August 8, 2011 By Matt Williams
Two months ago Greg Franklin was appointed the deputy director of health information technology for the California Technology Agency. Although it might sound like he is joining the new breed of “state health IT coordinators” who have been put in charge of health-care modernization, that’s not really Franklin’s job.
His main responsibilities will be “working with state and local entities to establish standards and develop policies for health information technology and exchanges to better serve all Californians,” and “aligning California with federal technology mandates specific to health information exchanges, Medicaid expansions, and electronic health records.”
Franklin has worked for many years in various capacities for the California state government, most recently as deputy director for health care operations at the Department of Health Care Services. Prior to that he was assistant executive officer at CalPERS, the state’s public employees’ retirement system, where he oversaw purchasing of health services for 1.3 million CalPERS members.
This summer Franklin talked to Government Technology about his new job and how he envisions helping the state build systems, standards and processes that support interoperable health IT systems.
A.: In the whole rubric of health information technology (HIT) at the state level, there are two positions: One is the “state HIT coordinator,” who works with the Health and Human Services on the federal “Meaningful Use” criteria and works on statewide [health information exchange] from a programmatic standpoint — and coordinates all the health-care reform activities related to HIT modernization and implementation.
Then there is my role here at the California Technology Agency, which is monitoring and being a consultative part of the actual technology pieces — in terms of how it is going to work: Does it follow state standards and what are the standards? Does it meet our goals of having a more consolidated infrastructure? And looking at ways of being innovative and saving money — either from cloud computing or mobile computing. So that is my role.
Then add the connectivity that I bring to the health community and other endeavors that occur in our agencies, such as GIS. How can GIS applications [aid] health-care reform and other initiatives? We also are doing some work on 911 reporting and modernizing that system, but is there a nexus for the health-care community with the 911 system? So that’s my role, which is more than just what is occurring with health-care reform.
I think there is some traction for looking at some of our existing systems and applications, and seeing how they could be modernized or made more efficient. Another is taking the new thinking and innovation that our folks at the California Technology Agency are coming up with and overlaying that on existing applications.
The other piece we are really focused on is consolidation where we can to reduce costs. Given the various data warehouses and data systems around the state, and looking at a lot of the innovation that is occurring in pockets — how can we bring that to the forefront? I think that’s going to be a big part of my focus: to understand the landscape a little better, as well as look at opportunities to innovate.
Several departments are embarking on their own modernization of some existing legacy systems. The issue with legacy system modernization is twofold: No. 1, most of these systems have different sources of funding. One could be funded through the state and one could be funded primarily by the federal government. So there has to be some account for how these systems are going to be updated.
No. 2, a lot of these systems drive organizational structure. So the state’s organizational structure would have to be examined as well, so you are potentially talking about reorganizing as an organization at the same time as modernizing the system. For example, CalPERS is in the process of implementing its Pension System Resumption program, which is called “My CalPERS.” Part of implementation of My CalPERS necessitated a reorganization of the organization. So those are the types of steps that we might see organizations take as they look to update their legacy system.
It is extremely important. … If you look at what has been occurring in this country over the last four or five years, we’ve had a severe economic crisis and state budgets have totally flipped upside down and are recovering slowly. If you think about just those two factors alone, it begs for people to start thinking innovatively and about how dollars — and systems — can be used more efficiently. Doing more with less has been the theme over the years. This is a trend that you are going to see — where you have initiatives that are being developed, improved or modernized. But then the question becomes since we are doing this, what else can we do to make this system more efficient that could potentially reduce cost and better serve the people of California?
From a GIS standpoint, being able to map, for example, concentrations of uninsured populations or concentrations of diabetes and cardiovascular disease. How would you do that? You have health information exchange, so the assumption is that providers will be able to capture data though electronic health records — and be able to make data transactions from specialists to primary care providers and move the data around. At the same time, if you are able to capture that data and you have a geocoding service — and some organizations already have it — you can geocode that data. But that data is collected through a central point, maybe through an HIE system itself.
From a mapping standpoint, you would be able to look at pockets of [the population] that may be enrolled — let’s say, in a commercial health plan like Blue Shield of California. You may be able to see a lot of diabetes in Blue Shield of California’s population, but where is it geographically. If it were found in Los Angeles, San Francisco and Fresno, that would allow you to tailor certain health-care programs and target those populations in those geographic areas. Is the geocoding [data] part of the HIE mainframe or should it be retained locally at the provider’s organization? Those things would need to be worked out. But clearly there is opportunity to have this massive endeavor to geocode the data moving around the state and be able to report on that from a mapping standpoint, and allow targeting at those specific geographic sites.
That one might be a little more difficult only because, historically, those systems have been owned by police and fire — so you would need to have the discussion of why is this so valuable to hospitals and hospital emergency rooms and why they should they get a piece of this action. That one might be a little more difficult, but ideally I think it is a discussion worth having.
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