Transforming Arizona’s Health Care System: Developing and Implementing the Health-e Connection Roadmap
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R E V : J A N U A R Y 6 , XXXXXXXXXX
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Professor Lynda Applegate (Harvard Business School) and Professors Ajay Vinze, T. S. Raghu, and Minu Ipe of the W. P. Carey School of
Business, Arizona State University, prepared this case. HBS cases are developed solely as the basis for class discussion. Cases are not intended to
serve as endorsements, sources of primary data, or illustrations of effective or ineffective management.
Copyright © 2007, 2009 President and Fellows of Harvard College. To order copies or request permission to reproduce materials, call XXXXXXXXXX-
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L Y N D A A P P L E G A T E
A J A Y V I N Z E
T . S . R A G H U
M I N U I P E
Transforming Arizona’s Health Care System:
Developing and Implementing the Health-e
Connection Roadmap
Introduction
By using information technology, Arizona’s health care industry can improve the quality of care, while
ealizing increased efficiency and cost savings. The Arizona Health-e Connection is one of the best examples in
the nation of the health care industry coming together to drive innovation in health care services.
— Arizona Governor Janet Napolitano
In October 2005, Governor Napolitano issued Executive Order XXXXXXXXXXto create a roadmap for
Arizona to achieve statewide electronic health data exchange between various entities in the health
care delivery system. This project was called the Arizona Health-e Connection. The primary objective of
this initiative was to promote the digitizing of health records and the creation of pathways for the
electronic exchange of health information across the state. The Arizona Health-e Connection
Roadmap was a five-year plan to create a health information technology infrastructure within the
state, building upon existing efforts in this area.
On April 4, 2006, the Roadmap was delivered to Governor Napolitano by state CIO and Arizona
Health-e Connection Steering Committee Co-Chair Chris Cummiskey. The Roadmap project was a
key strategic initiative for the state, and a bold step in addressing problems afflicting the health care
system. The Roadmap development process represented an innovative public-private partnership
approach to policy making. The state, coordinated by the Government Information Technology
Agency (GITA), had facilitated the process by building a coalition of partners representing
stakeholders in the health care arena around the state. Developing the Roadmap within the six-month
time frame identified by the governor—a project involving almost 300 volunteers—required a
mammoth effort by Cummiskey and his team at GITA.
This document is authorized for use only in Nilmini Wickramasinghe's Introduction to Health Informatics Management course at Deakin University, from March 2017 to May 2017.
XXXXXXXXXXTransforming Arizona’s Health Care System: Developing and Implementing the Health-e Connection Roadmap
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The Roadmap represented the first step in transforming the health care system in Arizona. As in
other parts of the country, the health care industry in Arizona had been a relatively slow adapter of
technology to maintain and exchange health records over the years. Across the country, the challenge
of transforming the health care system was being addressed through various local and statewide
efforts, but few states had made significant progress with their initiatives. As the first State to develop
a statewide Roadmap, Arizona was being recognized as a national leader in the area of health care IT.
While Cummiskey and his team had successfully initiated a large-scale transformation within the
state, they were now faced with the challenge of transforming the blueprint into reality.
In the spring of 2007, Cummiskey was prepared to transition the leadership that developed the
Roadmap to the Arizona Health-e Connection, a nonprofit organization that was formed to oversee the
Roadmap’s implementation. As Cummiskey prepared for the transition, he recognized the challenges
involved in implementing the Roadmap at various levels within the health care sector.
• Would the public-private partnership created during the Roadmap process be successful
in accomplishing the mission identified in the Roadmap?
• Would the state be able to overcome the myriad challenges that stood in the way of an
electronic health data exchange system?
• Was Arizona ready to move its health care sector into the twenty-first century?
Background to the Case
Since the late 1990s, there had been increasing awareness of the enormous problems afflicting the
health care industry. The magnitude of the issues su
ounding the delivery of health care had
prompted action from the federal government as well as state and regional governments. All levels
agreed that the lack of adequate information technology infrastructure was one of the most critical
issues. Overwhelming evidence proved that the inability to preserve and access accurate information
in a timely manner had serious consequences for consumers and providers of health care. These
consequences included:
• Thousands of deaths annually from avoidable medical e
ors;1
• Millions of dollars wasted from redundant tests;2
• One of every seven primary care visits affected by missing medical information;3
• Hundreds of thousands of reactions, injuries, and deaths from prescription drug e
ors and
unintended drug interactions;4
• Millions of dollars wasted from medical transactions conducted by telephone, fax, or mail.5
1 Kohn, L.T., Co
igan, J.M., & Donaldson, M XXXXXXXXXXTo e
is human: Building a safer health system. Washington, D.C:
Institute of Medicine.
2 Bates, D. W., Boyle, D. L., Rittenberg, E., et al XXXXXXXXXXWhat proportion of common diagnostic tests appear redundant?
American Journal of Medicine, 104, XXXXXXXXXX.
3 http:
www.hhs.gov/healthinformationtechnology/consumerAwareness.html.
4 Johnson, D. J., Pan, E. C., Walker, J., Bates, D. W., & Middleton, B XXXXXXXXXXThe value of computerized provider order entry in
ambulatory settings. Boston, MA: The Center for Information Technology Leadership.
This document is authorized for use only in Nilmini Wickramasinghe's Introduction to Health Informatics Management course at Deakin University, from March 2017 to May 2017.
Transforming Arizona’s Health Care System: Developing and Implementing the Health-e Connection Roadmap XXXXXXXXXX
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The U.S. Department of Health and Human Services estimated that in the nation’s $1.9 trillion
health care industry, $140 billion per year could be saved through the adoption of appropriate health
information technology (HIT) systems, which would reduce duplicative care, avoid e
ors, and lower
health care administrative costs. These savings would represent nearly 10% of the total health
spending in the United States each year. In 2004, recognizing that investing in electronic health
ecords and creating pathways through health information exchanges (HIE) was a significant part of
containing costs and increasing the efficiency of the system, President Bush challenged physicians
and hospitals to convert their paper-based systems to interoperable electronic health records within
10 years. Additionally, he established the Office of National Coordinator for Health Information
Technology (ONC). The focus of ONC was to achieve 100% electronic health data exchange between
payers, health care providers, consumers, researchers, and government agencies within the stated
time period. At the same time, federal and local organizations were working on developing standards
and compliance issues as HIT and HIE projects were initiated across the nation. (For more
information see http:
www.hhs.gov/healthinformationtechnology/.)
In Arizona, Governor Napolitano took the lead in prioritizing quality and efficiency in the
delivery of health care with her executive order to create the Health-e Connection Roadmap. Arizona
had some unique challenges in the health care arena. In 2005, Arizona’s growth rate was the second
fastest in the nation. A population of 5.7 million with a growth rate of 3.5% posed significant
challenges to the delivery of health care across the state. The geographical spread of the state’s
population compounded this challenge. About 76% of Arizona’s population resided in Maricopa and
Pima counties, providing opportunities for developing regional and state-level data exchange.
However, because each of the other 13 counties contained less than 4% of the state’s population,
espectively, the state faced numerous challenges in providing access to health care in rural areas as
well as in the state’s 22 tribal nations.
Perhaps because of the population growth and spread, Arizona ranked 33rd in the nation in the
number of physicians per capita. According to the Bureau of Health Professions, the state had a ratio
of 172 physicians per 100,000 people, which fell substantially below the national ratio of 198
physicians per 100,000.6 Arizona’s concentration of physicians in small and medium-sized practices
also posed a challenge to the extensive adoption of health information technology across the state.
Approximately 1,460 of Arizona’s 4,000 physicians practiced in primary care practices, and 92% of
those practices consisted of one to three physicians. While the use of HIT had been slowly gaining
momentum among physician practices, it was reported that of the 87% of physician practices that had
high-speed Internet access, only 13.5% used electronic health records.7 In addition, there were
problems with security and privacy of data in digitizing health records.
Despite the challenges that stemmed from demographics and geography, Governor Napolitano
made health care issues a priority by issuing the directive to develop the Roadmap. She set an
aggressive target for the adoption of HIT and HIE in the state—by 2010—four years ahead of the
federal deadline set by President Bush. Cummiskey summarized the thinking behind the Arizona
Health-e Connection Roadmap:
The roadmap was developed to provide a path for the state to improve the quality and
delivery