Gov. Ernie Fletcher

What is e-health?

It involves public health officials, a Medicaid system, employee health care systems, individual insurers and hospitals. The technology itself requires the digitalization of health care records. When you look at an individual, they have individual paper records, some insurance information, an eligibility record, whether they were insured or using the public health department, whether they were Medicaid or Medicare.

So what we’re saying [is if you] integrate those repositories, you get a lot more data for being able to track diseases epidemiologically. You get the ability to take care of the patient in a much more effective way, so an individual walking into an emergency room — whether its in California or Kentucky or whether its in Munich, Germany — can have full access to all this health care information on a Web-based system.

What is the immediate cost savings of reducing this redundancy?

We will see a tremendous reduction in unneeded tests, duplicated tests, unneeded treatments. One of the things that’s very important is the algorithms and best practices that can be integrated. When an individual looking at a diagnosis can look immediately at best practices, it can help ensure that we’re giving more effective health care. The patient having access to the medical records on the Web site can take more personal responsibility for their health care and at the same time, if someone’s ordering an MRI for them, they get on the Web site and it costs “X” dollars there and “X” dollars there, let’s get it done there.

Do you need other states to be doing similar things or can it stand alone in Kentucky?

Yes, we welcome it. That’s why we want to get out and talk about what we’re doing. The more states you have doing things, the better it’s going to be. It’s got to be universal, it’s got to be national and it’s got to be eventually international.

The advantage of doing this is, say you’ve got a patient who spends the winter in Florida and they go down there and go to the emergency room and have a hip replacement or have bypass surgery or have a stroke or something. Right now it would all be on paper. That means all that information would need to be carried back or mailed back or faxed back to a physician whose office would have to scan it or type it in. That’s going to cost a lot. That’s not going to be efficient and a lot of times, that information is not going to be put in there. A patient may not come back and say, “Hey you’ve got to get all these records.”

You talk about five years. Do you think this really can be done in five years?

Why not dream big?

Gov. Donald Carcieri

What got you interested in health IT?

[Health care costs are] a big cost driver [in Rhode Island]. It’s the mismatch between Medicaid growth, which is essentially healthcare inflation, and revenue states need to balance their budgets every year. You just can’t deficit spend, and so it’s become a major part of the budget and a real driver.

We’ve got a five pronged health agenda about wellness, but IT, I felt, had the most potential, fastest, particularly in our state. I felt with two insurers, two payers, two major hospital networks in the pretty concise geography of Rhode Island that we could get people around to actually do this.

So where does it stand technologically?

We got the patient-identifiers record done. We’re now trying to spread out what the health information record itself should contain and then how should this exchange operate. So we’re in the process of that design and with just the money from the general assembly. I would like to have some private money come in to match that so that there’s equal contributions. Once we set up that exchange we can begin.

There are all kinds of “how do you implement it” [questions]. Do you start today? Do you try to digitize past records, which is a huge undertaking, or do you just say start today going forward and begin to build, which won’t be as effective in terms of your history of the past 10 years. But it will at least be current.

It this a public/private partnership, the group that’s going to make those decisions, or is there a committee?

Right now there’s a task force working on this and they’re grappling with a lot of these issues. We just created the position of health commissioner a year and a half ago.

You just created that position?

Rhode Island never had a health commissioner. Some of the functions of oversight and regulation were within the department of health, so all we did was break out a health commissioner specifically to look at regulatory issues regarding the hospitals and providers, but also to be the point person on this. That’s why I’m optimistic I’ve got, within the state government, the talent and resource to really drive this.

So that was broken out with the idea that he or she would deal with the whole idea of health IT?

Yeah, the whole evolution of the system. Well I think that bigger states have different problems, but I think that every state’s got their issue, and so like it or not, they’re going to have to get engaged in this because of the inflation of health care cost. In other words, the hospital costs rising, physician reimbursements, all those things. And I think instead of debating who’s going to pay, they’ve got to get engaged in how to moderate the inflation ... and slow down growth rate [in costs].