Guiding Digital Government Reform

January 5, 2021

California has seen a dramatic increase in the use of electronic health records, but has made less progress in connecting doctors and hospitals to systems that share those records. As the state works on that problem, policymakers should bear in mind the recommendations of the Little Hoover Commission’s 2015 report Customer-Centric Upgrade for California Government.

Progress in the use of electronic records has been striking. In 2008, only 9 percent of California hospitals used a basic system for electronic health records. By 2017, 97 percent adopted a federally-certified system.

Both the state and federal governments have played a role in this increase. In 2009, Congress passed a law that funds multiple incentive programs, providing funding for 90 percent of the costs, as long as the state provides a 10 percent match in non-federal funds.

At a November hearing of the Assembly Health Committee, Dr. Linette Scott of the state Department of Health Care Services highlighted key state programs, including the California Technical Assistance Program, in which DHCS worked with approximately 7,500 Medi-Cal professionals from 2015 to 2020 to help them adopt electronic records, and a program that has provided over $1.6 billion in federal funds since 2011 to nearly 26,000 Medi-Cal professionals and 331 hospitals to use of electronic records.

By contrast, the sharing of these records among health care providers has lagged. Only 26 percent of Medi-Cal providers, for example, are connected to a regional organization that allows them to easily and securely share records, called a Health Information Exchange Organization, or HIO.

Improving the sharing of records is now a key focus for the state. Federally approved in early 2020, the state developed the Cal-Hop program, which provides $50 million in state and federal funding to increase the number of Medi-Cal providers that exchange data through an HIO and to increase the abilities of those already connected to one.

Building on these efforts to improve connectivity, the federal government released new rules earlier this year that would require specific federally-regulated payers to make patient health information available in a standardized data format to allow this information to be easily and securely shared with third-party applications. The goal of these rules is to allow patients to access all of their health information in one place, such as a phone app, regardless of their health care provider or plan. Among others, this new consumer-oriented data exchange would impact all of California’s 13 million Medi-Cal beneficiaries.

The state still has work to do to increase the sharing of records, and some federal funding is set to expire in the fall of 2021. As California works on this issue – and as it works on similar technology-related problems in other policy areas – policymakers can benefit from a recognition of the Commission’s 2015 recommendations:  

  • Acknowledging that no single delivery mode will work equally well for everyone, the state should offer maximum options for Californians to conveniently access government services – whatever the platform they choose, whether mail, email, telephone, in person, online, or on a mobile device.
  • Designing new websites, service portals, and mobile apps with users in mind and building around responsive designs with the flexibility to work on multiple platforms. Additionally, the state should consider whether the efforts and costs to produce and maintain government-built mobile apps for specific programs are worth the payout in terms of usage.
  • Connecting the state’s technology sector with state government leaders. Innovators in the technology industry can help the state brainstorm solutions to specific challenges or help policymakers know what’s possible with technology.
  • Researching customer experiences for continuous improvement. The state should ask Californians about their experience interacting with government and use any information learned to refine how they deliver services and ensure those services are accessible and relevant.

These recommendations can help California create a government more focused on its customers, and on providing services efficiently and economically.

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