Lessons Learned from Santa Barbara

The key instigators of one of the most prominent health-IT demonstrations in the past decade came to Washington on August 1 to issue an unusual mea culpa for the Santa Barbara Care Data Exchange, which flamed out in December 2006. The soul-bearing by participants, including recently departed U.S. health-IT czar David Brailer, who was primarily responsible for originating the demonstration in 1999 while he was CEO of a health-IT company called CareScience, was timed to coincide with the appearance of a series of articles on the Web site of Health Affairs magazine, which sponsored the briefing.

Brailer, Sam Karp, vice president at the California HealthCare Foundation (CHCF), which provided $10 million for the Santa Barbara experiment, and Robert Miller, a University of California professor, addressed the failures of the project which was once a shining star, but which ultimately crashed and burned. “Many thought the Santa Barbara project had been successful,” explained Miller, “which is why a lot of people were surprised when it was closed down with very little data exchange having occurred.”

Among the project’s key failures was the absence of any community leadership, which was passive in the face of the CHCF doing all the heavy lifting financially, mishandling of the software needs, particularly the complexities of developing data interfaces and the failure to develop and sell a value proposition relating to the use of health information at the point of care. “The business model was out of line with the value proposition,” Brailer said. Physicians and hospitals viewed the project as costing them money and losing revenue, he added.

He explained that he believes the business model will triumph over the value model. “But I don’t know how long that will take,” he states.

Brailer argued that he was well aware of the project’s failings in 2004 when President Bush appointed him as National Coordinator for Health Information Technology at the U.S. Department of Health and Human Services. Brailer said that he applied what he’d learned so far in that job, although none of the three speakers addressed the important question of whether the health-IT infrastructure nationally benefited from Brailer’s propounding of the Santa Barbara lessons during his four year tenure.

Certainly the continuing effort by the HHS to speed up development of a national network has borne not much more than mixed results. With regard to software development, Karp criticized the federal effort here, which has been centered around the American Health Information Community, an advisory group to the HHS, which is now being transitioned into a private sector group. “National data standard development has been too slow, too cumbersome, and politically dominated by large vendors, and that has   to change,” said Karp.

Moreover, Karp cited a report released on July 26 by the Commonwealth Fund which evaluated the major congressional bills aimed at speeding health-IT implementation. The report said the “provisions may be insufficient to promote the adoption of information technology.”

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