Duncan's article provides an insightful and comprehensive discussion of the nature, characteristics, and value of CHINs. CHINs would appear to provide great value to community efforts to improve the health status of their members. If the value is there, then why have so few CHIN efforts moved beyond the planning stages? According to Drazen and Staisor (1995), several factors interfere with CHIN development in a community: * The value has been difficult to quantify and has large externalities. The value often accrues more to the community than to the participating organizations. * Faced with the large capital requirements to establish a CHIN and unquantified benefits that have large externalities, organizations have been hesitant to redirect scarce capital and human resources to CHIN development. * Health care organizations are feeling competitive pressures that make it difficult for them to collaborate and to fund initiatives that benefit all rather than the organization differentially. * Organizations have difficulty resolving CHIN issues such as allocation of costs, data ownership, and governance structure. * Communities often lack a strong entity that can force collaboration and resolution of issues--for example, a strong, organized business coalition. CHIN DEVELOPMENT IN BOSTON Boston is such a community. The transformation of a community's culture and infrastructure to one that enables CHIN development can be a lengthy process. What can a community do in the interim to foster CHIN development and reduce the magnitude of the eventual task? One possibility is the pursuit of a strategy similar to the one currently underway in Boston--the creation of the Affiliated Health Information Networks of New England. The Affiliated Networks is sponsored by the Massachusetts Health Data Consortium (MHDC). MHDC is a not-for-profit organization dedicated to serving the needs of the community for health data collection and analysis. The Affiliated Networks Planning Committee is composed of the chief information officers (CIOs) of 21 managed care and provider organizations in the state. These organizations include academic medical centers, community hospitals, community health centers, HMOs, and insurance companies. The Planning Committee reports to a Governance Committee overseen by MHDC. The Governance Committee is composed of three provider and three payer representatives. The Planning Committee's charter is to initiate activities designed to: facilitate an effort to improve the state's healthcare information infrastructure by fostering the growth of a variety of health information in Massachusetts, building on systems already in place, while encouraging collaboration and standardization among those networks (MHDC 1994). To fulfill the charter, these activities should: * Address meaningful challenges faced by the participating organizations as they create their own health information * Leverage the power of numbers of organizations --that is, pursue initiatives where the collective pursuit of a challenge enhances the value of the solution or the ability to effect a solution * Address areas that the participating organizations do not view as a potential basis for competitive advantage * Not require the implementation of a specific technology or service. CHIN FOUNDATION INITIATIVES The Affiliated Networks have identified five joint initiatives: durable clinical data set, clinical data interchange standards, standardized provider dictionary, patient confidentiality, and electronic eligibility determination. Each initiative has a review board composed of members nominated by the participating organizations. DURABLE CLINICAL DATASET For any patient, there are a small number of clinical data elements that have long-term clinical utility--for example, allergies, chronic problems, and a precis of prior surgeries. …
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Nov 1, 1997
John P Glaser 