The Washington State Health Care Authority’s health record bank system has gone live in Bellingham, Cashmere and Spokane, while the Oregon Department of Human Services has released a Request for Proposal for its HRB.
Having government develop HRBs may seem ironic, given that one of the core tenets of the HRB concept is having a trusted institution in charge, but leaders of both projects say that state government, including public payers, plays a key role.
“Medicaid is a fertile place to experiment,” said Barry Kast, project director for the Health Record Bank of Oregon. For one, master patient indexes aren’t necessary. While critics say that the population is too transient to track, Kast argues that high use of healthcare services, especially in the emergency rooms, and the constant status changes are the very reasons Medicaid beneficiaries should have a personal health record stored in an HRB.
“That’s why we’re doing it,” he said.
DHS/DMAP’s initiative is being funded by a $5.5 million Medicaid Transformation Grant. HRBO received a one-year extension from the Centers for Medicare and Medicaid Services that will take the project through the end of March 2010.
State legislators desiring to reform healthcare set the stage in 2005 for the Washington State Health Care Authority to become the facilitator of the HRBs, said project manager Juan Alaniz.
The hope is that an entity, either in the private sector or the community itself, can take over, Alaniz said.
“We made it clear we didn’t want to be in the business of running health record banks,” he said, although WSHCA would help other communities wishing to open HRBs.
In the meantime, Alariz said, with the three chosen communities, WSHCA will determine the government’s proper role.
Despite the general distrust the public has of government, its role of trusted regulators of institutions such as financial banks is an advantage, said William Yasnoff, MD, PhD, managing partner of NHII Advisors and consultant to both projects.
“Governments need to provide HRB oversight separate and apart from the organizational entities operating HRBs, even if the HRB organization is another part of the government,” he said.
With the three communities operating the HRBs, Washington can easily assume the role of independent regulator, he said. An independent department within the Oregon government not connected to Medicaid can be tasked with providing regulatory oversight, he said.