCRIBE HELP THEM SUCCESSFULLY
YEARS HAVE BEEN OPENED BY
ORGANIZED I'LL START WITH.
CREDIT ON FLIGHT TO. CHRIS IS A
PRIVATE NONPROFIT COMPANY THAT
WAS A COLLECTED BY MARYLAND
HEALTH CARE COMMISSION IN A
COMPETITIVE PRODUCT THAT BV
DESIGNATED. THEY MIGHT HIV AND
BEING DESIGNATED COURT DOESN'T
MEAN NO OTHER ORGANIZATIONS ARE
SUPPOSED TO FACILITATE EXCHANGE
IN MARYLAND BUT WE ARE THE
ORGANIZATION WITH WHICH THE
STATE WORKS CLOSELY AS WELL
DESCRIBED. I'M ALREADY TO
DESIGNATE. WITH THE TABLET IN
THAT THE BIT OVER A DECADE AGO
THE SECRETARY OF HEALTH I HAD
THE PARTY TO DO GRANT TO CHRIS
OUT BY OF THE SOMETIMES
CUMBERSOME STATE PROBE CRIED
THAT. AND THE SOURCE OF THE
KERR I IN WHOLE OR IN PART
FEDERAL DOLLARS. THANK YOU DOES
PROVIDE BY THE EPIDEMIC SUPPORT
RIGHT FUNDED. THAT NINETY TWO
MATCH. ALONG WITH THAT SPECIAL
STATUS THE BEST A FOR CRYPTO
OBLIGATE PLACED ON IT BY THE
STATE THE MOST IMPORTANT OF
WHICH ARE REQUIREMENTS FOR
BOARD COMPETITION. TO HAVE
CERTAIN NINETY THREE THIRTY
AUDIT POLICIES DESIGNED TO
PROTECT. HM PRIVATELY. OUR
DESIGNATION IS RENEWED MUST BE
RENEWED EVERY THREE YEARS AND
THE MARYLAND HEALTH CARE
COMMISSION USE THAT
OPPORTUNITY. TO TAKE STOCK OF
OUR PERFORMANCE I THINK ALSO.
THAT OF THE MODEL. SO WHILE WE
ARE A NONPROFIT- AND WE WORK TO
MAINTAIN OUR INDEPENDENCE AND
GOVERNANCE YOU CAN PROBABLY
TELL FROM THE DESCRIPTION.
REALLY A PUBLIC PRIVATE
PARTNERSHIP OF SORTS. THAT WE
PERFORM SOME OF THE WORK THAT
THE STATE MIGHT OTHERWISE- NEED
TO HANDLE AND WE'VE BEEN ABLE
TO DO SO EFFICIENTLY. YOU'RE
FREE FROM THE FIVE WERE ALSO A
PART OF AFFILIATION AMONG FOR.
STATE BY WHICH WE SHARE A
SINGLE- I. T. INFRASTRUCTURE-
NONPROFIT ENTITY AND- THE
DISTRICT ONE B. AT WEST
VIRGINIA AND- AS OF LAST MONTH
CONNECTICUT. WORK WITH THE TEAM
ON THE OPERATION OF THE HIV
TECHNOLOGY- EVEN AT THE
SEPARATE BOARDS OF DIRECTORS
PRIOR. A PROJECT IN EACH STATE
ENABLING LEGISLATION HELP ONCE
ALL FOUR OF THOSE AFFILIATE HIV
THOSE. ALL FOUR HAVE BEEN
DESIGNATED. AS THEIR STATE- H.
I. L. NG BUT WE DIFFERENT PROP
THAT THE- I'M ALL FOR OUR STATE
WIDE AND- ALL OUR PARTNERS IN
SOME WAY WITH THEIR STATE OUR
PUBLIC HEALTH AGENCY AND WITH.
AND WITH MEDICAID. SO ON FLIGHT
THREE I HAVE BEEN GENERAL I'M-
ABOUT. SOME H. I. EVEN AGAIN
ARE GENERAL. AND NOT HARD AND
FAST RULES THERE BATES ON VISIT
BACK MADE TO- AT LEAST TWENTY
FIVE H. I. OWES AROUND THE
COUNTRY- OVER THE YEARS
INCLUDING THREE IN CALIFORNIA.
I'M ALSO ON THE BOARD OF THAT
THE CHOIR PROJECT WHICH
OPERATES TO THE NATIONAL
NETWORK THE HEALTH EXCHANGE AND
AIR QUALITY. ITS FIRST THREE
BULLET ONE EACH IS REALLY ABOUT
THE CATEGORY. OF H. I. O. AND-
I GROUP A LITTLE DIFFERENTLY
THAN DOCTORS AGAIN HE- I LEFT
UP A SMALL IDEA AND- THE
CATEGORY AND I ADDED ANOTHER
WHICH IS THAT THE FOR PROFIT
VENDORS. WHICH I'LL SPEAK TO IN
A MOMENT. YOU HAVE ALREADY
HEARD ABOUT THE NATIONAL
NETWORKS FROM MY DOCTOR'S THE
CHEN YEAH MY FIRST OBSERVATION
TO SHARE THAT THE FAST NETWORKS
ARE. IMPORTANT FOR BASIC DATA
TRANSPORT. THEY OPERATE TODAY
IN CALIFORNIA AT THAT THE MAP
SHOWS- THEY ARE SUPPORTED BY
THE HEALTH RECORD VENDORS. AND
THE TRANSACTION VOLUMES ARE
GROWING EVERY YEAR. IN MY
EXPERIENCE THOSE NATIONAL
NETWORKS ARE TYPICALLY LEVERAGE
MOST SUCCESSFULLY BY. THE FIFTY
KATE AT HOSPITAL THE- HELP PLAN
FUTURE MANAGER MALL PRACTICES
ARE ADULTS FAR LEFT INVOLVED
AND AGAIN THAT'S NOT A HARD AND
FAST RULE- DEPENDING ON YOUR
EHR SOME SMALL PRACTICES TO
PARTICIPATE. BUT I'D SAY THAT
UP ARE LEFT AND THEN LARGE
TROPICAL SYSTEMS. ARE NOT
ALLOWED THE PATIENT HAS BEEN
ACROSS TOWN AT A DIFFERENT
HOSPITAL. I NATIONAL WITH CREE.
EASY FOR A NEARBY. TO OBTAIN
ELECTRONIC SUMMARY OF HIS DAY.
NOW THAT SUMMER WILL PROBABLY
COME TO THE DOCTOR AND THE BIG
LONG ELECTRONIC FILE. BUT IT
FIRST VACATED HOSPITAL EMPLOYER
IS HELPING- TO PARK DOWN THE
MOST RELEVANT DATA. SHE'S GONNA
HAVE WHAT SHE NEEDS FOR
IMPROVED DIAGNOSIS AND
TREATMENT DECISIONS. SO ON THE
SECOND BULLET IMPORTANT
COROLLARY AT THE TOP SURVEYS
ABOUT THE NATIONAL NETWORK IF
THE DATES FOR THE STRONG STATE
H. I. L. ARE DOING. MUCH MORE
THAN MOVING DATA. EIGHT EIGHT
CHAU ARE AGGREGATING RECORDS
FROM SKILLED NURSING FACILITIES
PHARMACY PUBLIC HEALTH AGENCY.
RECORDS ARE OFTEN PAIRED WITH
CLAIMS DATA FROM COMMERCIAL
PAYERS MONTHLY MEDICAID. OUR
MARYLAND MEDICARE AS WELL. NOT
A BIG COOK AT THE MOMENT IS TO
CAPTURE MORE DEMOGRAPHIC AND
SOCIAL DETERMINANTS OF HEALTH
INFORMATION- H. I. DOES
NORMALIZE THEM THAT THEY DID TO
MAKE IT CONSISTENT AND THEY
PARKED OUT THE IMPORTANT THING.
THAT EVEN A HEALTHCARE PROVIDER
WITHOUT SOPHISTICATED I. T. IS
ABLE TO USE THAT. H. I WOULD
TURN DATA INTO QUALITY MEASURES
AND REPORTS WHICH THE
COMMUNITY- I USE AS A BASELINE
AND REPORT SHARED SAVINGS
PROGRAM. AND H. I WAS TRACK
PATIENT RELATIONSHIPS THAT
FACILITATE COORDINATION BETWEEN
ORGANIZATION. DOCTORS DID HE
MENTIONED THAT THE A WIDESPREAD
SERVICE THE PUSH NOTIFICATIONS
AND STATE H. I. O. I DO QUITE A
BIT AT THAT MAKING SURE THAT A
PRIMARY CARE PROVIDER WORK YOUR
MANAGER KNOWS WHEN THEIR
PATIENTS SHOW UP EMERGENCY ROOM
ARE MATED OR DISCHARGE FROM THE
FACILITY NATIONAL NETWORKS
DON'T YET PUSHED MUCH
INFORMATION THEY RELY INSTEAD
ON DOCTORS TO QUERY. AT THE
RIGHT TIME THIS BULLET AT THE
CABIN OF FOR PROFIT BENDERS.
AND THAT THE BEYOND THE
NATIONAL NETWORK- WHICH THAT
WERE SUPPORTED BY- THE HEALTH
RECORD VENDORS- AND THE
NONPROFIT EIGHT EIGHT THAT
WOULD I THINK THE FOR PROFIT
INTER OPERABILITY VENDORS ARE
INCREASINGLY IMPORTANT MARKET
PLAYER. AND SOME DO OPERATING
CALIFORNIA. THE COMPANIES ARE
BRINGING PRIVATE CAPITAL AND
INNOVATION FOR THE INTER
OPERABILITY SPACE THE NATIONAL
NETWORK AND H. I. O. SUCH AS
MINE TYPICALLY HAVE CUMBERSOME
GOVERNANCE WHICH REQUIRES
CONSENSUS AMONG PROVIDERS
PAYERS AND PATIENT ADVOCATE THE
INTEROPERABLE ENDERS ARE. OFTEN
MOVED AND INNOVATE RAPIDLY I'D
SAY THEIR BIGGEST ACCEPTED WITH
QUICK NOTIFICATION THEY'RE
ADDING FILTERS AND INTELLIGENT
THE BRAIN- THE MOST IMPORTANT
EVENT THE ATTENTION OF CARE
MANAGERS. AND CURRENTLY THEIR
BIGGEST CONSTITUENCY- BEING TO
BE HEALTH PLAN- THEY DO
SOMEWHAT LAPS WITH- BASIC DATA
MOVEMENT. AND GENERALLY THE FOR
PROFIT INTEROPERABLE STANDARDS
ARE NOT. BAD PARTNERED WITH
PUBLIC HEALTH OFFICIALS IN THE
WAY OF THE STATE H. I. L. BE.
AFTEREFFECT OBSERVATION THE
FOURTH AT IS THAT SUPPORT FOR
PUBLIC HEALTH NOW MUCH TOP OF
MIND. BUT THE THREE MARKET THE
STATE H. I. O. HAVE BEEN THE
MOST TIED THE PUBLIC HEALTH
PURPOSES. I'VE BEEN A BIG FOCUS
MY OWN. WHICH WE HAVE A PEOPLE
WHO HAVE NOT MET OF PUBLIC
HEALTH WE HAVE THREE DOCTOR AT
THE PUMP HEALTH. BUDGET TO HELP
BUT BE A BETTER PARTNER- WITH
THE- THREE NOW. FOR PUBLIC
HEALTH ORGANS A WE WERE. I HAD
NO YOU THINGS WE DONE AS FAR OF
THE CODE REST. TRACKING
INSEMINATING REAL TIME HOT
LEVINE WORKING CALCULATING
DEMOGRAPHIC TRENDS INCLUDING
RACE AND ETHNICITY DATA FOR
INDIVIDUAL TO BEEN CATHOLIC FOR
THOSE WITH POSITIVE DIAGNOSIS
AND PERFECT TALIBAN WE'VE DONE
THAT BY LINKING OTHER DATA THAT
THE SPECIALLY CLAIM OF
RANELLIDAE TECHNIQUE BY
INTERMINGLED BY THE CODE. AND
BY PERCENT THIS BLOCK. RELEVANT
COME. THE CARE. MEDICAL AT THE
MERGE TO. WE'VE BEEN HAND THAT
CONTACT RATING CAPABILITIES
ABOUT THE DATE INFORMATION-
FROM RICK AND HEALTH CARE
ENCOUNTERS PROVIDED ALSO
MECHANISM FOR. CREDENTIAL
CLINICIANS TO. ORDER TASK DRIVE
THROUGH LOCATIONS WITH STATE OF
MARYLAND- SET UP AND THAT THE
ORDERING PROCESS THAT ALLOWED
THEM TO AVOID LONG LINES. THOSE
pOTHER H. I EAT IN THE COUNTRY
ARE- ARE PERFORMING ARE NOT
SIMPLE DATA EXCHANGE. ITS
MARKET IS DONE BY THE PHABLET
AND WEALTH FUND H. I. THAT ARE
PARTNERING WITH AND REGULATED
BY. THE STATE- SOME IN THE
INDUSTRY HAVE TAKEN TO CALLING
BUT ORGANIZATION THEIR STATE.
WHAT HEALTH DATA. UTILITY ABOUT
MY WORK BLYDE OF FIVE MAKES.
SOME OBSERVATIONS ABOUT THE
CAPITAL STATE H. EYES AGAIN YOU
CAN FIND EFFECTIVE THE
STATEMENT THE TAKEN A
GENERALIZATION AND I WOULD LIKE
TO GIVE A SHOUT OUT THE FEW
STATES THAT HE- THE ONES IN
ARIZONA INDIANA NEBRASKA
COLORADO MICHIGAN. DELAWARE NEW
YORK RHODE ISLAND AND MAINE
THEY'VE ALL BEEN OUT SOMETHING
ON MY MODEL IS NOT PULLING OUT
THE BULLET POINTS. THE AND THE
FIRST IS THAT THEY TEND TO BE
STATEWIDE. MY PARTNERS ARE
PUBLICHEALTH WHEN YOU CAN ONLY
COVER A PART OF THE GEOGRAPHY.
DEPARTMENT ONCE FOR INSTANCE
YOUR H. I. L. TO MAKE.
IMMUNIZATION DATA AVAILABLE
POINT OF CARE WHERE THEY WANT
TO USE THE HIV CAPTURE RESULT
THE- OFFICE ADMINISTERED RAPID
PATH. THEY'LL WANT THE PROJECT
TO COVER THE WHOLE STATE FACE
LIKE MICHIGAN HAVE MIGRATED
FROM REGIONAL H. I. OWES TO A
ONE PROMINENT. A STATEWIDE H.
I. L. I'M GONNA TALK ABOUT NEXT
STEPS INTO THE APPLE WITHIN A
FEW MINUTES WELL. BUT I THINK
IN BOTH THEIR PRIVATE
NONPROFITS WITH STRONG AND
DIVERSE. THEY COLDER
INVOLVEMENT IN GOVERNANCE. THE
H. TIME FOR OFTEN STATE I THANK
BY- THE GROUP WHICH WAS MOST
PROMINENT IN THEIR FOUNDING. IN
MARYLAND THAT WAS HOSPITAL IN
INDIANA IT WAS RESEARCHERS IN
UTAH IT WAS INSURERS- BUT THE
MOST SUCCESSFUL H. I IT WAS I
BELIEVE BRING TOGETHER THE
DIVERSE STAKEHOLDER GROUPS. AND
OFF THE TOP OF PATIENT ADVOCATE
THE AND H. I. O. THAT IS. TO
ALIGN WITH ONE OF THOSE BURKE.
AT TEN TO GET OUT OF BED AND
DOESN'T DOESN'T SERVE THE
OTHERS AS WELL. A IS ACCEPTABLE.
H. I. O.'S ARE PARTNERED WITH
PUBLIC APART THE THINK I HAVE
THAT. IF PLAY I'LL TAKE YOUR H.
I. O. I HI LOOK THE BACK TO
COUNTRY BEEN FOR A LONG AND-
THEY HAD PREVIOUSLY PARTNERED
WITH THE STATE ALL THAT MUCH
BUT THAT TOTALLY CHANGED THIS
YEAR AND THEY ARE- WORKING WITH
THE MUCH CLOSER MUCH MORE
CLOSELY AT THEY RESPONDED CODED.
OF COURSE TAKE I INTEND TO
LEVERAGE MEDICAID FUNDING WITH
GENEROUS FEDERAL MATCH. IN THE
CASE OF CRAP- AND ART AND I
STILL ALL. THREE OF OUR
PARTNERS HERE- ALL OF OUR WHAT
YOU CONSIDER CAPITAL INVESTMENT
COMES FROM GRANT DOLLARS. A
USER P. USER FEES PAY FOR.
ONGOING OPERATION BUT EVEN
THERE WERE LEVERAGING SOME
MEDICAID MONEY TO OFFSET
OPERATING COSTS. SHARE THE DATA
I O'S AND RECEIVE SOME DATA BY
MEN. RIGHT MAKES A COMPLETE
ACROSS THE STATE THE HARDEST
THING TO DO IS IN A TIGHT- IS
TO CONVINCE EVERYONE TO
PARTICIPATE. THEY TAKE- TIME
AND A BIG MONEY. BUT A SUBSET
OF DATA IS NOW BEING COLLECTED
BY MANDATE IN MANY STATES
HELPING A CHILD GO FROM THE
THERE TO FIX THE ISSUE WELL
MUCH FASTER. BUILD LAB RESULTS
HOSPITAL ADMISSIONS AND
DISCHARGE AND- OPIOID
PRESCRIPTIONS ARE GAMPEL OF
DATA THAT SOME STATES MANDATE
GO TO THEIR DESIGNATED. H. I.
L. THE BROWN. IS EXAMPLE OF
DATE WHICH OFFERS DRUG RECORDS
BAD UP TO THE STATE DESIGNATED
H. I. L. AND THE SIX BULLET
HERE ARE DEAD. AND REGULATED
THAT HOW UTILITY. WHEN YOU'RE
TABLET THE MANDATE IN THE PRIOR
BALLOT I THINK REGULATED ABOUT
THE NECESSARY AT THE AGE I WAS
THE COURTS DON'T ALWAYS LIKE IT
AND MY OWN BOARD I. TELL OF THE
PRESERVE INDEPENDENT BUT TOPPLE
REGULATION OF THE HEALTH DATA
UTILITY OR H. I. O. MAKE YOUR
DESIGNATED A CHILD MAKE SURE IT
DOESN'T. TAKE A MONOPOLY WHICH
ADDED THE FENCE THEY BEING
HANDED. AND SHUT OUT THE OTHER
MARKET PLAYERS. AT THE STATE OF
MARYLAND FOR INSTANCE MANDATE
BACK IN BUT OTHER H. I. OWES.
AND THAT SERVICES AS THOSE
WHICH SHARE. HM VAMPED
DIRECTIVE. AB ONE MORE BULLET
HERE AFTER A OF THE QUESTION
THAT. WERE CRAP DAVID BECKHAM
TO JAN HE AND THAT IS I WOULD
MOST OF THE FIX THE H. I. AND
TOWARD CENTRAL. DATA STORE
ROUTE. THAN A DISTRIBUTOR THEM
BOTH LIKE THEY ARE HYBRID
THERE'S OF BOTH BUT A MOST
CENTER. I THINK FOR THE DAY
SERVICE. THAT DATA. ARE JUST
EASIER TO LAW WITH CENTRAL
MODEL. IF YOU JUST MOVE BASED
DATA HOSPITAL THAT MORE LIKELY
TO BE DONE. DECENTRALIZED. I
HAD ONE LAST WHY WHICH IS THE
PITFALLS I BEEN. IN OTHER STATE
NINE LIKE TO CALL OUT AND SHIPS
WENT MULTIPLE VICTIM BE. I'VE
BEEN IN OTHER STATES WHERE THAT
ARE TRYING TO BUILD- AND H. I.
O. SOMEONE WILL POINT OUT NO
THE DOCTOR ALREADY GET RECORDS
FROM THE HOSPITAL ACROSS TOWN.
AND THEY'LL BE CLEAR THAT THE
WHOLE PROBLEM IT'S ALL. BUT IT
REALLY IS THAT ASSEMBLY MOVING
DATA- AND YOU MIGHT BE WITH THE
NATIONAL NETWORK IT MAYBE A 25%
POLLUTION. A SUCCESSFUL STATE
H. I. L. H. I. WILL DO A MUCH
MUCH MORE. THAN THAT. OKAY
SECOND BULLET. IS THAT THE IN
MY EXPERIENCE ESPECIALLY WITH
LARGER STATE. A THEY LOOK AT A
BUNCH OF EXISTING H. I. OPEN
TODAY. WE'RE GOING TO SOLVE
THAT BY MAKING A NETWORK OF
NETWORKS. AND THAT WITHOUT
NAMING NAMES THE STATE AND
GENERALLY NOT MANAGED TO TURN
ON THE BAND H. I. E.
CAPABILITIES. NAMIK SECTION OF
NEW YORK STATE WHERE A STRONG
ORDINATING ORGANIZATION. HAD
MADE THEIR REGIONAL H. I. O. A
FACTOR IN SERVING PUBLIC HEALTH
NEEDS. AND I'LL CALL OUT HELD
BACK IN NEW YORK CITY HE'S DONE
VERY WELL THIS YEAR. I BELIEVE
RESPONDING TO- THE CODED A
MERCHANT ST. BUT EVEN IN NEW
YORK STATE RETAIN SOME
CONSOLIDATION AMONG. THE
STATE'S REGIONAL- H. I. L. AND
AFTER. PITFALL THAT THE
BALLPARK THE RIGHT WORD FOR THE
BALLOT BUT AMONG THE MOST BASIC
H. I. YOU GO ABOVE SHOULD BE
THE ABILITY OF A DOCTOR OR CARE
MANAGER TO SUBSCRIBE. TO
RECEIVE NOTIFICATIONS EVERY
TIME A PATIENT WHO BELONG TO
THEM GO TO THE HOSPITAL IT
DISCHARGED ITS NETWORK OR STOP
WORKING EVENT LIKE- AND OVERDUE.
FOR APPROVED NINETEEN FATHER
THAT THAT THE DESCRIBING IS
IMPORTANT AND NOT JUST RELYING
ON THE PATIENT TO REMEMBER
WHICH DOCTOR TO WRITE DOWN AT
THE TIME OF HOSPITAL
REGISTRATION. IF IN A STATE
MULTIPLE AND TO THE PROVIDE
THAT'S BUT THEY DO NOT IN IRAQ.
DR IN CARE MANAGER ARE NOT
BEING WELL SERVED AND I GUESS.
WE ARE ALSO FEELING THE PATIENT.
PEOPLE BENCHMARK FOR A STATE
NOT THE BJP CAPABILITIES ARE
ANY GOOD THE FIGURE OUT WHETHER
NOTIFICATIONS ARE BEING MADE TO
DOCTORS. EVERY TIME. AND I'LL
CLOSE BY GIVING ONE OBSERVATION
THAT PACIFIC THE CALIFORNIA- I
HAVE SEEN FIRSTHAND THE
CALIFORNIA- IS THAT THE GREAT
EXPERTISE TO KNOW HOW. WHETHER
IN- H. I. O. TOP IT'LL- WAR
TECHNOLOGY COMPANY AND I JUST
HAVE TO BELIEVE THAT ONCE YOU
HAVE EVERYONE. ARE RUNNING THE
SAME PLAY SO TO SPEAK THAT THAT
THE STATE IS GOING TO
ACCOMPLISH GREAT THINGS. THANK
YOU. THANK YOU VERY MUCH THAT'S
THAT'S REALLY HELPFUL- I KNOW
WE CAN HAVE I THINK WE HAVE
SOME QUESTIONS- MISS
AGUIAR-CURRY. THEN TATIAN-
APPRECIATE YOUR TIME. HOW WAS
MARYLAND CONVINCED- ALL OF
THESE DIFFERENT ENTITIES LIKE
THE PLANS AND INSURERS
HOSPITALS DOCTORS ACCEPTED TO
PARTICIPATE IN THE NETWORK. THE
HOUSE CHRIS WOULD DRESS THE
ISSUE OF EXPENSIVE ELECTRONIC
HEALTH RECORD SYSTEMS FOR ALL
THE PROVIDERS CONNECTING TO THE
NETWORK. THANK YOU. AT GREAT
QUESTIONS ON THE FIRST ONE- BUT
HE DIDN'T BRING EVERYONE TO
PARTICIPATE. WE HAD. I THINK
THE BOTH THE GOVERNOR AT THE
TIME AND ARCTIC FELT. REALLY
HISTORY POINT WITH PROTECT THE
TEN. I BELIEVE GOING BACK TEN
YEARS NOW AND- THE MESSAGE
BAKED THAT WAS- FOR THE BAILED.
IF YOU DON'T DO THIS ON YOUR
PARTICIPATION
STRONG- PARTICIPATE IN- AS A
RESULT WITH THAT- WE- ALSO- I
HAVE OVER THE YEARS. INCLUDED
IF YOU MANDATE AND WE GET SOME
DATA THAT COMES DIRECTLY FROM-
FROM THE STATE HELPING THE
REPORTABLE CONDITIONS UNDER LAW
GO TO THE STATE AND THEY FOR
WORKER COPY OVER TO- AT THE AGE
THAT WE TAKE THAT INFORMATION
AND WE DELIVER IT BACK TO THE
POINT OF TEARS UP SOMEONE IT.
BUT THEY HAD A POSITIVE VIEW
GET THAT. AND IT PREGNANT THAT
IS REPORTABLE. AND WE ARE
FLASHING ADD UP TO A DOCTOR IN
THE EMERGENCY DEPARTMENT. I
WANT TO ARRIVE. THE SECOND PART
WHETHER WE HOW WE DEALT WITH
THE- EHRS. AND I BELIEVE YOU
MEANT IN THE AMBULATORY SPACE
WE HAVEN'T ENTIRELY ACCEPTABLE.
ALL OF OUR LARGER PRACTICES
CERTAINLY ALL OF OUR HOSPITAL
PRACTICES- PARTICIPATE. AND A
VERY HIGH PERCENTAGE OF
PRACTICES WITH THE INFORMATION
FROM US ESPECIALLY THOSE BEEN
COUNTER NOTIFICATION- BUT- A
DISAPPOINTINGLY LARGE NUMBERS
BILL. DO NOT STAND UP CLINICAL
INFORMATION THEY'LL SEND US A
ROSTER OF. AFTER WE KNOW WHAT
INFORMATION BENEFIT THEM- BUT
WE'RE NOT GETTING EVERYTHING.
WE NEED YET PROBLEM NOT FROM
SMALL PRESS. GREAT THANK YOU
ARE THERE ANY QUESTIONS FROM
OUR REMOTE. NOTE OF CITY OKAY I
HAVE A COUPLE QUESTIONS- AND
YOU ANSWERED I HAD DIED SEVERAL
BUT YOUR HANDS ARE A COUPLE OF
THEM SO IT'S SO ENCOURAGING TO
SEE THAT THE ADDITIONAL
SERVICES PROVIDED DURING THE
PANDEMIC BYE BYE CHRIS- I'M I'M
CURIOUS IS THERE A DIFFERENCE
BETWEEN THE DATA THAT'S
AVAILABLE THROUGH CHRIS THAN.
VERSUS WHAT WE SEE
INTERNATIONAL EHRS AND OR
THROUGH ANY HEALTH EXCHANGE.
MORE DETAILS ABOUT THEIR YES
THERE ARE SOME DIFFERENCES- THE
COR DOCUMENT IF YOU WILL THEY
GET MOVED BY THE NATIONAL
NETWORK IS A- A STANDARD
DOCUMENT CALLED- A DVD OR
SOMETIMES THE TVA. AND IF THAT
IT'S A STRUCTURED ELECTRONIC
DOCUMENTS THAT ALLOW THE H. R.
ON THE FAR SIDE TO. INJECTED
AND MAKE IT PART OF THE WITH
THE MESSAGE IF SO CHOSEN ON THE
FAR END. AND THERE'S A CERTAIN
SOPHISTICATION OF THAT. WHAT WE
FOUND IS THAT. WHAT CLINICIANS
USE FROM CRAP THE MOLD. AND
COULD BE SIMPLER INFORMATION
THAT WE HAVE. A PART OUT OF
THOSE WERE WHICH WE'VE REPEATED
SOME OTHER WAY. SO WE MIGHT
DELIVER JOHN. THE LIST OF KNOWN
DIAGNOSES ENTER OF THE FULL
DOCUMENT FOR. PROBABLY OUR
MOST- WORKFLOW FRIENDLY HING
THAT WE DO IS. IN CERTAIN
HOSPITALS THAT THE POSITION IS
BORDERING PRESCRIBING AN OPIOID
WE POP UP IMMEDIATELY PRIOR
OPIOID THAT HAVE BEEN
PRESCRIBED OR AN OVERDOSE THAT
THAT THAT A PATIENT MIGHT HAVE
EXPERIENCE. SO THE WORD
DEFENDING BETTER THAN FORMATION
BUT WE'RE TRYING TO DO IT IN A
MORE WORK FLOW FRIENDLY WAY.
AND THEN I'D CALL THAT A BIG
DIFFERENCE BETWEEN- THE
NATIONAL NETWORKS AND OURSELVES.
FREE THANK YOU. WHO HAS ACCESS
TO THE DATA IN CRISP IS IT
HEALTH PLANS INSURERS PUBLIC
HEALTH DEPARTMENT- IS IT A
SUBSCRIPTION HOW TO HELP PEOPLE
GET HAD PEOPLE GET TO THE
INFORMATION. WHO AND WHO GETS
TO THE INFORMATION ABOUT. YES
HELLO WE REALLY BEGAN WITH-
WITH THE HEALTHCARE PROVIDERS
OPPOSITION TO NURSES. AND OUR
PURSUIT CASE THEY ARE
CREDENTIALED THROUGH THEIR OWN
ORGANIZATION THE PRICKLY. OUT
WORK THERE A SMALL PRACTICE
WITH THEIR CREDENTIALED-
DIRECTLY WITH- WITH B. H. I. L.
AND- THE LAW PRACTICE WOULD LOG
INTO THE PORTAL TO ACCESS
INFORMATION A- A HOSPITAL OR
LARGER PRACTICE MIGHT ACT THAT
THE INFORMATION RIGHT WITHIN
THEIR OWN. HR HEALTH PLANS HAVE
ACCESS TO THE DATA BUT IT IS
FAR MORE LIMITED PURPOSES AT
THE FIND IN IN OUR
PARTICIPATION AGREEMENT. AND
PUBLIC HEALTH HAS ACCESS TO THE
DATA AGAIN FOR SPECIFIC
PURPOSES ALLOWED BY LAW I
BELIEVE INVESTIGATION PRINT
THAN. AND THEN WE DO A LOT THAT
IS TAKING DATA THAT COMES TO A
IDENTIFIED. ABROGATING IT AND
THEN DISTRIBUTING IT BACK OUT
TO THE COMMUNITY HE IDENTIFIED
AND- THAT MAY BE MADE AVAILABLE
VERY BROADLY. RIGHT SO AND THEN
MY FINAL QUESTION IS A LITTLE
BIT- WAS ACTUALLY COUPLE COUPLE
QUESTIONS EMBEDDED HERE BUT
IT'S AROUND THE SAME SUBJECT.
SO IS THERE EVER BEEN ANY
CALCULATION ON THE RETURN ON
INVESTMENT OF HAVING AN
EXCHANGE. BECAUSE WHAT AND THE
REASON I ASK THIS IS ONE OF THE
USE CASES AS- A REPUBLICAN A
REDUCTION IN YOU KNOW
DUPLICATIVE LAB WORK OR IMAGING
OR READMISSION. COSTS OR YOU
KNOW AN EASY VISITS SO WHAT I'M
LOOKING FOR IS ANYONE
QUANTIFIED WHAT IT COSTS TO
ESTABLISH THE EXCHANGES. VERSUS
A SAVINGS THAT WOULD HAVE THAT
THAT HEALTH CARE COSTS
HEALTHCARE SAVINGS COSTS THAT
WOULD RESULT FROM. FROM THEM.
RIGHT THERE HAVE BEEN SOME
ACADEMIC STUDY THAT LOOK AT THE
I. WOOD CHARACTERIZED ALL OF
THEM AS MEASURING- VOEPEL. AS
LOOKING AT PRODUCTS MEASURES
AND NOT HEALTH OUTCOMES IT'S
VERY DIFFICULT TO GO ALL THE
WAY TO- THE IMPACT YOU'RE
HAVING ON HEALTH THROUGH THESE
TOOLS THE TOOLS ARE ALWAYS
JUST- SUPPORT THE OTHER
CLINICAL INITIATIVES OR THINK
THAT DOCTORS ARE DOING. SO I
HATE TO SAY THAT THE BODIES MAY
NOT BE ENTIRELY SATISFYING AND
HOW WELL THEY ACCOMPLISH WHAT
YOU'RE DESCRIBING- BUT THEY
HAVE BEEN TEMPTED. I GUESS AND
THE REASON I ASK IS THAT YOU
KNOW ONE OF THE BIG- CONCERNS
OBVIOUSLY WE HAVE IS THE
GROWING COST OF HEALTHCARE. AND
ELIMINATING SOME OF THE
DUPLICATE DUPLICATION AND
HEALTHCARE- IS ONE OF THE
STATED GOALS OF THIS BUT I YOU
KNOW I THINK WEEK WE KIND OF AT
SOME POINT REALLY NEED TO
UNDERSTAND ARE WE ARE WE ARE WE
ADDING THE LATE ADDING
SOMETHING TO THE SYSTEM. AND
GETTING OUT WHAT WE'RE
EXPECTING TO GET OUT AND IF WE
ARE AT WHAT LEVEL THAT'S
HAPPENING SO- THOSE ARE THE
KINDS OF THINGS THAT WE- YOU
KNOW AS STEWARDS OF PUBLIC
RESOURCES HERE REALLY NEED TO
UNDERSTAND SO. MAY NOT BE THE
QUESTION YOU CAN ANSWER BUT BUT
TRUST ME AT SOME POINT WE'RE
GOING TO YOU KNOW A THAT AS WE
MOVE FORWARD WE WILL NEED
ANSWERS AROUND THAT- THERE IS
NO DOUBT THE INFORMATION IS
EXTREMELY VALUABLE- BUT I'M
LOOKING AT THIS FROM THE
STANDPOINT OF. OF HOW WE- HOW
WE USE THIS IN A WAY TO HELP
MAKE HEALTH CARE MORE
AFFORDABLE SO ANYWAY IF YOU
HAVE ANYTHING TO ADD ON THAT
THAT'S THAT WOULD BE GREAT BUT
I KNOW I. AND I KNOW IT IT
ACTUALLY MAY BE PREMATURE QUITE
FRANKLY- YOU KNOW BASED ON ON
WHERE WE ARE IN THE PROCESS. I
CAN TELL AT THAT THOUGHT RATHER
THAN FOCUSING. PRIMARILY ARE
ONLY ON- BENEFITS WITH THEM AT
THE POINT OF CARE. YOU COULD
ALSO LOOK AT THE BENEFITS THE
YOUR PUBLIC HEALTH AFTER. AND
AS I MENTIONED- YOUR IN THE
WAKE OF THE PANDEMIC. THAT THE
H. I. OWES WHICH HAVE WHICH
WERE ALREADY IN THE BORDER AND
WHICH ALREADY HAD A SIGNIFICANT
AMOUNT OF DATA ARE PROVING A
REALLY VALUABLE TO THOSE PUBLIC
HEALTH EFFORTS. I WOULD LOOK AT
THAT AS WELL AS YOU CONSIDER.
THE BEST ORDERS OR OUT TO
CALIFORNIA GREAT GREAT. WELL
THANK YOU VERY MUCH- ASSUME
IT'S- DINNERTIME OUT THERE HER
PAST DINNER TIME SO- APPRECIATE
VERY MUCH APPRECIATE YOUR YOUR
FIRST PARTICIPATION AND VERY
VERY HELPFUL INFORMATION SO
THANK YOU VERY MUCH MR HORROCKS.
AND WITH THAT WE WILL GO AND
MOVE ON TO OUR TO OUR LAST
SPEAKER- OUR LAST SPEAKER. IS
JONAH FROHLICH. THE MANAGING
DIRECTOR FOR MANAGEMENT AT
HEALTH STRATEGIES- AND THE
AUTHOR OF EXPANDING PAYER AND
PROVIDER PARTICIPATION AND DATA
EXCHANGE OPTIONS FOR CALIFORNIA
SO- AS THE LAW OBVIOUSLY A LONG
HISTORY IN THIS AND IS ACTUALLY
IN OUR WITNESS VIDEO ROOM IN
THE STATE CAPITAL SO. WHENEVER
YOU'RE READY. RIGHT THANK YOU
AFTERNOON THANK YOU ASSEMBLY
MEMBER WOULD AND AGUIAR-CURRY
FOR THE- OPPORTUNITY TO SPEAK
WITH YOU TODAY- ABOUT. THE
TOPIC. ONE OF MY MENTORS DR
MARK SMITH A FORMER CEO OF THE
COMPANY HEALTHCARE FOUNDATION-
HE WAS IMPRESSED UPON ME THE
NEED YOU'RE CONVEYING IMPORTANT
MESSAGES FORUMS LIKE THESE THAT.
IT'S IMPORTANT AT FIRST YOU
TELL THE AUDIENCE WHAT YOU'RE
GONNA TELL THEM. CAN YOU TELL
THEM. ANY TELEMARKETER. SO THIS
IS A PART IN IT TELL YOU WHAT
TO TELL YOU. THREE THREE ABOUT
THREE THINGS THAT REALLY BASED
ON WHAT'S IN THE REPORT THAT
YOU. JUST REFERENCE THE MEMBER
WOULD. FIRST NEED TO TELL YOU
ABOUT THE LEVERS THAT ARE
AVAILABLE. MEMBERS ARE
AVAILABLE TO- POLICYMAKERS
AGENCY LEADS- NON GOVERNMENTAL
ORGANIZATIONS. HEALTH PLANS
OTHERS TO ENCOURAGE ADOPTION
AND USE OF HEALTH INFORMATION
TECHNOLOGY IS NOT THE
COMMISSION EXCHANGE. THEN I'M
GONNA TELL YOU ABOUT SOME OF
THE EXPERIENCES OF CALIFORNIA
AND OTHER STATES AND HOW THEY
USED SOME. OF THE FIRST TO TRY
TO ENCOURAGE HEALTH INFORMATION
EXCHANGE AND THEN. A LITTLE BIT
ABOUT WHAT YOU THINK CALIFORNIA
CAN AND SHOULD THE NORTH.
EXCHANGE TOPIC THAT. VERY NEAR
AND DEAR TO MY HEART AND MANY
OF THOSE WHO PRESENTED TODAY
AND HAVE A VERY. THERE'S A
SLIDE DECK THANK YOU CAN'T JUST
TURN TO THE FOR PAGE. ITS TITLE
BACK AFTER TEAM POLICY
CONTRACTING AND FINANCE LOVERS.
AND HERE- ONE OF PRESS UPON YOU
THAT VARIETY OF THESE ARE
LOOKING ON EACH EXCLUSIVE
LEVERS THAT CAN BE USED TO
ADVANCE A CHILD EITHER THINGS
THAT CAN BE DONE TOGETHER- IN
ORDER TO ADVANCE INFORMATION
EXCHANGE- AND THERE'S DIFFERENT
LEVELS OF INTENSITY I MEANING
pSOME OF THEM ARE. MUCH MORE
RIGOROUS AND INTENSE AND OTHERS
ARE SOFTER TOUCH SO STARTING ON
THE LEFT THERE SOME LEVERS THAT
ARE MORE SUPPORTIVE.
COLLABORATIVE ADVISORY BODIES
AND FINANCING IN SUPPORT OF
INCENTIVE STRUCTURES. THAT CAN
HELP CREATE AND SUPPORT
INFORMATION EXCHANGE. THEY'RE
CONTRACTING AND- REGULATORY
LEVERS THAT ARE MORE DIRECTIVE
ESSENTIALLY TELLER DIRECT
STAKEHOLDERS. WERE IMPLICATED
BY OTHER REGULATION OR CONTRACT
BUT THEY SHOULD DO. AND THEN
THERE ARE THOSE ARE MORE
EXECUTIVE OR LEGISLATIVE THERE
ARE YOU HEARD. THERE A LITTLE
BIT ABOUT SOME OF THE MANDATE
EXAMPLE VARIOUS STATES- AND
THAT'S THROUGH LEGISLATION. AND
I THINK IT'S IMPORTANT IN THE
CONTEXT OF ALL THIS THAT BEFORE
CONSIDERING WHICH LEVERS TO
DEPRESS OR TO USE THAT IS
REALLY IMPORTANT- TICKET LATER
VISION AND THE PROBLEMS THAT
NEED TO BE SOLVED. BEFORE
APPLYING THESE LEVERS OTHERWISE
YOU'RE ESSENTIALLY. YOUR HAMMER
CHOOSE ANY ONE OF THESE YOU'RE
LOOKING FOR AND THEY'LL IT. SO
THE FIRST THING TO DO IS REALLY
WHAT IS IT WE'RE TRYING TO DO
WHAT'S THE VISION OR THE
PROBLEMS WE'RE TRYING TO SOLVE.
THE NEXT FIVE DAYS. SO IF WE
START THE FAR LEFT SIDE OF THE
SPECTRUM HERE. WE START WITH
THE MORE SUPPORTIVE LETTERS.
AND THESE ARE AROUND
COLLABORATIVE'S ADVISORY
COUNCILS AND FUN AND FINANCING
WEAVERS. NOW THESE LEVERS- ARE
CAN BE EFFECTIVE. IN SUPPORTING
A COLLABORATIVE PROCESS THAT
BROUGHT STAKEHOLDER ENGAGEMENT-
AND THEY HELP CREATE THINGS
LIKE POLICIES STANDARDS-
PROGRAMS AND OTHER. INITIATIVES
INCLUDING INCENTIVE PROGRAMS
THAT COULD BE DONE TOGETHER.
AND ENACTED TOGETHER AND
SUPPORTED. AND THERE ARE A
COUPLE OF EXAMPLES OF THOSE
THAT EXIST ALL OVER THE COUNTRY
CALIFORNIA HAS A K. HIGH AND
DOCTOR STOPPAGE OF THIS
EARLIER. WHICH IS A GROUP OF
ORGANIZATIONS HEALTH
INFORMATION ORGANIZATIONS
POLICYMAKERS AND OTHERS WHICH
HELPED CREATE. POLICY
DOCUMENTS- COUNTERSIGNED
SUPPORT THINGS LIKE THE
DEVELOPMENT OF C. TEN. AND
THERE ARE OTHER EXAMPLES FOR
EXAMPLE IN MICHIGAN THAT HAS- A
QUALITY COLLABORATIVE THAT'S-
MANY YEARS OLD VERY EFFECTIVE-
THAT SUPPORTS A SERIES OF
QUALITY MEASURES DIRECTED BY A
LARGE PART THAT THE PRIVATE
CARE TO CROSS THEIR AND
INCLUDES COLECTING QUALITY
MEASURES AND DATA. THEN OUR
FINANCING PROGRAMS UNDER
FINANCING PROGRAMS AND DR SCOTT
MENTIONED SOMEBODY'S ALREADY
THAT HIGH TECH IN THE USUAL
GRAHAM WHICH- PROVIDE. SOME
FUNDING FOR- SUPPORTING HEALTH
INFORMATION EXCHANGE- AND THERE
ARE OTHERS INCLUDING FIVE
MEDICAID WAIVERS AND PRIVATE
PHILANTHROPY AND PURCHASING
INCENTIVES FOR- THROUGH PUBLIC
AND PRIVATE PURCHASERS THAT
CAN. I SUPPORT INFORMATION
EXCHANGE EXAMPLES AGAIN THE
DOCTOR SCOTT REFERENCED WAS CAL
HOT WHICH IS A FIFTY MILLION
DOLLAR PROGRAM TO SUPPORT ON
BOARDING UP MEDICAL PROVIDERS
TO INFORMATION EXCHANGES OR
OTHER INFORMATION EXCHANGE
ORGANIZATIONS. NOT THE CONSERVE
SOME OF THESE ARE OR IS THAT
ONE IS WITHOUT. POWER
ENFORCEMENT A FORTY BECAUSE
THIS IS NOT A RULE OF LAW THIS
IS NOT A REGULATION IT'S REALLY
DIFFICULT I TO COMPEL
PARTICIPATION OR TO ACT ON AND
SOMETHING LIKE AN ADVISORY
COUNCIL RECOMMENDATIONS. A
SECOND ISSUE IS THAT FUNDING
FOR SOME OF THESE INITIAL
ONBOARDING COSTS ON ARTS US THE
STATE SO THEY MAKE FUNDING FOR
ONBOARDING. BUT FOR ONGOING
COSTS OF WHICH CAN BE QUITE
SUBSTANTIAL- OFTEN MANY OF
THESE FUNDING SOURCES DON'T
SUPPORT THOSE ONGOING COSTS IN
THE LAWSUIT JUST THE USE OF THE
HIGH TECH ADMINISTRATIVE
FUNDING TO SUPPORT- HEALTH
INFORMATION EXCHANGE THAT'S
GOING TO EXPIRE. THIS WAS LAW-THAT WAS PASSED OVER A DECADE
AGO THE CREATED THIS INCENTIVE
PROGRAM INCLUDING A 90% FEDERAL
MATCH AND THAT'S GOING TO
EXPIRE NEXT YEAR. SO THAT
FUNDING OPPORTUNITY WILL LIKELY
BE SOMEWHAT CLOSED. SO NEXT
SLIDE PLEASE WE'RE ON SLIDE. A
THREE DIRECTED LEPERS SO THIS
IS SORT OF THE LEVERS THAT
DESPITE CONTRACTING RULE MAKING.
I TOOK PART IN OPERABILITY. I
TOOK PART MISSION EXCHANGE
MARKS NETWORK PARTICIPANTS
STATE PURCHASERS REGULATORS AND
OTHERS THE PROMULGATED EXCHANGE
REQUIREMENTS AND RULES. SO A
CONTRACTING AUTHORITY IS JUST
AS IT SAYS IT'S THE FORTY
THAT'S AT ISSUE THROUGH THE
CONTRACT THE PROCUREMENT OF A
MANAGED CARE ORGANIZATION BY A
PURCHASER CAN INCLUDE
INFORMATION EXCHANGE
REQUIREMENTS. A COVER
CALIFORNIA WHICH YOU HAVE A
VERY NICE PASSED BY THE WAY.
SOME OF THESE REQUIRED IN THE
TOP SEVEN HAS HAD IN THE PAST
THAT TRIED TO INCENTIVIZE
CREATE THE RIGHT SORT OF.
ALIGNMENT TO ENCOURAGE HEALTH
PLANS TO USE. NETWORKS THAT
HAVE INFORMATION EXCHANGE
REQUIREMENTS AS PART OF THEM
STATE AGENCIES CAN ALSO USE
REGULATORY RULEMAKING- TO
ADVANCE HEALTH INFORMATION
EXCHANGE. AND THESE CAN ARE
REALLY ALIGNED WITH- AGENCY
GOALS- IN ORDER TO CREATE
INCENTIVES OR THERE CAN BE
LICENSING RULES THAT ARE
ESTABLISHED AROUND HOW CERTAIN
TYPES OF ORGANIZATIONS WHETHER
HOSPITALS NURSING HOMES OR
OTHERS. MAY BE REQUIRED TO USE
INFORMATION EXCHANGE OR
EXCHANGE INFORMATION AS PART OF
A LICENSING PROCESS SO THERE
ARE SOME EXAMPLES AS WELL- OF
HOW THESE TYPES OF RULES THESE
TYPES OF LETTERS HAVE BEEN
USING MICHIGAN'S ANOTHER ONE
WHERE MANAGED CARE
ORGANIZATIONS. ARE ACTUALLY
REQUIRED TO PROVIDE.
CONNECTIVITY THROUGH THEIR
THROUGH THE MANAGED CARE
CONTRACTS. NOW SOME SOME OF THE
CONS OF THESE OF PARTICULAR
CONTRACTING SITE IS THAT THEY
CAN BE DIFFICULT TO ENFORCE A
CONTRACT AND HAVE. ALL SORTS OF
CLAUSES IN IT. BUT THERE ARE
SOME CASES- SOME RISKS
ASSOCIATED WITH ENFORCING THOSE
RULES ESPECIALLY IF YOU AVE A
FRAGILE NETWORK- YOU MAY NOT
HAVE HEY. YES THEY ARE WEALTHY
PAYER. AND SO IF YOU HAD A SET
OF REQUIREMENTS AND PENALTIES
THAN. THOSE WHO ARE BEHOLDEN TO
THE CONTRACT HELPED BY THE
PROVIDER NETWORKS MAY SAY THE
COST IS TOO MUCH. AND THEY WALK
AWAY FROM IT AND SO IT MAKES
THOSE NETWORKS MORE FRAGILE AND
UNSTABLE THE OTHER IS THAT. IN
THIS IS A PARTICULAR AROUND
RULEMAKING- GUIDANCE THAT
WITHOUT CLEAR DIRECTION FROM
STATE LEADERSHIP SOME AGENCIES
MAY PRIORITIZE OTHER THINGS
OTHER OTHER PRIORITIES AND
DIFFERENT AGENCIES MAY PURSUE
DIFFERENT PATHS WHICH CAN
RESULT IN DOWNSTREAM I
STAKEHOLDERS THAT ARE IMPACTED
OR AFFECTED BY RULES MAY BE
AFFECTED BY. RULES THAT ARE
CONSISTENT OR ONLINE. I'M AND
SO THOSE ARE SOME OF THE
CONCERNS- THAT OR OR SOME OF
THE SHORTCOMINGS OF THIS
CONTRACT OF THESE CONTRACTS FOR
RULEMAKING OF APRS WE HAVE SEEN
AGAIN SOME OTHER STATES THAT
HAVE USED EFFECTIVELY SOME OF
THESE CONTRACTING REQUIREMENTS
NORTH CAROLINA IS A GOOD
EXAMPLE. WHERE THEY HAVE BOTH
BLUE CROSS. WILL BLUE CROSS- IS
A LARGE PAIR THERE AT THE S. OR
THE BIGGEST PRIVATE PAY ARE.
ALSO INVOLVED OR WILL BE LIKELY
MEDICAID WHEN THEY GO THROUGH
MANAGED CARE. AND THEY HAVE
CONTRACTED REQUIREMENTS AND
THEY ACTUALLY REQUIRE-
CONNECTIVITY TO A STATE HEALTH
INFORMATION EXCHANGE BECAUSE
THAT'S THE HEALTH CONNECTS. I'M
AS PART OF THEIR- THE CONTRACTS
THEY HAVE WITH THEIR PLAN WITH
THEIR PROVIDER NEXT SLIDE
PLEASE. FINALLY ARE ON THE FAR
EXTREME IS EXECUTIVE ORDERS AND
LEGISLATIVE LEVERS AND SO
GOVERNOR'S AN EXECUTIVE ORDER-
AS YOU KNOW HOW TO FORTY TO
DIRECT STATE REGULATORY
AGENCIES TO AND- AND PURCHASES
ARE THE PURVIEW TWO TO-
ENCOURAGE HEALTH INFORMATION
EXCHANGE- THROUGH A CERTAIN
RULE MAKING THAT EXIST WITHIN
EXISTING THAT THAT THEY HAVE
WITHIN THEIR EXISTING
AUTHORITIES- LAW OF COURSE CAN
ANYTHING HENCE. THE AUTHORITY
OF VARIOUS STATE AGENCIES AND
CREATE NEW RULES OR
REQUIREMENTS FOR THOSE WHO DO
BUSINESS WITH THEM OR FOR OTHER
ACTORS IN THE STATE LIKE PLANTS
AND PROVIDERS. REQUIRE THEM TO
DO THINGS SURE AT THE PROS AND
CONS ARE AS FOLLOWS ON FOR AN
EXECUTIVE ORDER- THEY CAN BE
ACTED VERY QUICKLY- SO THEY CAN
BE DONE WITHOUT GOING THROUGH
THE LEGISLATIVE PROCESS- AND
THEY CAN DIRECT STATE AGENCIES
TO COORDINATE THEIR ACTIONS. IN
CERTAIN WAYS AS LONG AS THOSE
AGENCIES ACTUALLY HAVE NINE
FORTY TWO ACTON IN WAYS THAT
THEY'RE DIRECTED BY THE
GOVERNOR. AND THEN LEGISLATIVE-
IS A LONGER TIME FRAME TO GO
THROUGH A PROCESS OBVIOUSLY IF
OF- OF HEARINGS ETCETERA- BUT
IT CAN IT CAN ENACT NEW
AUTHORITIES ARE YOU CAN CREATE
NEW LAW. MANDATES AS YOU'D
HEARD- PREVIOUSLY THAT WILL
REQUIRE FOR EXAMPLE- THE
EXCHANGE OF INFORMATION AMONG
STEP IN FRONT SPECIFIED
PARTICIPANTS. SO WHAT ARE WHAT
ARE THE CONS OF THE TWELFTH
FIRST EXECUTIVE ORDER. YOU CAN
ORDER STEP WE DON'T GO THROUGH
A LEGISLATIVE PROCESS SO THERE
ARE OPPORTUNITIES FOR HEARINGS
TYPICALLY- THEY DON'T GO
THROUGH THAT SORT OF
STAKEHOLDER PROCESS AND SO
THEY'RE OFTEN THEY CAN CREATE
OR BREED MISTRUST OR- OR ANGST
OR OR OR WORSE- ABOUT THE NEW
RULES AND- NEW REQUIREMENTS
THERE PUT. PLACE I GUESS IN
TERMS OF THE. IN TERMS OF THE
LEGISLATION. ONE OF THE
SHORTCOMINGS IN SOME CASES
MAYBE THE ENFORCEABILITY OF THE
LAW AND THERE'S ONE EXAMPLE IN
MINNESOTA WHERE THERE IS A
STATEWIDE MANDATE FOR
ELECTRONIC HEALTH RECORD USE
AND INFORMATION EXCHANGE IN
WHILE MINNESOTA THE- THE
MANDATE FOR EHRS RELIEF- HAD
WENT INTO EFFECT AND WHAT WAS
ALIGNED WITH HIGH TECH THERE IS
REALLY VERY. MINIMAL
ENFORCEMENT MECHANISMS FOR THAT
THE INFORMATION EXCHANGE
MANDATE AS A RESULT- THAT
REALLY HASN'T COME TO PASS
THERE HASN'T BEEN THE SAME SORT
OF THE LEVEL OF INFORMATION
EXCHANGE. THAT YOU SEE IN
PLACES LIKE MARYLAND OR
MICHIGAN OR NORTH CAROLINA
WHERE. LEADERSHIP AND
DIRECTIVES AND MANDATES- HAVE
EXISTED AND HAVE HELP TO PUSH
FORWARD INFORMATION EXCHANGE.
SO THAT'S SORT OF WHERE THE
VARIETY OF DIFFERENT LEVERS
EXISTS NOW WHAT DID WE LEARN
AND WHICH DESCRIBE IN THE PAPER
ABOUT HOW THESE ARE USED
TOGETHER- FIRST OF ALL- I THINK
ONE IS THAT WE FIND THAT. A
MAJOR BARRIER IN AND STATES
THAT CONTINUE TO STRUGGLE WITH
INFORMATION EXCHANGE IS THAT
THERE'S A LACK OF SUPPORT OF
STATE POLICIES AND LEADERSHIP
YOU HEARD FROM AGAIN FROM THEIR
HEART THAT. IN MARYLAND WHAT
REALLY GOT. THE STATE MOVING
WAS A GOVERNOR AND THE
SECRETARY WHO WAS BEING- WHO
TOOK THIS ON AS A MAJOR
INITIATIVE FOR THE FOR THE
STATE. AND FOLLOWED UP WITH
LEGISLATION THAT ESSENTIALLY
REQUIRED PARTICIPATION HIV OR
H. I. O. SO WE FIND THAT NGUYEN
IN STATES WHERE YOU HAVE THAT
KIND OF STRONG LEADERSHIP AND
SUPPORT OF POLICIES THAT ARE
DIRECTED INCLUDING MANDATES.
YOU TEND TO GET STATES THAT ARE
MORE SUCCESSFUL. THE SECOND IS
THAT THERE'S THIS IN MANY
STATES THAT HAVEN'T REALLY
ADVANCED THE BALL AS MUCH-
THERE CAN BE A LACK OF A
COMPELLING BUSINESS CASE AND A
LACK OF INCENTIVES OR
FINANCING. MARYLAND TOOK CARE
OF THAT BY HAVING THIS GLOBAL
PAYMENT PROGRAM WHICH REALLY
ALIGNS WELL WITH THE
REQUIREMENT TO EXCHANGE DATA.
MICHIGAN SIMILAR REYES HAD A
PAIR OF I'VE MENTIONED. THAT
OUTLINED INFORMATION EXCHANGE
REQUIREMENTS AND MANAGED CARE
IN MEDICAID ALSO HAS
REQUIREMENTS AROUND INFORMATION
EXCHANGE. SO YOU YOU HAVE WERE
STRONG REQUIREMENTS OF STRONG
PAYER ALIGNMENT INCLUDING
INCENTIVE PAYMENTS AND THE SAME
THING WITH NORTH CAROLINA- YOU
HAVE A MANDATE IN THE STATE.
YOU HAVE A CARE IN BLUE CROSS
THAT IS INCENTIVIZING AND
REQUIRING INFORMATION EXCHANGE.
YOU HAVE STATE FUNDING FOR THE
INFORMATION EXCHANGE AND YOU
HAVE INCENTIVE PAYMENTS AND-
FOR THE PAYMENTS TO SUPPORT
ONBOARDING FOR NUMBER OF
ORGANIZATIONS. YOU KNOW THE
LACK IS AROUND PRIVACY CONCERNS
FOR SOME TYPES OF DATA THOSE
ARE SOME OF THE MEDIATED BY
HIPAA AND- OTHER ACTS. BUT
THERE STILL REMAINS SIGNIFICANT
CHALLENGES AROUND- EXCHANGING
INFORMATION FOR PEOPLE WITH
WITH WITH. THERE IS A PROCESS
MONITOR SUBSTANCE USE DISORDERS
AND HIV- AND THOSE ARE
SIGNIFICANT CHALLENGES
PARTICULARLY IN CALIFORNIA. SO
MOST OF WHAT WE FOUND IS THAT
MOST STATES HAVE BEEN
SUCCESSFUL HAVE REALLY CREATED
A SERIES OF LEVERS ARE
DEPRESSED MULTIPLE LEVERS OF
WANTS TO BOTH. CREATE MANDATE
HAVE A SUPPORT STRUCTURE THAT
INCLUDES INCENTIVES AND
PAYMENTS. AT THAT HAS- A WINE
CONTRACTING BOTH IN MEDICAID
AND ALSO IN THE PRIVATE CONTEXT
AND THEY ALSO USED A SERIES OF
THESE SORT OF SUPPORTIVE
STRUCTURES LIKE INCENTIVES. AND
THE SUPERVISORY GROUPS THAT
HELP DEFINE AND SUPPORT POLICY
DEVELOPMENT. SO WHEN I TELL YOU
I TOLD YOU- WHAT KIND OF
LEVERAGE WERE AVAILABLE. I'M
WHAT WE SEEN ACROSS THE COUNTRY
IN TERMS OF SOME OF THE STATES
THAT HAVE USED A VERY SLIPPERS
AND- HOW THOSE LEVERS CAN BE
USED IN COMBINATION AND HAVE
BEEN MOST EFFECTIVE WHEN USED
TOGETHER. IN A FRIDAY STATES TO
ADVANCE INFORMATION EXCHANGE-
AND WITH THAT I THINK THAT-
HELLO WE'VE OPENS YOUR
QUESTIONS THANK YOU. GREAT WELL
THANK YOU VERY MUCH- DO WE HAVE
ANY QUESTIONS FROM. ANYONE
OTHER THAN ME. MR BONTA. BUT
YOU NEED A NEED THERE THANK YOU
CAN YOU HEAR ME YES I THANK
YOU- MISTER CHAIR MISTER-
FOLLOW FOR YOUR TESTIMONY AT X.
ONE THINK ARE OUR OUR CHAIR
FOR- UPLIFTING THIS IDEA
PROVIDING THE ROBUST AND
THOROUGH DISCUSSION TODAY FROM
MANY DIFFERENT PERSPECTIVES I
DEFINITELY THINK THAT HEALTH
INFORMATION EXCHANGES ARE-
WORTHY OF OUR VERY SERIOUS
CONSIDERATION I THINK WE SHOULD
CHAMPION AT THIS YEAR AND- IT
REALLY BE A SYSTEMIC AND
STRUCTURAL CHANGES WELCOME IN
OUR HEALTHCARE SYSTEM AS WE TRY
TO PROVIDE. A TO ACCESS TO HIGH
QUALITY AFFORDABLE HEALTHCARE
TO EVERY SINGLE DAY CALIFORNIA
I THINK IT'S SOMETHING IS
MISSING RIGHT NOW SO I'M I'M
I'M A STRONG SUPPORTER- AND IF
THERE'S A COALITION BUILDING TO
WORK ON THIS I'M I I'M HAPPY
TECH TO WORK WITH THE
COALITION- SO THANK YOU MISTER
CHAIR IN OUR COLLEGE
PARTICIPATED TODAY I THINK YOU
CAN REALLY REMOVE- SOME
INEFFICIENCIES REMOVE IT
ADMINISTRATIVE COSTS ARE WHAT I
CALL FRICTION IN THE SYSTEM
THAT THAT NEED TO BE THERE THAT
LEADS TO WORSE PATIENT OUTCOMES
AND WORST PATIENT CARE YOU CAN
INCREASE AFFORDABILITY.
ABSOLUTE OF GOOD BENEFITS TO IT
AND I APPRECIATE THE MENU OF
OPTIONS I JUST PRESENTED-
SHOULD TO THE LEGISLATURE
WANNA- OR SORRY SHOULD
CALIFORNIA WANT TO AS
AFFORDABLE AS POSSIBLE GIVEN
ARE PROJECTED FIFTY FOUR
BILLION DOLLAR DEFICIT I WANT
TO MOVE IN THIS DIRECTION OUT
WITH AS MUCH CLARITY AS
POSSIBLE TO GET A HEALTH
INFORMATION EXCHANGE UP AND
RUNNING AS SOON AS POSSIBLE
WHICH OF THE MENU. WHICH OF THE
OPTIONS IN THE MENU. WE YOU
RECOMMEND. I YOU SWIMMING ABOUT
THAT THAT'S A REALLY GOOD
QUESTION- BUT I THINK FIRST OF
ALL. ARTICULATING A VISION FOR
WHAT THE STATE REALLY WANTS TO
ACCOMPLISH IN ITS PRIORITIES
IT'S THE MOST IMPORTANT THING
IT NEEDS TO HAPPEN FIRST AND IF
THE STATE CAN DO THAT WITH THIS
LEADERSHIP WITH THE LEGISLATURE
AND THIS ADMINISTRATION. AND
DEFINE WHAT THOSE PRIORITIES
ARE THE BEST PRIORITIES COULD
BE ANYTHING FROM CAROLINE AND
ADVANCING PUBLIC OPTING OF THE
THAT THE PROGRAMS THAT CALTRAIN
IS INTENDED TO- IMPROVE AROUND
ENHANCE CARE MANAGEMENT- OR
FITS AROUND PANDEMIC RESPONSE
FOR SERIOUS MENTAL ILLNESS AND
EXCHANGE INFORMATION. FIRST
DEFINING WHAT THOSE THOSE USE
CASES AND THOSE ISSUES ARE.
THAT'S THE THAT HAS TO BE A
PRICE. FOLLOWING THAT. IT'S
REALLY HARD TO SEE CALIFORNIA
ADVANCING FURTHER WITHOUT
HAVING SOME SORT OF DIRECTIVE
FROM THE STATE AND THE FORM OF
A MANDATE OF SOME KIND THAT
SUPPORTS THAT VISION. OUT WE'VE
TRIED FOR DECADES- AND I'VE
BEEN AT THE STATE WHEN WE TRIED
AND DID NOT SUCCEED IN
ADVANCING INFORMATION EXCHANGE
AS MUCH AS WE SHOULD WE DID IT
WITHOUT A MANDATE- AND- QUITE
FRANKLY WITHOUT HAVING SOME
MORE DIRECTIVES BUT ALSO
SUPPORTIVE POLICIES- BECAUSE
UNFUNDED MANDATE AND AS YOU
MENTIONED WE HAVE A DEFICIT-
DOES NOT CREATE THE KIND OF
NVIRONMENT IT REALLY IS GOING
TO SUPPORT ORGANIZATIONS IN
PARTICULAR THOSE IN THE SAFETY
NET. WE'RE GONNA BE IMPACTED BY.
SO I THINK IT'S I THINK IT IS
IMPORTANT THAT YOU CONSIDER THE
VISION GOALS. CREATE A
LEGISLATIVE. PROCESS TO BE
DIRECTIVE BUT ALSO TO BE
SUPPORTIVE OF THE ORGANIZATIONS
WE'RE GONNA HAVE TO BEAR A
GREAT DEAL ACOSTA AND FINDING
THOSE FUNDING SOURCES WHETHER
IT'S LEVERAGING. FEDERAL MONIES
90% FEDERAL MATCHING.
ABSOLUTELY SHOULD BE A PRIORITY
IN PROCEEDING. THINK OF IT
THANK YOU. MISTER CHAIRMAN ACT
OR OF COURSE PLEASE. THANK YOU
MISTER CHAIRMAN WELL I
APPRECIATE THOSE COMMENTS I
DEFINITELY AND AM INTERESTED IN
ANY FEDERAL MATCHES 90% IS-
HIGHLY WELCOME ENCOURAGED IF
IT'S IF IT'S POSSIBLE- AND- AB-IT SOUNDS LIKE YOU'RE SAYING
THAT YOU KNOW CLARITY IT IN
MAYBE IN THE FORM OF A MANDATE-
YOU KNOW I'M A LEGISLATOR AND
AT AND WE CAN. AND THIS IS A
LEGISLATIVE BODY SO WE SEE A
LOT OF THINGS TO THE LEFT OF
LEGISLATION I KNOW THAT'S NOT
THE ONLY. WAY TO MOVE-
IMPORTANT POLICIES FORWARD BUT-
IT SOUNDS LIKE YOU MIGHT BE
SAYING LEGISLATION IT COULD
COULD BE A AN IMPORTANT WAY TO
PROVIDE THE CLARITY DEPRIVE THE
MANDATE- AND YOU HAVE A-
COMPARATIVE PERSPECTIVE-
MEANING YOU YOU SEE WHAT OTHER
STATES HAVE DONE AND DONE WELL.
YOU MENTION YOUR TESTIMONY
MARYLAND NORTH CAROLINA YOU
THINK THAT NORTH CAROLINA
STATUTE OR SOMETHING WE SHOULD
BE LOOKING AT CLOSELY I. I
THINK IT IS I THINK ONCE ONCE
THERE'S A CLARITY OF THE VISION
AND THE PROBLEMS TO SOLVE THE
PRIORITIES. LOOKING AT THE
VARIOUS MODELS OF STATES HAVE
TAKEN- MARYLAND'S NORTH
CAROLINA- HARD PART TWO. GOOD
EXAMPLES BUT THERE ARE OTHERS-
WOULD BE. A VERY WORTHWHILE
ENDEAVOR JUST TO ENSURE THAT
WHAT. WE'RE TRYING TO ACHIEVE
MAKE IT CHEAPER BOND HAS AND
WHAT RESULTS. HAVE BEEN.
APPROVED NOT ANOTHER STATE SO I
WOULD. CERTAINLY LOOK AT THEM
AS- ESPECIALLY IF IT ALIGNS
WITH SORT OF THE VISION OF THE
PRIORITIES THAT. WE NEED TO SET
UP. THANK YOU MISTER PHILIP
YOUR TESTIMONY WAS VERY HELPFUL
TO ME I APPRECIATE IT VERY
MUCH. THANK YOU VERY MUCH
NEVADA THANK YOU AND THANK YOU
MR BONTA APPRECIATED GOOD TO
SEE YOU- A COUPLE QUESTIONS-
MISTER PRODUCT AND- THE FIRST
OF ALL WHAT DO YOU SEE AS SOME
OF THE MOST SIGNIFICANT. GAPS
IN HEALTH INFORMATION DATA
EXCHANGE RIGHT NOW. WELL ONE
INPUT- OTHER THAN FOR THE
LEVERS YOU MENTIONED AROUND
IRAQ. HELLINGER LEGAL
REQUIREMENTS ONE IS JUST AROUND
FUNDING- THERE ARE. HUNDREDS OF
HOSPITALS FOR HOSPITALS IN THE
STATE OF CALIFORNIA MANY WHICH
ARE SAFETY NET HOSPITALS ARE
CRITICAL ACCESS HOSPITALS THAT
DO NOT HAVE EXTENSIVE- AND BACK
SENSE OF RESOURCES TO BE ABLE
TO IMPLEMENT SOMETHING. TO BE
ABLE TO CONNECT TO AN
INFORMATION EXCHANGE TO BE ABLE
TO SUSTAIN THAT CONNECTION
THERE COMMUNITY CLINICS EIGHT
HUNDRED CORPORATIONS
ORGANIZATIONS- OVER TWO HUNDRED
EIGHTY CORPORATIONS AND A
NUMBER OF SMALL PRIMARY CARE
PRACTICES THEY CANNOT AFFORD TO
CONNECT AND SUSTAIN A
CONNECTION BASED ON THE CURRENT
REVENUES PARTICULAR MANY THE
MARKET VERY HARD. I COVERED. SO
THAT'S A SHIFT THAT'S IT
INSTEAD MORE. CONCERN OR ISSUE
BUT IT LONGER TERM YOU STILL
HAVE SMALL PRACTICES THAT JUST
COULD NOT BEAR THE BURDEN OF
CONNECTING TO AN INFORMATION
EXCHANGE. AND SUSTAINING THAT
COST THERE NEEDS TO BE SOME WAY
TO SUPPORT THAT- MANY OF THOSE
CONSTITUENCIES. THAT'S ONE I
THINK THE SECOND IS THERE'S A
LACK OF THE KIND OF A REALLY
COMPELLING BUSINESS CASE. WHEN
HEALTH CARE IS STILL. LIKE IT
OR NOT IT'S STILL A BUSINESS
FOR THE MOST PART IT MAY BE
PRINT NOW PREDOMINATED BY A
NUMBER OF NONPROFIT
ORGANIZATIONS BUT- IT IS A
MARKET DRIVEN. ECONOMY AND
UNLESS THERE IS A VERY CLEAR
BUSINESS RATIONALE. AGAIN IT
CAN BE SUPPORTED BY ENABLING
LEGISLATION OR OTHER POLICIES
BUT UNLESS THERE'S A CLEAR
RATIONALE ORGANIZATIONS ARE
GOING TO CHOOSE. WHAT TO INVEST
IN BASED ON MANY THANKS THEIR
MISSIONS MANY OF WHICH ARE
KNOWN IF THERE'S NO MARGIN IS
NO MISCHIEF THEY NEED TO MAKE
SURE THEY CONTINUE TO EXIST-
AND SO THEY HAVE TO MAKE
INVESTMENTS BASED ON- THEIR
BUSINESS INTERESTS. AND THERE
IS NOT REALLY YET COMPELLING
BUSINESS CASE IN CALIFORNIA-
UNLIKE IN MARYLAND WHERE
THERE'S ESSENTIALLY A
REQUIREMENT BASED BECAUSE THEY
PRODUCT LOCAL. THE PRODUCT
GLOBAL BUDGET PROCESS AND THEY
GET DATA FROM THE HOSPITAL
THREE THIRTY JACQUI TO ENABLE
AND SUPPORT THAT- SO WITHOUT A
COMPELLING BUSINESS CASES
WITHOUT FINANCING THOSE ARE TWO
OF THE BIGGEST BARRIERS I THINK
THAT WE FACE. TODAY SO- FROM.
NOW MAY I MISS BECAUSE THIS IS
A VERY COMPLICATED SUBJECT
OBVIOUSLY I MAY HAVE MISSED.
MAY MISUNDERSTOOD THIS BUT- IS
THE FUNDING FOR SOME OF THIS
RUNNING OUT IN SEPTEMBER. FOR
IS THAT WE HEARD FROM MARK FROM
DH CS THAT- THAT THERE WAS
THERE'S SOME FUNNY RUNNING OUT
IN SEPTEMBER. IS THAT. IS THIS
TIED TO THE 90% FEDERAL MATCH
IS THAT GOING TO BE AN ONGOING-
MATCH THAT'S OUT THERE IN
PERPETUITY OR OR OR NOT MORE WE
CAN NEVER KNOW EVER. BUT BUT
BUT YOU KNOW IS THAT IS THAT
OUT THERE FOR THE FORESEEABLE
FUTURE RIGHT SO DR SCOTT
DESCRIBED THE CALVET BROKE
GROUND THIS WAS THAT FIFTY
MILLION DOLLARS THANKS TO FIVE
MILLION DOLLARS FOR THE
LEGISLATURE- FOR. CREATING A
90% MATCH THE 10% FOR THE 90%
DRAWDOWNS FIVE MILLION FROM THE
STATE FORTY FIVE NINE FOR THE
FEDERAL GOVERNMENT FIFTY
MILLION TOTAL FOR POWERHA UP
WHICH IS. THIS INFORMATION
EXCHANGE ONBOARDING PROGRAM FOR
MEDICAL PROVIDERS. THOSE FUNDS
DO EXPIRE THEY GO AWAY IN
SEPTEMBER OF TWENTY TWENTY ONE.
THE THOSE FUNDS WERE ENABLED BY
THE HIGH TECH PROGRAM OR THE
AFFORDABLE CARE ACT WHICH IS
THE LAW THAT WAS PASSED HIGH
TECH WAS A BILL WITHIN IT. AND
IT ENABLED AND SUPPORTED THEY
HAD AN AND DR SCOTT WENT
THROUGH THIS VERY LONG WITH THE
A PROGRAMS THAT IT WAS THAT
ENABLED. ONE OF WHICH WAS JUST
NINETY TEN FUNDING STREAM FOR
HIV. THAT FUNDING STREAM. WILL
GO AWAY IN SEPTEMBER OF TWENTY
TWENTY ONE WITHOUT ANY CHANGE
UNLESS SOME CHANGE THAT ARE
MADE A I DON'T. AND I WOULD
HAVE TO BE UT OF THE CHANGE UP
OFF THE FUN STREAM THEN STATUS
MEAN THAT ALL FUNDING OPTIONS
INCLUDING. TEN FUNDING UP GO
AWAY THERE'S OTHER TYPES OF
NINETY TEN OR SEVENTY THIRTY OR
FIFTY FIFTY MATCHES. WE COULD
POTENTIALLY TAP INTO. AND A
STRAIGHT FOR. MEANING THEY HAVE
TO BE TIED TO THINGS LIKE THE
MEDICAID- ENTERPRISE MANAGEMENT
SYSTEMS SO YOU YOU HAVE TO MAKE
A CASE. CALIFORNIA THAT.
FEDERAL DOLLARS BEING ACCESSED
THROUGH THAT PARTICULAR
CHANNEL. I REALLY GOING TO
SUPPORT MEDICAID ENTERPRISE
SYSTEMS. WHICH COULD BE LIKE AN
ELIGIBILITY ENROLLMENT SYSTEM
IT COULD BE A PAYMENT SYSTEM
BUT- THE DOORS ARE. ARE ARE ARE
NARROWER. WHEN IT COMES TO
THOSE PAYMENT STREAMS- THAT
HIGH TECH NINETY TEN FUNDING TO
DEPART EXPIRES IN SEPTEMBER
WAS. DIRECTED AND DEDICATED TO
THIS KIND OF ACTIVITY AND
THAT'S WHAT'S GOING AWAY. OKAY
THANK YOU. AND MR BONTA TOOK
ONE OF MY QUESTIONS WHICH WAS A
GOOD GOOD FOR HIM BUT- AND WELL
AS WELL DOWN ON HIS SIDE ON HIS
HANDS. BUT YOU GO BUT I WANT TO
GO BACK TO THE QUESTION
ACTUALLY HAD FOR MR HORROCKS
AND THAT IS- BUT BUT THIS IS A
LITTLE BIT OF A TWIST BECAUSE
YOU'VE ADDED NEW INFORMATION
HERE. YOU KNOW YOU'VE TO TALK
ABOUT THAT IT'S COSTLY FOR
SMALL SMALL PROVIDERS IT'S
COSTLY FOR SMALL HOSPITALS TO.
DO TO MAKE THE INVESTMENTS TO
GET THIS GOING BUT ALSO TO
MAINTAIN IT AS WELL. AND THAT
THERE ISN'T A COMPELLING
BUSINESS MODEL FOR THAT- FOR
THIS FOR THOSE ENTITIES IS THAT
A FAIR. SO YES. SO OBVIOUSLY DH
CS HAS A HAS A HAS A BIG
INTEREST IN THIS BECAUSE WE
HAVE THIRTEEN MILLION MEDICARE
BENEFICIARIES. YOU WHO ELSE HAS
A BIG INTEREST IN THIS AND HOW
DOES THAT HELP THE CONSUMER ON
THE OTHER END. WELL YOU'RE
WEARING ONE OF THEM THE COVER
CALIFORNIA HAS A BUSINESS
INTEREST THE CASE. THAT
INFORMATION EXCHANGE CAN
PROVIDE VALUE THAT IT CAN
ACTUALLY HELP REDUCE
UNNECESSARY UTILIZATION COSTS
IS AS THEY PARKS MENTIONED
THERE IS EVIDENCE OUT THERE. IT
IS IT IS- IT'S NOT SO
CONVINCING THAT EVERYBODY'S
GONNA SAY THIS IS WHAT WE HAVE
TO DO IT IS GOING TO GO AHEAD
AND DO IT BUT THERE ARE. CASES
AND THAT REPORT- THAT- YOU
REFERENCE THE BEGINNING OF MY
TESTIMONY. HAD A COUPLE OF
EXAMPLES AND CITATIONS FOR- FOR
RESEARCH STUDIES FROM THAT
EARLY MARKET MEDICAL
INFORMATICS ASSOCIATION. ABOUT
SOME OF THE SAVINGS- FROM HIV
SO THERE. THERE IS SOME
EVIDENCE THAT THAT- THAT
DOLLARS CAN BE SAVED AND
OUTCOMES CAN BE IMPROVED AND
UTILIZATION UNNECESSARY
UTILIZATION CAN BE DECREASED.
SO THERE'S A BUSINESS INTEREST
ON FROM- FROM COVER
CALIFORNIA'S PERSPECTIVE- TO
TRY TO MANAGE TO KEEP COSTS AND
PREMIUMS DOWN. FOR ALL THE
BENEFICIARIES WILL ACCESS
COVERAGE THROUGH THE MARKET
PLACE. AND BUT ALSO TO CREATE
THESE- THESE- THESE INCENTIVE
PROGRAMS THESE PAY FOR
PERFORMANCE PROGRAMS SHOULD
SAVINGS PROGRAMS. MUCH OF WHICH
RELY ON EXCHANGING INFORMATION-
ACROSS VARIOUS PARTIES AND SO
AND SO YOU HAVE COVERED
CALIFORNIA'S CALPERS CAL IS
ANOTHER LARGE PURCHASER IN THE
STATE- THEY'VE HAD SOME SUCCESS
IN SOME OF THEIR INNOVATIVE-
PAYMENT PROGRAMS WHETHER IT'S
AROUND- WHETHER IT'S AROUND
THERE- I CAN PUT YOUR
ORGANIZATION WITH BLUE SHIELD
AND DIGNITY AND- HEAL
PHYSICIANS. THEY'VE SHOWN REAL
SAVINGS- AND CREATING THOSE
PROGRAMS WHICH REQUIRE.
INFORMATION EXCHANGE WITHIN
THAT NETWORK OF PROVIDERS AND
PLANS. SO THERE ARE THEIR
PURCHASERS LIKE CALPERS AND
EVEN PRIVATE PURCHASERS WHO
WOULD BE WHO COULD BENEFIT FROM
THE MANAGEMENT OF TOTAL COST OF
CARE- AND BEING ABLE TO
EXCHANGE MORE INFORMATION TO
MANAGE MORE COMPLEX PICTURE SO
PURCHASERS ALL AROUND REALLY
QUICK BENEFIT. BUT THAT THE
IMPLEMENTERS ARE BROADER THAN
PURCHASERS YOU'VE GOT AS WE
MENTIONED PROVIDERS AND OTHERS
WHO HAVE TO PUT THESE TOOLS IN
PLACE AND THEN USE THEM AND
INTEGRATE THEM INTO THEIR
WORKFLOWS AND THAT'S
CHALLENGING ESPECIALLY FOR
SMALL PRACTICE. GREAT WHAT WHAT
THANK YOU AND THAT THIS IS
REALLY HELPFUL I MEAN I'M- I'M
I'M SEEING THIS AS A AS A AS A
AS AS AN INTEGRAL COMPONENT IN-
OUR EFFORTS AS A STATE TO HELP
MANAGE THE OVERALL.
AFFORDABILITY OF HEALTHCARE SO.
NONE OF THESE BY THEMSELVES IS
THE MAGIC BULLET ALL OF THEM
TOGETHER WORKING. THINGS LIKE
THE ALL PAYER CLAIMS DATABASE
AND OTHER THINGS THAT WE'RE
LOOKING AT. ALL OF THESE THINGS
NEED TO BE FIRING ON ALL THE
SAME CYLINDERS FOR US TO HELP
GET THE MAXIMUM BENEFIT WE'RE
GOING TO HOPE TO ACHIEVE. AS WE
AS WE LOOK TO BEND THE CURVE-
ON ON THE COST OF THE COST OF
HEALTHCARE SO. SO THAT THAT'S
MY TAKE AWAY IS THAT THIS IS
THIS IS AN IMPORTANT PIECE OF
IT. BUT IT IS NOT A MAGIC
BULLET THERE IS NO MAGIC BULLET
THERE'S A LOT OF MAGIC BULLETS
I GUESS WE JUST NEED HIM ALL
THE SAME PLACE AT THE SAME TIME
SO. SO I WANT TO THANK YOU VERY
MUCH FOR YOUR FREE INFORMATION
AND IT WAS KIND OF A GREAT
SUMMARY TO WHERE WE- WHERE FROM
WHERE WE STARTED FROM SO. IT
CERTAINLY TAKES A LOT TO
THERE'S A LOT HERE AND IT'S A
COMPLICATED SUBJECTS ARE VERY
MUCH APPRECIATED THANK YOU
THANK YOU VERY MUCH FOR THEIR
SHIP AND SHIP. THANK YOU. SO
WITH THAT. THAT WOULD THAT IN
THAT IS THAT THAT IS MISTER PRO
BECAUSE OUR LAST SPEAKER OF THE
AFTERNOON AND WE WILL GO AHEAD
AND MOVE. TO A PUBLIC COMMENT.
AND WE'RE GONNA ASK US SPEAKERS
TO. WILL TRY TO LIMIT THEIR
COMMENTS TO TWO MINUTES PER
SPEAKER- IS THERE ANYONE IN ANY
OF OUR WITNESS ROOMS- LOOKING
FOR A PUBLIC COMMENT. DOESN'T
APPEAR SO THEN WE WILL. ASK FOR
ARE MODERATED- TELEPHONE
SERVICE- TO. YOU UP AND- AND
HAVE PEOPLE WHO WANT TO- IF
ANYBODY HAS ANY QUESTIONS FOR
US OUT THERE SO- LETTER
OPERATOR TAKE OVER AT THIS
POINT AND- AND- BRING QUESTIONS
FOR KIRK ACTUALLY IS NOT
QUESTIONS AS PUBLIC COMMENTS SO.
THIS IS A COMPLICATED TOPIC I
DON'T THINK I HAVE THE ANSWERS
QUITE FRANKLY. SO THANK YOU AND
LATE. THANK YOU LADIES AND
GENTLEMEN IF YOU DO HAVE A
PUBLIC COMMENT THIS TIME PLEASE
PRESS ONE AND THEN ZERO ON YOUR
TOUCH TONE PHONE. ONE CAN LEAVE
GENERAL GIVE A COMMENT TO TIME
PLEASE PRESS ONE ZERO. AT THIS
TIME I HAVE KNOWN IN Q. OKAY-
SEE. WE THOUGHT WE HAD. QUIT
WITHOUT WE HAD ABOUT A FEW
PEOPLE IN THE QUEUE SO. CAN WE
DOUBLE CHECK THAT. CERTAINLY AN
ONCE AGAIN LADIES AND GENTLEMEN
IF YOU DO HAVE A QUESTION AT
THIS TIME WE'RE CONFERENCE I
COMMENT THIS TIME PLEASE PRESS
ONE THEN ZERO ON YOUR TOUCH
TONE PHONE. WHAT.
AND CURRENTLY
KNOWN AS QUEUING UP TO MAKE A
COMMENT OR A- COMMENT. HANG
HANG TIGHT FOR A SECOND PLEASE.
SO WE CAN SEE THAT THERE ARE
PEOPLE OUT THERE BUT APPARENTLY
THEY'RE NOT QUEUING OUT SO.
FEELS LIKE A FISH FINDER WHAT
WE'RE TRYING. TRYING TO TRY TO
GET SOMEONE WHO- WHO WANTS TO
GIVE US A COMMENT. NTSB
CHAIRMAN IF YOU DO WISH TO MAKE
A COMMENT PLEASE PRESS ONE AT
THE END YOU KNOW WHAT. I WOULD
SAY THAT WE ARE ACCEPTING
COMMENTS IN WRITING SO IF- IF
PEOPLE OUT THERE DO YOU NOT
WANT TO MAKE A PUBLIC COMMENT
THIS POINT WE ARE WE CERTAINLY
WILL ACCEPT COMMENTS TO OUR-
ARE SIMPLY HEALTH WEBSITE. SO
THAT THAT'S CERTAINLY AN OPTION.
APPARENTLY MR ROBERT- I GUESS
PEOPLE ARE TRYING TO IMPRESS
ANYONE IS HERE AND THEY'RE NOT
GETTING THROUGH SO. NOT SURE
WHAT THE ISSUE IS. RE DIAL. I
WONDER PEOPLE MIGHT WANT TO
CONSIDER DIALING YOU KNOW
HANGING UP AND DIALING BACK IN
MAYBE I DON'T I DON'T I DON'T
KNOW I MEAN OBVIOUSLY THERE'S
THAT WE CAN SEE WHY PEOPLE WHO
WANT COMMENTS SO. I APOLOGIZE I
HAD ISSUED OUR FIRST QUESTION A
COMMENT ARE FIRST COME WILL
COME FROM ONE NUMBER FORTY FIVE
PLEASE GO AHEAD. THANK YOU.
AFTERNOON WITH THE JOINT CAMP
ON THE HAPPILY CARE THE LARGEST
PUBLIC MANAGEMENT. AND THE
NATION'S SERVING OVER TWO POINT
TWO MILLION MEMBERS THANK YOU
FOR HOLDING IMPORTANT HEARING.
ORDER FAR COMPLEX HEALTHCARE
SYSTEM TO EFFECTIVELY THIRD.
PATIENTS INTO THE CREEK
IMPORTANT THAT HELP STATE.
STATEMENT THE CURLY SHARE
ACROSS ALL STAKEHOLDERS
INCLUDING PAY THEIR CAREGIVERS.
PROVIDERS AND HELP. THE COURT.
LEVERAGING THE REACH REPORT BMS
IN OUR BUILDING WILL AND
TECHNOLOGY ALONG WITH THE BOOK
HEALTH AND- EXCHANGE. PROVIDED
FOUNDATION ON WHICH TO BUILD
ADDITIONAL A COPY THANK YOU.
THANK YOU. NEXT CALL. YOU YES
OUR NEXT COMMA COMPLY NUMBER
FORTY ONE PLEASE GO AHEAD.
HELLO MY NAME IS RONALD KOEMAN
BEYOND THE ALCATEL BACK THE
CALIFORNIANS THERE'S NO DOUBT
THAT MULTI DIMENSIONAL CHANGE
COULD LEAD TO BETTER HEALTH
BETTER CARE MORE FISHING CORGI
COORDINATION OF CARE PROVIDE
PUBLIC HEALTH BENEFITS WHILE
ALSO HELPING TO CONTROL
HEALTHCARE COSTS. EXHORTATION
TO GO BE ABLE TO MAKE THAT THAT
AND- TO THE PATIENT CONSUMER.
OTHER CAN. WE ALSO HOPE THAT.
HELPS WITH HEALTH CARE EQUITY
WE WANT TO BE CAUTIOUS WHILE
MODEL THAT NEED TO BE. AND
QUALITY CARE WE ALSO MUST
ENSURE THAT IT IS BECAUSE IT
INCLUDING PATIENTS WHO CONSUME
THE TRUMPETED. COMMUNITIES AND
WORKS WELL BECAUSE IT
CONNECTIVITY. AND BUILDS IF THE
BILL TO MAKE FREQUENTLY.
SUBJECT LASTLY WE MUST ENSURE
THAT WE BURKE THE THOUGHT
SHOULD TOP. INTERTEK OF
HEALTHCARE DATA SHARED THAT
HELP IN MAKING CHANGE SHOULD
PROTECT AGAINST. ME DATA
INCLUDING ABOUT THAT. TO DENY
HELP CARE ORANGE COVERAGE OR
TO. A PATIENT'S. AND BATTERED
LONGHORN MATCH TO ORG IN
ENFORCEMENT WE THANK YOU MISTER
CHAIR FOR. TEARING YOU CAN LOOK
FOR TO ENGAGE THE STATE TO.
BENEFITS CAL TO HELP COSTS.
THANK YOU. THANK YOU MUCH. OUR
NEXT COM WILL COME NUMBER FORTY
PLEASE CALL. THANK YOU CAN
ACROSS I AM SHE REGULATE
OFFICER A COMPANY CALLED
CITIZEN WHICH IS A PLATFORM
THAT ENABLES PATIENTS TO GATHER
THEIR HEALTH INFORMATION WE
HAVE AT THEIR FINGERTIPS. TODAY
STATE AND FEDERAL LAWS ALLOW
COULD ACTUALLY GIVE THEM BACK
THEIR RIGHT TO GET THIS THING
DONE. BUT IT. IT'S STILL VERY
IN TO DO SO CONSEQUENTLY AND IF
THERE S. B. H. I. EMAIL IN
PLACE THAT HELP TO. THE ABILITY
OF PATIENTS TO GET THEIR DATA-
IT COULD SIGNIFICANTLY EASE THE
PROCESS FOR PEOPLE WHO. WANT TO
GET THEIR DATA AND PARTICIPATE
IN THE MANAGEMENT OF THEIR CARE
MORE ACTIVELY CONTRIBUTE TO
RESEARCH- ETCETERA ALSO INVOLVE
THEIR CAREGIVERS AND THEIR CARE
WHO CAN ALSO HAVE ACCESS TO THE
DATA THAT WOULD ENCOURAGE YOU-
TO CONTINUE THESE CONVERSATIONS
I. FULLY SUPPORT THE TESTIMONY-
IN THE TICKET BUYERS IN SUPPORT
OF CREATING A SORT OF A STATE
WIDE STRATEGY- AROUND STATEWIDE
HIV- AND THANK YOU FOR THIS
TIME. PRITCHETT THANK YOU VERY
MUCH. NEXT CALLER PLAY. I NEVER
COME ACROSS ONE OF OUR FIFTY
SIX PLEASE GO AHEAD. GOOD
AFTERNOON BOB THIS IS FELIX IT
WITH BLUE SHIELD OF CALIFORNIA
AND WE ARE IN. TOTAL INCLUDES
OTHER SUPPORT- THE GOAL OF
UNIVERSAL HEALTH INFORMATION
EXCHANGE ACROSS THE STATE. BUT
OTHER NON PUBLIC HEALTH PLAN TO
SHOP MISSION IS TO PROVIDE
CALIFORNIANS ACCESS TO HEALTH
CARE THAT IS HIGH QUALITY AND
STATE THE PORTABLE. AND
OBVIOUSLY SHARING PATIENT
HEALTH RECORDS IS A CRITICAL
PART THAT MISSION. R. FOUR
MILLION MEMBERS AND IN FACT ALL
CALIFORNIANS DESERVE TO HAVE
ACCESS TO THE RECORDS IN A
SEAMLESS DIGITAL BILL TIME
FORMAT. AND IT IS THE MISSING
LINK THAT WILL ALLOW OUR
HOSPITAL AND PHYSICIAN PARTNERS
TO SHARE AND MUSICAL IN THE
NATION AND DO THINGS LIKE.
REDUCE UNNECESSARY CATCHES YOUR
BUDGETS TO AVOID COSTLY
MISSIONS AND A GOOD PATIENT
OUTCOMES AND WOULD ALSO ADD
THAT IT WOULD PROVIDE THE STATE
WITH LOW BUSTY INFRASTRUCTURE
TO ADDRESS PUBLIC PUBLIC AND
SHE'S LIKE ME COVER NINETEEN
PANDEMIC. SO THIS UPCOMING YEAR
WE LOOK VERY MUCH FORWARD TO
WORKING WITH THE LEGISLATURE
AND ADMINISTRATION- POLICIES
THAT WILL HELP MAKE STATEWIDE
HEALTH INFORMATION EXCHANGE A
REALITY THANK YOU. THANK YOU
VERY MUCH. NEXT CALLER PLEASE.
CONNECT COMMENT BECAUSE MY
NUMBER ONE PLEASE AHEAD. IT MY
NAME IS DOUBLE THREE EXPECTED
DIRECTOR WITH THE RIVER COUNTY
MEDICAL. WHICH REPRESENTS THE
INTO IN IN FEATHER CAL. AND WE
HAVE BEEN ON HEALTH ANTHONY
THAT FOR AT LEAST A LOT TWELVE
YEARS AND IT WILL HERE IN THE
EMPIRE THAT A ROBOT H. I. E.
BUT WITH IT BUT THEN THE IN ONE
SEVEN. AND DR THREE ON A ROPE
GAVE IN ORDER MAKE THAT GOOD
MEDICAL VISION BUT THEIR
PATIENTS. AND THOSE THAT LIMIT
AB DIPPED SORRY ALL THESE CUTS.
THE INFORMATION THAT HAVE. TO A
PAY L. THE FAULT. THEY HAVE NO
ABOUT AND THAT'S WHY IT SO
IMPORTANT THAT WE DO HAVE A
ROLE THAT. HR EAT COVER THE AND
STAY. SO IMPROVE IS THE FOR THE
PAY AT THE TIME. THAT THAT
ASIAN IS NEEDING CARE. THE ONLY
NUMBER WE HAVE ALSO HAVE AN X.
KERRIGAN. AND WE RELY. ON THE
L. THAT THAT COME THROUGH OUR
HEALTH INCLUDING NEXT. BROWN
THE HOPPER CLINIC IS BEING GET.
AND BECAUSE THE- EIGHTY FIVE
FOR. OF PATIENTS BETTER BEEN
DESTROYED FROM THE- IN OUR
ACCOUNTABLE CARE ORGANIZATION
OUR THEME BY THEIR PROVIDER
WITHIN SEVEN DAYS. IT'S IT IS
DOCTOR DID NOT GET THAT ALERT
WE WOULD HAVE NO IDEA THAT THE
PAGE YOU KNOW IT WOULD BE
DISCHARGED AND CAL AFTER THAT
TIME PERIOD MOST LIKELY. AND
POSSIBLY A RESULT IN RE
ADMISSION. AND HAVING THAT TYPE
OF INFORMATION AT THEIR
FINGERTIPS. GETTING ALERT COULD
BE ABLE TO BETTER CARE FOR
THEIR PATIENTS IS EXTREMELY
IMPORTANT SO I WOULD ENCOURAGE
THE STATE WE HAVE NOT BEEN ABLE
TO MAKE IN ROADS THAT WE'VE
BEEN OUT THERE WELL YEAR. WITH
THAT SAID- PARTICIPATION IN THE
INLAND EMPIRE BUT NOT
THROUGHOUT THE ENTIRE STATE SO
WE REALLY REALLY NEED TEMAS DE
PROGRAM FOR WORK- THROUGHOUT
THE DAY. THANK YOU. THANK YOU
MUCH NEXT CALLER PLEASE. ARE
NOT COME WILL COME FROM NUMBER
NINE PLEASE GO AHEAD. GOOD
AFTERNOON THAT COULD TURN THE
CUTTING DOWN GOT ON THE OF
COLLECTED THE- CARE CORPS CAN.
CLASS WOMEN YOU BY HUNTER FORTY
HOSPITAL CAL. WE REALLY IT.
ABOUT THE TO ONE THANK YOU FOR
ALL COMMENTS AND- AT THE LOOK
AT INCLUDE A BOTTLE FOR HELP
IMPROVE EXCHANGE AND RECOGNIZE
THE IMPORTANCE OF H. I EAGER
CALIFORNIA. PATIENT WE LOOK
FORWARD TO WORKING WITH ALL THE
STAKE HOLDERS ON SOLUTIONS AND
COLORED. THANK YOU VERY MUCH
THANK YOU NEXT CALL PLEASE. OUR
NEXT COMMON COMPLY NUMBER SIXTY
ONE PLEASE GO AHEAD. YES HI AND
SHERMAN WOULD MEMBERS OF THE
COMMITTEE THIS IS JENNIFER
STOLE AN EVP GOVERNMENT
RELATIONS FOR OCEAN IN THE
CALIFORNIA TELEHEALTH NETWORK
OR NATIONAL NONPROFIT REFERRED
YOU IN YOUR BACKGROUND REPORTED
TWO YEARS OUR SYSTEM THAT
ENABLES DATA EXCHANGE FOR
COMMUNITY CLINIC. WE WORK WITH
PUBLIC HEALTH DEPARTMENT- IN
THE STATE OF CALIFORNIA AND
HAVE BEEN HELPING THEM AS WELL
FQHCS AND OBSERVE SEVENTY OTHER
ORGANIZATIONS IN THE STATE
RESPOND AND MOVE DATA ONE OF
THE LARGEST DATA MOVERS IN THE
STATE OF CALIFORNIA AS WELL AS
ACROSS THE NATION AND WE'VE
BEEN IN BUSINESS FOR TWENTY
YEARS. AT THE NONPROFIT WORKING
WITH SAFETY NET PROVIDERS-
BELIEVE THERE'S TWO POINTS I
WANTED TO QUICKLY MAKE AROUND
HEALTH INFORMATION EXCHANGE ONE
IS- YOU CAN'T BE INTEROPERABLE
WHEN YOU'RE NOT OPERABLE- WE
FEEL FINE BECAUSE OF
UNDERFUNDING PUBLIC HEALTH- H.
I. T. INFRASTRUCTURE MANY
PUBLIC HEALTH DEPARTMENTS ARE
RUNNING OLDER SYSTEMS THAT ARE
NOT ABLE TO EVEN EXCHANGE DATA-
ON THE BALLOT BASIC LEVEL AND
SO- WE NEED TO MAKE SURE WE
CONTINUE TO SUPPORT FUNDING FOR
UPGRADING EHR SYSTEMS FOR
PUBLIC HEALTH AND PRIMARY CARE
PROVIDERS. ALSO HIV HAS GOT TO
BE VERY VERY SIMPLE AND VERY
LOW COST OTHERWISE IT WON'T BE
USED REDUCING THE TIME AND TIME
AGAIN ACROSS THE COUNTRY AT.
AGE I- WOULD CONTINUE TO SOUND
THEY OPEN SOMETHING CLOSE TO SO
AT THE STATE OF CALIFORNIA IS
EXPLORING- THE OPPORTUNITY TO
INCREASE H. ID WE LOOK FORWARD
TO BE PARTY PART OF THE
CONVERSATION AND- THANK YOU FOR
YOUR TIME AND WHAT A GREAT
PANEL TODAY. THANK YOU VERY
MUCH- NEXT CALLER PLEASE. OUR
NEXT TOWN COME FROM NUMBERS.
TWO GO AHEAD. THANK YOU READ
THE WITH PERMANENTE A THANK YOU
MISTER CHAIR FOR VARYING
HEARING TODAY OBVIOUSLY A VERY
COMPLEX TOPIC IN A RAPIDLY
EVOLVING LANDSCAPE AND
CALIFORNIA HAS MADE TREMENDOUS
STRIDES IN THIS AREA AND YOU'VE
HEARD WITH SIGNIFICANT PROGRESS
IN THE LAST THREE YEARS. AND
KAISER PERMANENTE A AND YOU
KNOW WHAT THE EARLY LEADER IN
THIS SPACE AND THIS YEAR ALONE
WE HAVE EXCHANGE HEALTH
INFORMATION OVER NINETY THREE
MILLION HìNH LET THEM
CALIFORNIA ITH OVER FIFTEEN
HUNDRED PHYSICIAN PRACTICES AND
OTHER PROVIDERS SITE OUTSIDE OF
OUR SYSTEM. ACROSS THE STATE
YOU DID IT THE THING THAT WORK
THE CALIFORNIA DOES HAVE AN
OPPORTUNITY TO CONTINUE TO LEAD
THE NATION AND BUILD ON OUR
SUCCESS IN STATEWIDE DATA
SHARING ACROSS THE HEALTH
SYSTEM BUT WE MUST PROCEED
CAUTIOUSLY AS WE EXPLORE THE
NEXT STEPS TO GET THAT
UNIVERSAL ROBUST DATA SHARING
THAT WE ALL WANT. UNFORTUNATELY
WE CAN RELY ON THE EXISTING
PROVEN SOLUTIONS THAT ARE
AVAILABLE TODAY IS THAT THE
MARKET BOARD THAT DOCTORS THE
DNC REFERRED TO THE WORKING
WELL FOR ALMOST ALL PROVIDERS
IN THE STATE BUT WE DO NEED TO
BETTER LEVERAGE AVAILABLE
FEDERAL FUNDING TO SUPPORT
GREATER ADOPTION OF THAT
TECHNOLOGY AND BETTER EDUCATE
PROVIDERS ABOUT THE INCENTIVES
THAT ARE AVAILABLE. AND WE'RE
ALSO FORTUNATE TO HAVE A VERY
CLEAR AND WELL THOUGHT OUT
NATIONAL STANDARDS AND
REGULATIONS THAT YOU'VE HEARD
ABOUT- AND THAT WILL CONTINUE
TO ADOPTION OF THAT WILL MAKE
IT EVEN EASIER TO SHARE
INFORMATION. AND WE DO AGREE
THAT SAFETY NET PROVIDERS AND
SMALL AND RURAL PHYSICIAN
PRACTICES WILL NEED SUPPORT TO
GET AND STAY CONNECTED AND WE
LOOK FORWARD TO WORKING WITH
THE COMMITTEE- AND OTHERS ON
SCHOOL CONCRETE IDEAS WE HAVE
IN THAT SPACE. AND WE ALSO
AGREED THAT A SEPARATE BUT
RELATED ISSUE IS THE NEED FOR
IMPROVEMENT IN HEALTH PUBLIC
HEALTH DATA FLOWS BEEN WORK
ALSO HAPPY TO OFFER OUR
EXPERTISE IN IN THAT FACES WELL
BUT IT'S IMPORTANT UNDERSTAND
THAT ISSUE WILL REQUIRE A
DIFFERENT TECHNICAL SOLUTIONS
IN DIFFERENT FUNDING SOLUTION
FELT. I THINK THE BEST CAN YOU
IT WILL BE REALLY IMPORTANT.
PINPOINT THE VERY THAT MAKE IT
UP FOR PROVIDE TO CONNECT. AND
THEN THE- CAN BE DESIGN TO
ADDRESS PARK THOSE HOW WHICH
WILL. REALLY VERY ACROSS OUR
LARGE INCOME THEY- AND THE
APPROACHES AND SOMETHING STATE
THAT MAY NOT WORK SO WE NEED TO
AVOID. ONE SIZE FITS ALL. THAT
WE VERY MUCH LOOK FORWARD TO
WORKING WITH YOU ON YOUR MISTER
CHAIRMAN AND ALL. THE BUILDING
THE CLUES WE ARE HAD AN PLACE
THANK HELL FOR THE WEEK GET
THAT. UNIVERSE OKAY. THAT WE
BEEN WORK TOWARD THANK YOU.
THANK YOU VERY MUCH NEXT CALLER
PLEASE. OUR NEXT COMMENT WILL
COMPLY SIXTY THREE PLEASE GO
AHEAD. HELLO DOCTOR WOULD AND
MEMBERS ENGAGED YET HERE ON
BEHALF OF SEIU CALIFORNIA.
THANK YOU FOR HAVING THE
HEARING A LOT OF INFORMATION
HAS BEEN PRESENTED AND WE'RE
LOOKING FORWARD TO WORKING WITH
YOU ON TRYING TO ACHIEVE THE
ULTIMATE GOAL IN TRYING TO
ACCESS HI NEED CLINICAL HEALTH
INFORMATION- AT THE A NEW WE DO
BELIEVE MEANINGFUL AND HEALTH
INFORMATION EXCHANGE IS NOT
ONLY ESSENTIAL TO BRINGING
DOWN. ESCALATING HEALTHCARE
COSTS WHICH CONTINUE TO HAMPER
OUR WORKERS ABILITY TO SECURE
WAGE INCREASES AT THE
BARGAINING TABLE BUT IT IS ALSO
IMPERATIVE TOOL THAT PROVIDES
THE CLINICAL INFORMATION
NECESSARY TO SUPPORT OUR
FRONTLINE HEALTH CARE WORKERS
AND- PATIENT. ONE OF THE MANY
THINGS THAT THE PANDEMIC HAS
ACTUALLY EXPOSED IS THE LACK OF
INFORMATION WHICH LEADS TO
FRAGMENTATION AND IT ALSO IT
CREATES HUGE CHALLENGES FOR
HEALTHCARE WORKERS PROVIDING
HEALTH SERVICES AND HOSPITAL
CLINICS PUBLIC HEALTH
DEPARTMENT COUNTY BEHAVIORAL
HEALTH IN OTHER SETTINGS. I DO
KNOW THIS IS VERY ALARMING WHEN
YOU THINK ABOUT THE TIME THE
ACCESS AND DELIVERY OF
HEALTHCARE AND BEAUTY AND WEBER
HOPES SERVICES HEY AND AS YOU
ALSO KNOW OUR WORKERS PROVIDE
CARE IN VARIOUS PUBLIC COUNTY
AND PRIVATE HEALTH CARE
SETTINGS WHICH USED DIFFERENT
PLATFORMS THAT MAY CREATE
LAGGED IN ACCESS BEING. PATIENT
HEALTH. INFORMATION WHAT
DEPENDING ON WHERE THE PAY
ACTUALLY AND- THE DIFFERENT
DELIVERY. THAT WE- OUR BURKE
ALL MAY NOT NECESSARY HAVE THE
REAL HI ACCESS TO INFORMATION.
SO FAR. WHEN A PATIENT HAS THAT
THE PA FOR CARBON NINETEEN IT'S
NOT OFTEN AVAILABLE TO
DIFFERENT TYPES OF PROVIDERS AS
PART OF THE PATIENT HEALTH
RECORDS. WHICH THEN EXPLODED
HEALTHCARE WORKERS- IN THE
UNFORTUNATE EVENT THAT. A BILL
WITH THE PATIENT THAT WOULD
HAVE BEEN POSITIVE BUT KOGAN
NINETEEN. AND SO WITH THAT SAID
WE DO THINK- THAT THERE COULD
BE INVESTMENT INSTRUCTORS THAT
DELIVER TIMELY AND ACCURATE
INFORMATION IN ORDER TO ENSURE
PATIENTS HAVE CARE AND ALSO TO
ENSURE THE- SAFETY AND
PROTECTION OF OUR HEALTH CARE
WORKERS THANK YOU. THANK YOU
VERY MUCH. NEXT NEXT CALLER
PLEASE. WHEN IT COMES ONE SIX
FOUR PLEASE GO AHEAD. HI GOOD
AFTERNOON DOCTOR WOULD AND- D.
COMMITTEE THIS IS CLAUDIA
WILLIAMS AND ITS CEO OF
MANIFEST NOT ACT. AND THAT IS
THE QUALITY OF THE STATEWIDE
HIV BUT PROVIDERS IN THIRTY
EIGHT AT THIRTY EIGHT COUNTIES.
SERVING OVER A HUNDRED
HOSPITALS AND HEALTH PLANS
ACROSS THE STATE WE SHARE DATA
FOR TWENTY FOUR MILLION
CALIFORNIANS TODAY AND THAT HAS
BLOCKED YOUR POINTED OUT WE'VE
MADE A LOT OF PROGRESS SINCE
HIS THAT REPORT FROM A COUPLE
YEARS AGO. I AM SO EXCITED
ABOUT THIS HEARING AS A FIRST
STEP TO REALLY ENGAGING THE
WHOLE STATE AND CRAFTING A
SOLUTION THAT WORKS. FOR
CALIFORNIA IN ADDITION TO THE
IMPORTANT GOAL THE PARTY
DISCUSSED TODAY- I THINK IT'S
WORK IT'S CRITICAL TO
ACCELERATE HEALTHEQUITY.
ENHANCE PATIENT CARE AND ALSO
THE TWO POINTS THAT I THINK
IT'S BEEN MADE PROFOUNDLY- TO
SUPPORT. PUBLIC HEALTH AND
REDUCE COSTS. WE'RE REALLY
BUSCA. OTHERS I THINK WE'D MAKE
PROGRESS. BUT I WANNA YES
CAPTURE. AND WHILE I THINK
THERE'S SCOPE. IN THE- AT THE
END OF. WHAT REALLY GREAT IS
THE CUT WE ARE NOT A FIRST
MOVER WE HAVE INCREDIBLE MODELS
AND MODE MAPS FROM OTHER STATES
AS WELL AS- SHARED BY DAVID FOR
APPS. I WANTED TO DEEPER PEOPLE
YOU MENTIONED FIVE THINGS THAT
I THINK THOSE MODEL SHELAGH.
TICKET STATEWIDE. WE CAN AFFORD
WHAT SPACE. THE LETTER LOOK FOR
THE MANDATE AND INCENTIVES THAT
LOOK UP TO A 100%
PARTICIPATION. TO LEVERAGE WHAT
WE FELT. WE DON'T HAVE A DECADE
AND BILLIONS OF DOLLARS OR EVEN
MILLIONS OF DOLLARS TO BUILD
FROM SCRATCH SO LET'S LOOK AT
WHAT WE HAVE AND FIGURE OUT.
HOW TO USE THAT. THIRD I THINK
OUR GOAL SHOULD BE TO SUPPORT
PUBLIC HEALTH AND COUNTY. IN
ADDITION TO PROVIDER CARE POINT
OF CARE THOSE ARE SUCH
IMPORTANT USE CASES AT THE
STATE SPEND NEXT YEAR AND YEARS
PAST THAT. TAKE ADVANTAGE OF
FEDERAL FUNDING AGENCIES IN
OTHER STATES GET 5280% OF
FUNDING FROM FEDERAL SOURCES.
AND WHILE WE SORT OF MISSED THE
BOAT AN ADDITIONAL FUNDING FROM
THE NINETY TEN HIGH TECH THERE
ARE OTHER FUNDING SOURCES
AVAILABLE. AND FINALLY FREE UP
THE PUBLIC HEALTH DATA MANY
OTHER STATES ARE TAKING THEIR
THEIR REGISTRY DATA FROM CAL
READY. TYPE REGISTRIES AND THEN
YOU GET TO H. I EAT THE WE CAN
ALERT PROVIDERS SO THAT THE
HUGE OPPORTUNITY THAT WE HAVE-
TO REALLY- HELP WITH THE
PANDEMIC RESPONSE. THANK YOU
FOR YOUR TIME NUMBER REALLY
EXCITED. TO WORK WITH YOU IN
THE YEAR I HAD. THANK YOU VERY
MUCH NEXT CALLER PLEASE. THANK
YOU AND AS LES GENERAL YORK
PLEASE PRESS ONE ZERO EXT KAMU
COME FROM ONE OF SIXTY FIVE
PLEASE GO AHEAD. ARE YOU ABLE
TO HEAR ME OKAY. YES ABSOLUTELY.
HI MY NAME S DANNY KELLY MY
HUSBAND IS INCARCERATED IT
PULLED FROM STATE PRISON- THE
PRISONS IN CALIFORNIA ARE NOT
HANDLING COBIT RESPONSIBLY AT
ALL AS SOON AS THE NUMBERS GO
DOWN THEY GO BACK UP AGAIN
WHERE ARE THESE CASES COMING
FROM THIS NOT. FOR INMATE
YOU'RE RESPONSIBLE YOU KNOW
WHERE THEY'RE BEING YOU'RE
RESPONSIBLE ABOUT THEIR
MOVEMENT AND TRANSFERS FROM
OUTSIDE AND STAFF COMING AND
GOING WITHOUT ACCOUNTABILITY IT
IS A FAMILY MEMBER THAT'S FOR
SURE MANY OF THE STAFF ARE NOT
TAKING THIS SERIOUSLY AT ALL IT
ALMOST SEEMS LIKE NO ONE IS IN
CHARGE. AND HOW ARE THEY ABLE
TO MAINTAIN ANY KIND OF A
PROPER DISTANCE FROM EACH OTHER
IN SUCH AN ATMOSPHERE WHERE THE
POPULATION IS STILL WAY OVER
CAPACITY. I WOULD WORK FOR THAT
I'M AWARE OF THE INMATE
POPULATION DEMOGRAPHICS THAT
I'D BE THE RECIDIVISM
STATISTICS I HAVE SEEN THAT IT
IS A TRAVESTY OF JUSTICE AT THE
VERY ONES WHO HAVE BEEN
PROGRAMMING CONSISTENTLY AND
THEY HAVE FULFILLED THEIR TO
THEIR ARM AND IN MOST CASES
CONTINUE THEIR CONFINEMENT MANY
YEARS BEYOND THEIR TERMS. THAT
THESE PRINTERS ARE NOT EVEN
CONSIDERED FOR ANY KIND OF A
VERY DEEP OF THEIR DEBT THAT'S
BEEN FULLY PAID AND THEN SOME
THEY REFUSE TO ACKNOWLEDGE
LIFERS IN THIS EQUATION AT ALL
RELEASED. EVEN DO NOT REACH TO
PRISON THEY ARE OLD WHY AND
HAVE THE- MORE. RESPONSE BEEN.
WHEN IT COMES TO THEIR HEAD. OF
FIRING BUT EVEN BEYOND. THE
OVER POP. IS SOMETHING WILL NOT
GO AWAY WITH THE BACK. AND IN
FACT THE KIDS TO BE A MATTER OF
COOL AND- PUNISHMENT. TO HOUSE
INMATES IN THESE. SPACE WITH
THE ELSE WHERE THEY CAN HARDLY
MOVE OR TRY TO GET IN. DONE
THERE MENTAL HEALTH SEPARATE
TERRIBLE AND HOW ARE THEY
EXPECTED FUNCTION IN THIS TYPE
OF ENVIRONMENT OR EVEN LIVE DID.
IS REDUCES THEIR- MAP AND THE
DESERVE. ANY DESIRE INCOME OF
THE SIGNET READ IN THE IN
POPULATION. CANNOT BE ACHIEVED
WITHOUT IT. THANK YOU THANK YOU
MA'AM. NEXT CALLER PLEASE. IN A
COMICAL FROM ONE NUMBER FIFTY
EIGHT PLEASE GO AHEAD. HI MR
CHAIRMAN MEMBERS- THIS IS DAVID
FORD WITH THE CALIFORNIA
MEDICAL ASSOCIATION- ECHO WHAT
MANY OTHERS HAVE SAID THAT WE
LOOK FORWARD TO WORKING WITH
YOU- INTO YOUR COME UP TO
EXPAND A TINY IN CALIFORNIA-
BUT I DO WANT TO UNDERSCORE
COUPLE THINGS ADDRESSES THAT MR.
FOR ALL EXCEPT EARLIER. THERE
ARE MANY FORMS A TECH THAT HAVE
IN THE STATE TODAY. REGIONALI
CHE. THAT NASH NETWORKS. BETTER
CREATIVELY WITH THE FED.
APPEALS STATE. BUT IT WILL BE
NOTHING. TO QUALITY THAT. OF
ALONG INTO THAT WORLD MANY OF
SYSTEMS ARE. THEY'RE VERY
TECHNICALLY COMPLEX AND WE NEED
TO PROVIDE SUPPORT FOR SMALLER
PRACTICES TO HELP BRING THEM
ALONG. I ALSO WANT TO-
UNDERSCORE SEVERAL PEOPLE SAID
WE DO THINK THAT EVEN WITH THE
END OF THE HIGH TECH ACT COMING
IN- SEPTEMBER TWENTY TWENTY
ONE. THERE ARE OTHER LIKE THE
FEDERAL FUNDING THAT CAN BE
ACCESSED AT. NOT JUST FOR THE
STATE. TO ACCORD TO FIGURE OUT
HOW WITH YOU. HOW TO BRING
THOSE TO BEAR CALIFORNIA THANK.
YOU THANK YOU VERY MUCH. NEXT
CALL PLEASE. AND CURRENTLY HAVE
NO FURTHER COMMENTS THANK YOU.
NO OTHER COMMENT SHE SAID. BACK
YES THANK YOU OKAY. OKAY WELL
THANK YOU I WANT TO SAY THANK
YOU TO ALL THE CALLERS I WANT
TO THANK ONCE AGAIN OUR
SPEAKERS AND THE MEMBERS WHO
PARTICIPATED WITH US TODAY IS
OBVIOUSLY A BARIUM IMPORTANT-
TOPIC A VERY COMPLICATED TOPIC
AND SOMETHING THAT WE PLAN TO
DISCUSS ANY FURTHER- AND MAKE
IN THE COMING IN THE COMING
SESSION SO I THANK EVERYBODY
FOR THEIR INTEREST IN THIS AND-
BEARING WITH US. IF YOU HAVE IF
ANYBODY OUT THERE HAS ANY
ADDITIONAL COMMENTS WERE WE
WILL ABSOLUTELY ACCEPT THEM IN
WRITING AND- WITH THAT I'M
GONNA GO AHEAD AND ADJOURNED
THE MEETING AND SAY THANK YOU
ONCE AGAIN TO EVERYBODY WHO WHO
WAS WITH US TODAY. THANK YOU.