San Diego Beacon does HIE as a utility

Dan Chavez, executive director of San Diego Beacon communityDan Chavez, executive director of San Diego Beacon community

'We're in a very dynamic, very fluid, very aggressive health IT environment as it relates to getting those resources applied to the HIE.'

This week, Healthcare IT News is spotlighting three of the 17 federally-funded Beacon Communities, as the $250 million project draws to a close. We asked them to look back on their accomplishments over the past three years and offer their thoughts about the opportunities and challenges that lay ahead as self-sustaining entities. Today, we profile the San Diego Beacon Community. Read Editor Bernie Monegain's introduction to the series here.

"San Diego is an island," says Dan Chavez, newly hired executive director of San Diego Beacon community. "You have the ocean to the west, the Mexican border to the south, a desert to the east and a Marine base, Camp Pendleton, that completely borders us to the north."

[See also: Beacon Communities shine light on economic improvement]

And on that "island," health information technology is "fairly advanced and quickly evolving," says Chavez, whose mandate is to see San Diego Beacon through the next phase of its existence, from a project funded by $15 million in federal grant money to a sustainable not-for-profit health information exchange.

The good news is that this particular community is in terrific position to do that. Of the 17 Beacon Communities first funded in 2010, San Diego is well ahead of the game in terms of its resources and expertise.

"Folks that work in health IT in San Diego have worked in health IT a lot of years," said Chavez. "It's a very interesting environment. You can find work with UCSD or Scripps, or Sharp or Kaiser, or the VA or the Department of Defense, and never leave San Diego. The HIE is really fortunate that it has this historical perspective, where a lot of folks have worked at a lot of these institutions."

Add to that firms such as Qualcomm, medical device manufacturers and biotech companies and the West Health Institute – organizations that "that provide big influx of people and technology and things to experiment with," he said. "We're in a very dynamic, very fluid, very aggressive health IT environment as it relates to getting those resources applied to the HIE."

[See also: San Diego RHIO takes step forward]

When the Beacon Community project was launched, Vice President Joe Biden looked forward to a day where these nationwide pockets of innovation would make it possible to "coordinate patient care with the stroke of a key or pull up life-saving health information instantly in an emergency."

San Diego Beacon Health Information Exchange has succeed on that front, with data flowing freely among world-class players such as Kaiser Permanente Southern California, UC San Diego Health System, San Diego Department of Veteran’s Affairs and Rady Children’s Hospital.

Another of the Beacon's projects was to set up an emergency medical hub that enables patient data from paramedics to be imported into any hospital EHR. Critical data can be relayed to cardiologists while patients are en route to the hospital, allowing them to marshal the correct and necessary resources.

Biden also saw the Beacons as a way to help spur "a whole new industry … one that will shape our 21st century economy for generations to come."

In San Diego, that's started to happen, too. Speaking at HIMSS11 two years ago, Mary Walshok, a sociology professor at the University of California at San Diego, told how she was studying the ways Beacons were changing the nature of jobs in their regions – and create new ones.

Thanks to "significant private sector leadership" and "collaboration and convergence around device diagnostics and medical records," the Beacon Community has helped further fuel an already-robust IT sector. "There's been a lot of start-up and growth companies," she said.

So, after all these successes, what's next?

If San Diego Beacon was ahead of the game when the project started three years ago, it's just as well poised for the future.

"Governance, getting the commitment of the major stakeholders to come together around to the table to demonstrate collaboration," was key, says Chavez. "Again, I think what makes us a little different is that the major stakeholders included the DoD, the VA, the county of San Diego and a major, multi-region provider and Kaiser."

Add in private providers of the caliber of Sharp, Scripps and UCSD and health plans – "a huge one, in Anthem, and a small Medicaid plan, Community Health Group" – and you've got a the right mix for success.

"Without question, the biggest achievement in preparing for the future is getting the broad mix of stakeholders around the table, agreeing to collaborate, and being committed," says Chavez. "The (federal) grant was one thing. But these stakeholders agreed to fund the HIE as it stands itself up for two years, post grant."

Still, there's work to be done. First and most important, "The remaining nodes of the network have to get up and running," he says. All the other docs and all the clinics and all the health plans have to get linked up. That’s going to happen over the next two years.

"The commensurate commitment is to get patients consented so their information can be shared across the HIE," says Chavez.

It's one thing to get the nodes of the network up, after all. It's worthless if there's no patient data behind it. "We're not a repository model, we're a federated model. So the commitment to get those patients consented is huge."

Finally, he says, "a real challenge for the HIE is that we're a hybrid federated model – which means that we're not going to dictate that everybody use the HIE in the same manner. We will adapt the HIE implementation within an institution to conform with the way they do business. That gives us some challenges, in our presentation, and how we format and how we educate our users."

Image sharing, patient identification issues and support for meaningful use Stage 2 are also on the to-do list. As is a renewed focus on "county, social and homeless kinds of issues," says Chavez. "It's always been a focus of the Beacon, and now we're carrying it forward as part of the focus on our not-for-profit. "

And, of course, the big task is finding the money to keep these projects moving forward.

"The participants agree to pick up the budget through 2015," says Chavez, then the plan is to move to more of a transaction model based on utility, come 2016.

Once everyone is using the HIE, "We'll have a great sense of how records are shared, how messages flow, and what their requisite value is," he says.

"Then we come out with a methodology: Here's how the water flows through the pipes, how people are using water for drinking, for agriculture, for waste disposal. Those have different values, and here's our proposed pricing model, come 2016. The challenge is trying to make as much water flow through our pipes so we generate economies of scale,” he continues.

"We're dealing with a big population, unlike other Beacons; we're the largest Beacon," says Chavez. "But I think we're in an excellent position."