Project

Santa Barbara County Care Data Exchange

Project Update

The Santa Barbara County Care Data Exchange (SBCCDE), one of the nation's first regional health information exchanges, ceased operations on December 31, 2006. Despite its eventual closure, the project helped to focus national attention on the value of health information exchange, which led to the federal government's adoption of a plan to establish regional health information organizations (RHIOs) throughout the United States.

The goals of this community-wide initiative were to improve the quality, clinical efficiency, and safety of health care by making patient medical data more readily available to hospitals, physicians, and other providers at the point of care. Supported by $10 million from the California HealthCare Foundation (CHCF), the initiative brought together leading public and private health care organizations in Santa Barbara County.

During nearly nine years of existence, the Exchange pioneered a variety of innovative approaches. Initially the Exchange sought to certify health IT vendors that could meet defined interoperability standards for the exchange of data. A community-wide governance model was established, which included a new nonprofit entity to oversee operations. The initiative was the first to deploy a Napster-like "peer-to-peer" technical approach to foster lower-cost, secure health information exchange. This approach is now widely used.

The Exchange encountered an array of hurdles, including technology development delays, issues surrounding data integrity and screening of sensitive data, and provider concerns about liability for security or confidentiality breaches. While most of these problems were ultimately resolved, the repeated implementation delays inherent in attempting to deliver the entire Exchange at once, with all of the institutional interfaces and clinical data available, created what might be characterized as a community-wide fatigue. The project ultimately collapsed under the weight of its all-or-nothing design. Hence, the key lesson learned from the project: Take an incremental approach toward delivering the clinical information most needed. Stakeholder buy-in is not achieved through a theoretical construct, but through value delivered.

Although the Exchange is not operational in Santa Barbara, alternative methods for exchanging data have been established through local hospital portals and direct laboratory feeds to providers.

RHIO development efforts will benefit from the Santa Barbara project's lessons about the efficiency and security inherent in peer-to-peer design, the importance of active local governance, the need for an incremental approach to establishing data exchange, and long-term planning for a sustainable business model.

CHCF commissioned an independent review of the Santa Barbara County Care Data Exchange by Robert Miller, Ph.D., a health care economist at the University of California, San Francisco. CHCF has published Miller's full report, The Santa Barbara County Care Data Exchange: Lessons Learned, available through the link below. In addition, a condensed version of Miller's findings were published in the journal Health Affairs, along with four perspective pieces on the Santa Barbara effort and the future of health information exchange.

CHCF is preparing to convey components of the Exchange software to a nonprofit foundation working in the open-source development arena to help accelerate the establishment of RHIOs, especially in underserved communities.

Encouraging innovation requires risk taking. The potential for advancing major improvements in health care delivery must be balanced with good financial stewardship. As part of its ongoing commitment to improving care, CHCF will continue to promote innovative approaches to improving the quality, safety, and efficiency of care delivery.