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Bredesen finance chief eyes legislation for eHealth
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CareHere CEO Ernie Clevenger was among local execs invited to brainstorm at the Vanderbilt CBH
Prospects are growing stronger that the General Assembly will soon receive a Bredesen Administration proposal aimed at accelerating adoption of health information technologies and regional health-information exchanges, while paving the way for ventures that improve healthcare quality and reduce expenditures.

The legislation is likely to address an array of financial, entrepreneurship, infrastructure, governance and financial issues, possibly including a proposal to create a new statewide entity that would oversee and-or coordinate continued development of the state's regional health-information exchanges, or RHIOs.

RHIOs are widely regarded as a key ingredient for creating a national e-health "ecosystem" that could eventually contain individuals' electronic health and medical records. Tennessee currently has four RHIOs, the newest being the Middle Tennessee eHealthConnect.

It was on Thursday that State Finance and Administration Commission Dave Goetz (left)discussed these and related issues with members of the Governor's eHealth Advisory Council, led by Chairman Antoine Agassi, during a six-hour session at the Tennessee Economic Development Center.

Goetz told the advisory council members and staff during last week's session that the Administration and the council should next begin an iterative process that should produce draft legislation for possible submission to the General Assembly in January. He noted that model stakeholders must be lined-up in support of the measure and proposals must address legislative concerns, including financial sustainability long term.

Goetz added that because e-health will evolve steadily, the legislative proposal must allow for flexibility, as well as accountability. While rules-of-the-road are essential, he said, excessive rigidity would impair the evolving system and discourage participation. Said Goetz, "We've got to be comfortable with 'messiness' and that's hard for government to do."

The advisory group's meeting came just days ahead of a progress report due out tomorrow from Gov. Phil Bredesen and Vermont Gov. Jim Douglas, in their capacity as co-chairs of the National Governors Association's two-year-old State Alliance on E-Health.

In addition to examining governance and infrastructure, the state's eHealth Council has been working closely with dozens of stakeholders to examine ways corporations and entrepreneurs could be encouraged to create value-added services atop the state's existing electronic infrastructure, as part of an effort to ensure that innovation, sustainable quality and affordability, security and other traits characterize the evolving e-health system.

As part of its private-sector outreach effort, the eHealth Council and the Vanderbilt Center for Better Health on Aug. 15 convened about 40 area executives for a daylong session exploring new models businesses and healthcare organizations might create, fund and sustain by offering products and services that improve healthcare quality outcomes, reduce healthcare expenditures and intensify innovation throughout the healthcare delivery system.

VCBH Chairman Bill Stead, M.D. (at right)who is also Vanderbilt's associate vice chancellor for health affairs, told the executives assembled Aug. 15 that the nation's health-information exchange movement is making too little progress – "stuck," as he put it – but the cause is not technology or infrastructure.

In August, Stead argued that progress will accelerate if instead of playing "a zero-sum game in healthcare," in which players are most concerned with avoiding additional cost, stakeholders work to ensure more economic benefits must flow toward the "hands of innovators" who want to compete to meet market demand for greater value in goods and services.

Stead urged the assembled executives to ask, "What's the high end of the opportunity here," adding, "I do not believe that question has been asked."

During the Sept. 18 council meeting, Stead again stressed his view that it's time for Tennessee to worry less about basic connectivity and infrastructure – which Tennessee now has in the form of the Tennessee eHealth Network – and to instead "put our energy into how to create the ecology to get people to start competing" to build new value-added business that would operate in what the council refers to as the "competitive zone."

Business ideas generated during the August session included three that won the conferees' strongest interest: "Adherence Management," a business centered around improving patients' safe use of medications as directed by their physicians, while minimizing wasted or unnecessary prescriptions; a "Caregiver Portal" that supports quick notification of caregivers and physicians, as part of patient followon care; and, a broader category, "Health Intelligence," in which informatics is used to inform decisions, processes and communications.

Tennessee's eHealth Advisory Council was created by a Bredesen executive order in April 2006 and has worked since then to establish new and expanded relationships among such stakeholders as providers, payers, consumers and others. The group has recently devoted much of its energy to pushing electronic filing of prescriptions by physicians and is now signing-up physician groups for use of the state's recently chartered telemedicine network, which is maintained and supported by AT&T under a 10-year contract with the state.

During the council's meeting Thursday, consultant Shaun Alfreds (left) outlined a preliminary report on pros and cons associated with an array of options for shaping and coordinating RHIOs within the state. The briefing was consistent with a 2007 NGA analysis and report. Alfreds began by describing an entity through which the state would have a "heavy hand" of control and responsibility, either in the form of a public authority; or, establishment of a government controlled corporation that would operate as a nonprofit enterprise.

Options that would involve lighter state-government involvement and arguably more private-sector investment might, according to Alfreds, include an organization similar to those that oversee public utilities and private-sector, and which, for example, set rates, develop policy and monitor industry efforts, developing responses to any "market failures" that impinge on "universal access and interoperability."

Alfreds outlined a third option, in which government participates in an independent health-information exchange organization, perhaps by holding one or more board seats, as well as through providing or withholding grants and contracts, and wielding the prospect of regulatory action, among other means.

Alfreds is due to present a final version of his report on e-health governance, oversight and accountability Thursday and Friday in Washington, D.C., during a meeting of state officials convened by NGA. Gov. Bredesen is not scheduled to attend that forum, according to NGA staff. Alfreds is a senior project director within the Center for Health Policy and Research, at the University of Massachusetts Medical School.

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Tags: , Antoine Agassi, Bill Stead, CareHere, Dave Goetz, eHealth Advisory Council, entrepreneur, Ernie Clevenger, Health IT, healthcare, Jim Douglas, Middle Tennessee eHealthConnect, National Governors Association, Phil Bredesen, RHIO, Shaun Alfreds, State eHealth Alliance, Vanderbilt Center for Better Health, Vanderbilt University


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