California's digital divide: Clinical information systems for the haves and have-nots

Health Affairs

Volumn 28, Issue 2, 2009, Pages 505-516

  Miller, Robert H ^a   D'Amato, Katherine ^a   Oliva, Nancy ^a   West, Christopher E ^a   Adelson, Joel W ^a  

^a UNIVERSITY OF CALIFORNIA   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; HEALTH CARE DELIVERY; HEALTH CARE POLICY; HEALTH CENTER; INFORMATION TECHNOLOGY; MEDICAID; MEDICAL INFORMATION SYSTEM; MEDICAL PRACTICE; PUBLIC HOSPITAL; REIMBURSEMENT; UNITED STATES;

EFFICIENCY, ORGANIZATIONAL; HEALTH RECORDS, PERSONAL; HUMANS; PROCESS ASSESSMENT (HEALTH CARE);

EID: 66149169978     PISSN: 02782715     EISSN: 15445208     Source Type: Journal    
DOI: 10.1377/hlthaff.28.2.505     Document Type: Article

References (38)

1. R.H. Miller et al., Barriers to Financing Clinical Information Systems in California Healthcare Delivery System Organizations: Report to the Governor's Health Information Technology Financing Advisory Commission (Sacramento: California Council on Science and Technology, forthcoming).
2. Tax-exempt bondmarket participants include borrowers, investors, and investment bankers that arrange selling and buying of debt obligations (often bonds); bond insurers or banks may guarantee repayments for those lacking investment-grade credit ratings needed to obtain low rates.
3. Some seek tax-exempt leases that only cover CIS hardware, a shrinking minority of total CIS costs.
4. Office of Statewide Health Planning and Development, The State Utilization Data File of Primary Care Clinics, Calendar Year 2006 (Sacramento: OSHPD, 2007);
5. and Health Resources and Services Administration, Section 330 Grantees Uniform Data System, Calendar Year 2005 Data, California Rollup Report (Washington: HRSA, 2006). We obtained information from thirteen managers in twelve CHCs purchasing EHRs, four managers in four clinic networks, and eight financial market experts from five firms.
6. CHCF, Snapshot: The State of Health Information Technology in California (Oakland: CHCF, 2008).
7. R.H. Miller and C.E. West, "The Value of Electronic Health Records in Community Health Centers: Policy Implications," Health Affairs 26, no. 1 (2007): 206-214.
8. Ibid.
9. For CHC full-time-equivalent billing providers, see OSHPD, The State Utilization Data File. We included estimates for county-run and rural health clinics that don't report to OSHPD.
10. For rural health clinic providers, see HRSA, "HRSA Geospatial Data Warehouse-Report Tool," http://datawarehouse.hrsa.gov/HGDWReports/RT-App. aspx?rpt=P8 (accessed 2 December 2008).
11. Data from 2003 and 2004 audited financial statements are from Capital Link and California Primary Care Association, Linking Financial Capacity, Capital Needs, and Creative Financing for California Clinics (Sacramento CPCA, 2007).
12. Administrative data for 2006 are from OSHPD, The State Utilization Data File.
13. Object Health, Building Clinic Capacity for Quality in Southern California (San Francisco: Object Health, 2007).
14. OSHPD, Hospital Annual Disclosure Report Data 2006 (Sacramento: OSHPD, 2007).
15. In addition to sources cited, we relied on interview data from eighteen executives in twelve counties, three interviewees in two public hospital associations, and three interviewees in two financial firms.
16. OSHPD, Hospital Annual Disclosure Report Data 2006.
17. Miller et al., Barriers to Financing Clinical Information Systems.
18. In addition to sources cited, we used data from OSHPD, Hospital Annual Disclosure Report Data 2006, and from interviews with executives in eight unaffiliated rural hospitals and two rural health care associations.
19. Interviewee data; and J.A. Schoenman, Small, Stand-Alone, and Struggling: The Adoption of Health Information Technology by Rural Hospitals, Working Paper no. 2007-2102, February 2007, http://www.norc.org/NR/rdonlyres/8A93D7E0-C7E8- 4593-96C8-C7E86C641883/0/finalreport-color.pdf (accessed 19 December 2008).
20. Fitch Ratings, Vital Signs of Critical Access Hospitals (New York: Fitch Ratings, July 2006).
21. OSHPD, Hospital Annual Disclosure Report Data, 2006.
22. See P. Cunningham and J. May, Medicaid Patients Increasingly Concentrated among Physicians (Washington: Center for Studying Health System Change, 2006).
23. For numbers of California physicians by practice type, see K. Grumbach et al., California Physicians 2002: Practice and Perceptions (San Francisco: Center for the Health Professions, University of California, San Francisco, 2002).
24. Regarding EHR adoption nationally, see C.M. Des Roches et al., "Electronic Health Records in Ambulatory Care-A National Survey of Physicians," New England Journal of Medicine 359, no. 1 (2008): 50-60.
25. In addition to sources cited, we used interview information from six executives in six IPAs either providing or close to providing EHRs to member physicians, and four executives in two physician associations.
26. In addition to sources cited, our findings were based on information from thirteen interviewees in eight California delivery system organizations and a hospital association, twelve interviewees in ten medical groups/IPAs and two medical group associations, eight experts in five financial firms, seven other interviewees, and twelve medical group participants in a group discussion. For hospital-sector financial health, see Price Waterhouse Coopers, The Financial Health of California Hospitals (Oakland: CHCF, June 2007).
27. For data on CIS adoption by risk-bearing medical groups, see Active California Medical Groups' Implementation Status of Electronic Medical Records and Chronic Disease Registries, http://www.cattaneostroud.com/medgroup-reports. htm (accessed 21 February 2008);
28. for limited data on financial health of risk-bearing medical groups, see California Department of Managed Health Care, "Summary of Reported RBO Data (FYE 2006)" (table), in Annual SB260 Report Updated 101507 for web.xls, http://www.hmohelp.ca.gov/providers/rbo/socad-ye06.pdf (accessed 19 December 2008).
29. R.H. Miller et al., "The Value of Electronic Health Records in Solo or Small Group Practices," Health Affairs 24, no. 5 (2005): 1127-1137. (Pubitemid 41577100)
30. For example, see C.J. Bolster, "Planning during Turmoil: Credit Challenges and Healthcare Finance," Healthcare Financial Management 62, no. 11 (2008): 54-62.
31. One California program has begun to do this for smaller health care organizations: see United Health Group/PacifiCare Health Care Investment Program, "Capital Access: Small Issue Program" (Costa Mesa, Calif.: United Health Group Inc., 2008).
32. National Academy for State Health Policy, "Results of State Medical Home Scan," http://www.nashp.org/-docdisp-page.cfm?LID=980882B8-1085-4B10- B72C136F53C90DFB (accessed 22 January 2009).
33. At least as reflected in operating margins, financial health for California CHCs was similar to that of CHCs nationally: see HRSA, California Rollup Report;
34. and HRSA, Section 330 Grantees Uniform Data System, Calendar Year 2005 Data, National Rollup Report (Washington: HRSA, 2006).
35. CHCs' EHR adoption rates are also low nationally: see A.E. Shields et al., "Adoption of Health Information Technology in Community Health Centers: Results of a National Survey," Health Affairs 26, no. 5 (2007): 1373-1383.
36. C. Moylan et al., NAPH Health Information Technology Source Book: Findings from the 2004 Electronic Medical Record Survey (Washington: National Association of Public Hospitals and Health Systems, 2005).
37. Fitch Ratings, Vital Signs of Critical Access Hospitals.
38. In addition to interviewee data, we used data from V.K. Smith et al., State E-Health Activities in 2007: Findings from a State Survey, Pub. no. 1104 (New York: Commonwealth Fund, 2008).