A wise advocate once told me that if I have a problem with wasting money, I should find a different profession. The latest example of that truth is HITE-CT, a quasi-public entity created in statute to develop a system of health information exchange (HIE) for our state. HITE-CT was dissolved by the legislature this year after wasting $4.3 million in federal grants and four years without accomplishing anything.
Accurate, timely information is key to effective health care. Patients with even modest health problems can have medical records in dozens of different systems that don’t talk to each other. An effective HIE can solve this problem, allowing providers access to the all information they need, but only what they need, to best treat the person in front of them.
With a functional HIE, no one would have to carry X-Rays between providers or remember medications and doses. If you ended up in an ER, the provider caring for you would know your health history, allergies, past surgeries, and anything else they need to keep you safe and make you well. A functional HIE can reduce medical errors, avoid duplication of services, help patients keep ourselves well, and allow policymakers to maximize scarce resources.
But HITE-CT failed. A new report by the state auditors cites some of the reasons for the failure, but as a HITE-CT board member I can offer more. The auditors found deficiencies in financial controls, legal problems, and a “need for improvement in management practices and procedures.” That is an understatement.
The report points out that HITE-CT developed an overly ambitious, unrealistic plan. HITE-CT leadership blamed the changing market, a lack of legislative support, and changing requirements from the federal agency that oversees HIE, but the real problem was mismanagement. The board fell apart and attendance at the monthly meetings waned as major decisions were made in small committees between meetings, and just submitted to the board as a done deal. Most meetings included long executive sessions, held out of public view, to discuss the continuing legal, personnel, and management problems.
As the consumer advocate on the board, I was particularly concerned about safeguarding privacy and security. While it is critical that your doctor sees your sensitive health information — your neighbor, your employer, or a marketing firm should never see it. Strong privacy protections are essential to the integrity of an HIE.
Unfortunately, with scant consideration, HITE-CT’s board voted against a sensible opt-in privacy policy that would have given consumers control over their sensitive information. All of our surrounding states’ HIEs have adopted opt-in privacy policies and a survey found that most Connecticut residents prefer an opt-in policy. The federal health information technology strategic plan strongly supports “patients’ rights to access, amend, and make choices for the disclosure of their electronic health information.”
But HITE-CT Board leaders even testified against a bill to let people decide how their information is used. Bad privacy policy undermines public trust and that lack of trust contributed to HITE-CT’s failure.
When they dissolved HITE-CT, the legislature moved responsibility for developing a sensible health information technology and exchange strategy to the Department of Social Services. While details are still forming, the draft plan is incremental and based upon the reality and the needs of Connecticut’s health system. The plan emphasizes integration and engaging people in their own care.
Unfortunately SIM’s new HIT committee, charged with advising DSS on the plan, includes many of the same HITE-CT leaders. Hopefully, they’ve learned from their failure and won’t repeat the same mistakes this time. Connecticut deserves better.
Ellen Andrews, PhD, is the executive director of the CT Health Policy Project. Follow her on Twitter @CTHealthNotes.
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