Mark at Health Informatics Response asks a great question, which has been asked before. However, now we have the economic stimulus money and I say we need to have everyone contribute their thoughts. So, please do so here or on Mark's post at: http://informaticsresponse.blogspot.com/2009/03/states-or-regions.html.
I'd like to comment about why I don't think a one statewide RHIO (or HIE) it will work at this point here in California. First, I don't really see the State of CA sitting at the table and by far, they are our biggest stakeholder. They are there in the room (representing different agencies who are stakeholders), but hovering and waiting for someone (maybe the Governor) to give the OK for them to be engaged in strategic and thoughtful way as a partner.
Second, the State has competing priorities at the moment. Yes, the stimulus funds and improvements in healthcare will help reduce costs for the State, but there are more immediate issues that need to be attended to... right now!
Third, the grand State of California is made up of small towns across the north, central and south portions of the state. We have small counties and large counties -- some with heavy population centers and others without great concentrations of healthcare consumers and providers. We also have two, maybe three cities that have economies that are bigger than some States and countries. What works for Modoc County just won't cut it for LA and vice versa.
Now, I'm sometimes way too optimistic (and rather proud of my leanings), but I just can't see it actually happening anytime real soon for all of California. Heck, we can't even get North Santa Barbara County and Santa Barbara to agree on most things and our little RHIO experiment may be a good example -- a little too close to home.
One more thing.... I really don't like bullies. I'm not saying that there are any bullies here in CA, but I do know that nothing will turn people off faster and create more mistrust than one big RHIO stepping in to take the lead (again at this point). Maybe it is a Western thing, maybe an American thing, or maybe its because there are just too many unknowns and we need time to sort through everything to get to a point when everyone can buy into that golden "shared vision."
Thanks for listening! Now, I need to get back to unpacking from my weekend trip to beautiful San Simeon (one of those really little towns) where I relaxed while searching for moonstones on the beach!