The concept behind Idaho’s Health Data Exchange (IHDE), a nonprofit organization created by a state commission in 2008, unquestionably has had merit. It was established to make health data more widely available for physicians and insurance providers (including Medicaid).

Anyone who has ever gone to a physician and been confronted by the problems posed by incomplete records can see the logic. According to its website, “Physicians and their medical staff need your current and past health history to accurately diagnose and treat you. Each physician who treats you may have just a portion of your medical record. When providers access each other’s records through the IHDE, they have more complete health information and make informed decisions that ultimately lead to better care for their patients.

So far so good, but Exchange management problems have exposed it to independence, accountability and security issues, according to a new report by the Idaho Office of Performance Evaluations (OPE). As Rakesh Mohan, director of OPE since 2002 told us, “The exchange was created by public officials for a public purpose with significant public funding, but little to no accountability mechanism in place.”

A few of the major issues exposed by the OPE Report:

• “The state treated the exchange like a monopoly, even as the Department of Health and Welfare paid millions to expand the exchange’s capabilities. Health and Welfare used a sole source exemption to state procurement laws and did not go out to bid for multi-million-dollar contracts to develop and improve the exchange. The state's special relationship with the exchange initially led Health and Welfare to focus on the exchange's financial stability rather than deliverables in its most recent improvement contract.”

• “The state’s informal mechanisms of accountability weakened over time as turnover left little overlap between the exchange and the state, particularly after consultants from out of state were brought in to manage the exchange in 2019. When Health and Welfare became concerned about the exchange’s new management team and tried to require more transparency, the relationship deteriorated. The exchange filed for bankruptcy after being sued by a subcontractor for withholding pass-through payments from the state.”

• “Health and Welfare IT experts did not believe there was sufficient documentation that the exchange met security requirements. The exchange still has a small data access contract with the state, but stakeholders reported that federal efforts to standardize and broaden access to other private networks leave uncertainty about the exchange’s future.”

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