State Government

With healthcare becoming one of the highest fixed operating costs for businesses it has become a key issue facing state governments. They face the challenge of working to achieve both the improved quality of healthcare delivered to citizens and the economic interests of the businesses that provide employment opportunities. States can use healthcare challenges and the attention it is receiving to support economic development focused on building healthcare innovations and create services that reduce costs. States now have the opportunity to establish themselves as the new homes for innovation in the growing industry developing around translational medicine to replace jobs lost to global competition and improve the quality of life for the citizens of their state.

Building an environment for healthcare innovation

States need to invest in the creation of a compeitive clinical research infrastructure to attract funding from federal grants like the CTSA awards, become better sites for conducting clinical trials and investment by pharmaceutical companies, and to attract the best scientists and physicians to their medical schools and academic medical centers. States who have invested resources in the establishment of research infrastructure like data repositories and medical informatics programs have demonstrated that the returns are significant in terms of the establishment of new tax revenue from medical and pharmaceutical companies as well as an increase in resources available to improve healthcare quality issues.

Most patient care is managed by independent private for profit and non-profit institutions but state governments and associated institutions like state medical schools hold the key to creating a collaboration by managing the governance and resources to establish secure research infrastructures that cross boundaries while ensuring that patients rights and the interests of participating providers are aligned.

Recombinant helps states to establish state wide research infrastructure projects:

• Creating and operating clinical research data repositories and tissue bank systems centered around state medical schools or research facilities that allow patient data and samples collected during the course of care to be included into an overall research process.

• Delivering implementations and support of open source translational research tools like i2b2, caBIG, and genomic analysis applications that can make public and private repositories accessible to researchers working to make medical discoveries and bring new therapies and medical interventions to market.

• Supporting the legal and organizational issues needed for multi-site IRB processes and data governance challenges that come from crossing institutional boundaries

• Training local resources who manage, operate and support translational research infrastructure

• Establishing partnerships between state initiatives and commercial entities like pharmaceutical companies looking to sponsor university research or execute clinical trials.

Supporting Quality Initiatives

Healthcare quality improvement at the state level requires broad collaboration among health care stakeholders including hospitals, health plans, purchasers, consumers, physicians and state agencies. By bringing together these organizations tools can be establish that use clinical data to measure quality, incent improvements, and communicate quality publicly to help consumers make more informed decisions. For example each state should have reports publicly available that compare how different medical groups across the state treat the same type of illness or condition. With better visibility through surveillance and publich DPH reporting initiatives they can also establish state campaigns across stakeholders that are focused on the major healthcare issues facing their populations. All of these programs are dependent on a reliable clinical data repository. Recombinant can help establish and support these repositories and integrate them with research initiatives where appropriate.

State quality solutions include:

• Establishing quality data repositories and public web based reporting tools to help measure care across sites and share information about successful quality improvement efforts.

• Most healthcare providers don't have an effective mechanism for using their electronic clinical data to improve quality. Programs like DOQIT were established to support investment into EMR applications. Recombinant can provide technologies and infrastructure to ensure there are sufficient and secure analytic resources and standards for managing care for high cost populations and conditions.

• The highest cost patients are most often the chronic care patients and the uninsured. By creating state wide chronic care registries for these populations states can reduce costs by following evidence based practices that reduce the costs and improve the outcomes for these patients.

Driving Economic Development

• Attract clinical trials and pharmaceutical industry investment

• Participate in more federal research and quality improvement grants

• Reduce state healthcare costs per citizen

• Improve healthcare quality expectations and productivity of citizens

• Recruit top scientists and physicians to universities and hospitals

Consortiums within States can establish consolidated data repositories by both integrating existing data warehouses at mature hospital sites and establishing new warehouses at sites to feed information into the consortium repository.

Using the i2b2 SHRINE and other collaboration interfaces like caGRID allows organizations to establish virtual repositories both with organizations outside of state boundaries and within organizations that are not able to combine data because of governance restrictions.