Editor's Corner

This week California became one of several states taking a forceful public stand promoting health data exchange. Like several states, California is responding to HHS secretary Michael Leavitt's call for national HIT investment.

The question is, where will the resources come from to pay for all of this health IT wonderfulness? While big providers like Kaiser, the Mayo Clinic and Geisinger may have the bucks, others, particularly small medical practices, are a lot more strapped for cash.

What are the options? Emerging models for financing data exchange for smaller players, each of which come with notable weaknesses, include:

* Direct government funding for health IT investment: The most obvious approach to cracking the nut, but the most expensive as well. Tax credits for health IT investment also come with a big price tag.

* Funding the infrastructure on a pay-for-play basis: As we see in the California RHIO example (see below), at least some groups hope to pay for health data exchange on pay-per-transaction basis. This approach does lower the bar for participants, as smaller practices would by definition incur lower bills, but does nothing to address the problem of absorbing startup costs for such a venture.

* Indirect funding: Practice Fusion (below) may be the first company to finance a shared EMR through advertising, but it won't be the last to try and push the infrastructure costs off on some third party. Getting advertisers or other third parties to pay for health data exchange does make things remarkably cheap for providers, but does raise questions as to how trustworthy the intermediary is.

Ultimately, I suspect the industry will find a way to take the best aspects of these models--such as, perhaps, getting a health IT vendor to build the infrastructure and having them get the venture paid for by, say, the pharmas. That kind of arms-length approach would let a trusted, already-paid intermediary do the work, and sidestep the issue of whether they'd need to sell their soul to get third-party support.

But that theory has holes in it, too, not the least of which is whether the industry would accept vendors in this role. After all, nobody wants a vendor in the position of calling all of the shots in your data exchange strategy.

Have you seen any examples of health data exchange funding which work well? If so, why not write to me and let me know what you've seen? This problem definitely calls for a lot more discussion! - Anne