California Health eQuality Project Summary
Greater LA HIE Coordination Project
January 2014
PROBLEM
The Greater Los Angeles Area is the second largest urban agglomeration in the United States, with a
population of nearly 18 million people. This metropolitan area surrounds the urban core of Los
Angeles County, stretching into Orange, Riverside, San Bernardino, and Ventura counties. A vast
network of safety-net oriented providers serves the low-income, uninsured, and vulnerable
populations of the region. These safety-net providers include government, non-profit, and private
organizations, defined by their commitment to provide health care to all. Safety-net providers in the
Greater Los Angeles Area face many obstacles to delivering coordinated care for their patients, as
these patients typically receive care from multiple unaffiliated organizations. The likelihood that
providers will have access to all of a patient’s current health information is low, contributing to
fragmented and inefficient care.
SOLUTION
CHeQ conducted a completive proposal process to identify a consulting organization to convene HIE
stakeholders in the Greater Los Angeles Area for both promoting coordination among regional HIE
initiatives and expanding HIE among safety-net providers.
Object Health was selected as the consulting organization to conduct this work. Between June and
October 17, 2013, the Object Health gained considerable insight into Los Angeles community
providers’ (CP) needs for data exchange with the purposes of improved patient care, increased
efficiencies and cost savings. They conducted 47 interviews with providers, HIE subject matter
experts, HIO stakeholder organizations, and LANES leadership. The team also completed a detailed
literature search, report review and environmental scan. The reports and scan were used to validate
interview information and update the understanding of the landscape of HIE services currently
offered and the current needs identified by the provider stakeholders in the market.
Based on the landscape assessment, Object Health conducted coordinated workshops to define,
develop and initiate implementation of two use case scenarios to address priority care coordination
needs among community providers. These workshops included two sessions as part of the CCALAC
HIT Roundtable (September 25 and October 17) and one session at the CPCA annual conference
held on October 3, 2013.
California Health eQuality Project Summary
Greater LA HIE Coordination Project
January 2014
RATIONALE FOR SOLUTION
There is a history of interest and need for community HIE in LA County, unfortunately previous efforts
have not met the full care coordination needs of the community. CHeQ had received a number of
proposals for HIE projects within LA and it became clear that there was a need for a neutral third
party to convene key stakeholders to consider the current landscape and how coordination could
move forward within the community. It was also important that this project identified stakeholders to
take this effort and carry it on past the funding period.
OUTCOME AND NEXT STEPS
Based on their work, Object Health had a number of observations and recommendations for moving
HIE forward in LA County. Safety net care coordination across LA County would benefit
tremendously from HIE. Unfortunately, County Health Service is at the very early stages of its EHR
implementation with Cerner. It will be many years before use of the EHR is robust enough to fully
address care coordination gaps. Similarly, SafetyNet Clinics are focused on improving productivity
internally the use of their EHR. The likely solution to most specialty care coordination data needs will
involve enhancement to the eConsult platform.
The challenge will be for the County to employ a process that engages community providers and
enables them to evolve eConsult workflow in a manner sufficient to meet long-standing gaps in care
coordination efforts with County. There are additional risks to health IT-enabled care coordination
that will stem from choices the county makes in how it implements the new Cerner EHR.
Community Partner Cohorts have participated in three monthly meetings and plan to meet on an
ongoing basis to discuss key issues in care coordination across the LA safety net. Community
Providers’ desire for widespread HIE is overridden by a desire for efficient access to electronic
discharge summary information from their care delivery partners in close proximity – and this goal
remains hindered by the policy and procedure challenges of provider authorization and access to
electronic patient health information. It is recommended that these convenings are supported with
technical assistance from trusted, neutral parties devoted to building solutions to care coordination
data exchange in the short term.
California’s approach to HIE has long been classified as, “privately driven, publically funded and
assisted.” In the greater Los Angeles area, the delays with the LANES project and the uncertainty of
its future leave the region without a community-wide or broad sweeping HIE solution. Instead, health
IT-enabled care coordination and exchange is being developed among local trading partners.
California Health eQuality Project Summary
Greater LA HIE Coordination Project
January 2014
Without a convener, provider organizations will continue their efforts in silos and health information
exchange will progress slowly and in micro pockets as the Community Partners or specialists reach
out to neighboring hospitals to address quality of care and operational pain points or as hospitals
roll out new policies for medical records requests and care coordination for their organizations.
The most successful strategy recommended from the work of the past six months is to support the
pockets of innovation already underway in the Greater Los Angeles area through technical assistance
and additional funding to coordinate Community Partner to create meaningful care coordination
programs by using available technology solutions.
County would do well to assign an informed Coordinator, like Dr. Diaz, or Dr. Giboney, to work with
Community Partners on needs gathering and to further develop the County’s strategy for health IT –
enabled care coordination.
BENEFIT
The updated landscape of the Greater LA County is a key outcome from this project. It clarifies the
current desire and readiness for HIE assisted care coordination. Object Health was able to engage
many stakeholders from hospitals and community clinics who are interested in continuing to work
together and keep a dialogue going. The County will benefit from the findings of this project as they
continue to move HIE forward. There is significant opportunity to continue the work in LA County.