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In search of a common digital language in health care

A new strategic road map emerges, far, far under the radar screen

Image courtesy of Gregg's Restaurant

A chocolate layer cake from Gregg's Restaurant is certainly more appealing, perhaps, than a four-part series on Rhode Island's Health IT Roadmap Strategy, but...

By Richard Asinof
Posted 10/12/20
A series of five reports on the creation of a state health IT strategic roadmap raises questions about the future plans for managing Rhode Island’s health information technology infrastructure.
How much was Briljent, the consulting firm from Fort Wayne, Ind., hired to write the strategic health IT roadmap, paid? What part of the fee will be picked up by the federal administration? Is there a specific amount requested in the proposed budget for FY 2021 for future health IT investments? How much is it? Will the R.I. General Assembly commission an audit of private contractors providing services through R.I. Medicaid?
One huge topic apparently left out of the Rhode Island HIT road map strategy is the proposed merger between Care New England, Lifespan, and Brown University’s med school and public health school. The costs of creating an interoperable system of health IT within a merged health care delivery enterprise have not been made public, but they are projected to run into the hundreds of millions of dollars. Exactly how any state HIT road map interacts with a large, consolidated private health system is uncharted territory. Further, an effort underway to control statewide health care costs using data mining with All Payer Claims Database remains a voluntary effort. Moving forward, one of the key problems by Sen. Josh Miller’s legislative study commission on health insurance reimbursement rates, is how to manage the apparent inequity in insurance rates for mental health and behavioral health care, dentistry, and women’s health care.

PART One

PROVIDENCE – When most Rhode Islanders hear the phrase “digital road map” these days, they most likely think about the clever phrasing of Boston Globe reporter Dan McGowan and his “Rhode Map,” delivered to digital subscribers on a regular basis, replete with McGowan’s quirky sense of humor and his dogged reporting style in pursuing the news.

The Boston Globe is now expanding its digital footprint in Rhode Island, hiring a new reporter and a new digital editor to go along with a new editor just hired for its Rhode Island enterprise, Lylah M. Alphonse.

But there is another “digital road map” strategy in the works, a statewide Health Information Technology Roadmap and Implementation Plan, one with huge potential risks and implications for how health care is delivered in the future in Rhode Island. [See link below to the road map strategy documents.]

The HIT Roadmap, as it is being called, is being managed by the R.I. Executive Office of Health and Human Services, in a three-year effort described as “developing a shared, statewide strategic roadmap to guide public health information technology across the state over the next three years,” in the executive summary of the initial planning document.

The map is not the territory it represents
In a nation on the precipice of a monumental presidential election, where the future of the American democratic experiment hangs in the balance, a four-part series delving into a proposed statewide Health IT strategic roadmap may seem like a distraction.

But the apparent distortions contained in the roadmap documents, wrapped up with the best of bureaucratic intentions and filled with persuasive, fervent language about the future of the health care delivery system in Rhode Island, capture the perverse way in which our local democracy and our state government is now at risk, driven in large part by our growing dependence on private contractors and consultants to serve as policymakers – and in their ability to define what the public good is.

Here are the basic facts:

• The initial 41-page analysis, “Rhode Island Current State Assessment,” was prepared by consultant Sean Carey of Briljent, LLC, and was submitted on Dec. 30, 2019. Briljent is a privately held consulting firm headquartered in Fort Wayne, Indiana.

• A second report, “Rhode Island Stakeholder Assessment,” once again prepared by Sean Carey of Briljent, LLC, was submitted on Feb. 17, 2020, and it provided an analysis of some 80 stakeholder interviews, detailed in a 22-page document.

• A third report, “Rhode Island HIT Gap Analysis,” was also prepared by Sean Carey of Briljent, LLC, and was submitted on April 29, 2020.

The 22-page document, the third in a series, included the acknowledgement that the two previous reports were written before the “outbreak” of the coronavirus outbreak. As a result, there was a need to reframe the previous work, saying “new opportunities and challenges were developing,” and that public health infrastructure and technology may need to become a greater focus area of the roadmap strategy.

Translated, the coronavirus pandemic had rendered many of the previous conclusions contained in the first two reports, ah, inaccurate, out of date, and perhaps inoperative.

Further, the HIT roadmap strategy also pivoted to include an alignment with the vision of the 10-year strategic plan produced by stakeholders working with the Rhode Island Foundation, which had been issued in February, a politically savvy move.

• A fourth report, the “Rhode Island HIT Strategic Roadmap,” was published R.I. EOHHS on July 24, 2020, detailing the actual strategy moving forward. Unlike the first three reports, the 27-page document was not written and produced by Sean Carey of Briljent. [Had the contract run out?]

In the executive summary of the strategic roadmap, it stated: “Three overarching core values surfaced and are imbued throughout the Roadmap and Implementation Plan.” These included: Health information technology is an enabler of broader health transformation effort; a race equity lens must be applied to efforts in order to reduce health disparities; and patients are key and must be considered with all initiatives.”

But wait, there’s more.

• A fifth document, a 25-page “Rhode Island HIT Strategic Roadmap Implementation Plan,” accompanied the release of the strategic roadmap document on July 24, 2020.

Taken together, that is an awful lot of consultant-ese and bureaucratic dogma to attempt to digest, read through, and understand, clearly not as appetizing and appealing as, say, binging on a chocolate cake from Gregg’s, as part of celebrating a three-day weekend.

Still, ConvergenceRI is persisting.

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