Arieh Rosenbaum, MD
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Director of Medical Informatics,
Hospitalist at California Pacific
Medical Center in San Francisco
Attended CAeHC town hall in
San Francisco in May 2009 and
the rest is history…
Amy Berlin, MD
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Psychiatrist in private practice in
San Francisco
Asked in early 2010 by CEO of
San Francisco Medical Society to
co-chair governance committee
and has not looked back since
Population:
Hospitals:
Physicians:
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805,000
11
~ 3,000
Significant patient organizational crossover
Substantial safety net population
Multiple large organizations in various stages of
technology deployment
Large independent physician population
Two large tertiary/quaternary care organizations
History of fierce competition between large
organizations
No predominant non-government payer
ARRA/HITECH the initial spark for early efforts
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CAeHC Town Hall (5/28/09)
Stakeholder meeting #1 (8/20/09)
Incorporation into SFMS CSF 501(c)(3)
Development of Governing Committee Structure
Development of use cases/data sharing priorities
Planning funds requirements
Hospital Council presentation (2/10/10)
Governing Committee Kickoff (3/17/10)
Initial task of the governance committee was to
evolve into a cohesive working group
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Much thought went into structure of our initial
meetings
Anticipated release of CeC grant application
functioned as orienting milestone
Early reconnaissance – meetings with Axolotl (a
local vendor), a visit to Santa Cruz HIE,
reviewing the literature (KLAS reports, etc.)
Lessons learned
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Impossible to chart path of an effort as
nebulous as launching an HIE more than one
step at a time
Give team members time to settle into their
new roles and trust the leadership of the
group
Face-to-face meetings are crucial to
building cohesiveness (conference calls
work better later on)
Generating RFIs & RFPs
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Cast a wide net to identify vendors
RFI constructed on shoestring budget
RFI released to 16 vendors -> 11 responses
-> short list (6) -> RFP released to 4 -> 2
finalists
Lessons learned
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The national HIE community is small,
collaborative, and eager to share
Use seed funding for focused professional
services
Delegate detail-intensive processes to subcommittees
RFIs, RFPs have educational value for
committee
All HIEs need a healthy dose of serendipity
Our approach to funding has evolved
significantly
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Early days full of financial “brainstorming”
SFMS provided “anchor donation”
Other organizations slowly followed
Key planning grant from MettaFund
Still working on payers
THE BUSINESS PLAN
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Key to buy-in from stakeholder
organizations as we approached the big
“ask” for CeC matching funds
Utilized business development consultant
services for budget model
Business plan outlined (the mostly indirect)
evidence for ROI from HIEs – hard numbers
difficult to come by in current HIE literature
Lessons learned
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Budget for business development from day
one
Crucial to business strategy is plan to
evolve, in the early years of operations, from
strict reliance on grant funding
As we evolve, so will our business plan (we
are currently working on version #2)
Value prop for individual organizations can
be variable
Rounding the bend on RFP release, we are closing
in the deadline for MOU submission from
stakeholder organizations when…
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Round robin with committee reps was
overwhelmingly positive
Key stakeholder organization falls through,
creating a domino effect
Application for Cal eConnect funding
aborted
Lessons learned
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HIE is still an abstraction for many
executives
Go directly to your customer; representative
model must be supplemented
No substitute for face time between C-suite
and HIE leaders
A comprehensive outreach effort
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Direct dialogue with stakeholder decisionmakers
Meetings with local and state civic leaders,
leading to favorable Op-Ed in the San Francisco
Examiner co-authored by Arieh and a mayoral
candidate
Rebranding as HealthShare Bay Area
Lessons learned
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Plan on an intricate network of point-to-point
interfaces (e.g., LOTS OF FACE TIME) to build
stakeholder trust and to make sure the “source
data” (details of HIE technology, sustainability,
and governance) get to the desired recipient
(check-writing decision makers)
Anticipate decisionmakers’ priorities, questions,
and fears
Understand the history and the culture of each
participating organization
It’s one thing to release an RFP, it’s another
to score it
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Tension between desire for purely
“democratic” scoring process and the reality
of inadequate understanding of HIE vendor
differentiators among constituents
Pursued a “salon” style of scoring responses,
with technical expert as leader
RFP scoring process enhanced group
cohesiveness
Demos an opportunity to showcase effort
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Comprehensive, clinically driven demo
scripts
Webinar, recorded to allow for remote and
asynchronous participation
Preparing for reference checks and site
visits in coming weeks
Lessons learned
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“Marathon” salon sessions allowed for deep
dive and shared understanding of vendor
offerings
Deep technical expertise crucial to
evaluations
Use demos as an outreach and educational
tool for stakeholder constituents
Recent accomplishments & activity
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Growing interest from East Bay stakeholders
Preparing for vendor negotiation
Recruiting legal services to draft
participation agreements
Networking with Cal eConnect Community
of Practice and other groups
Take home points
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Launching an HIE is like launching a start-up
Assemble a multi-disciplinary team
Productive collaborations, learning curves, and
trust building require time and face to face
meetings
Use planning funds wisely
Study HIE success stories
Get lots of practice answering difficult questions
There is no HIE “roadmap” – learn to love trial
and error
Arieh Rosenbaum, MD
RosenbA@sutterhealth.org
Amy Berlin, MD
amy@amyberlinmd.com