Greg Franklin knew he would be busy when he was put in charge of helping state agencies develop standards and policy for health information technology as California worked to enact federal health-care reform.
But shortly after he took the job two years ago, Franklin had what he called an "a-ha" moment about the true scope of his task.
"There was so much that needed to be done so quickly," Franklin recalled. "We had just come out of four or five years of bad state budgets and staff retirements. We didn’t really have the resources then within the state government then to run as fast we needed to run."
Franklin has been a big part of the sprint to the finish line. Unlike some states, California is on track to launch its health benefits exchange on time this fall. The online marketplace will offer a variety of health insurance plans through a program called Covered California to help people comply with the new federal mandate requiring health insurance coverage.
That’s only one piece of a larger picture. Franklin also has shared his expertise with state agencies that are installing new electronic health records systems, enterprise architecture supporting implementation of the Affordable Care Act, health information exchanges, mobility applications and many other projects.
Working as the assistant secretary of health IT with the California Technology Department, Franklin has done whatever needed to get departments talking and working together. For agency-level CIOs navigating an evolving landscape of requirements and regulations, Franklin has been everything from a sounding board and consultant, to a facilitator and meeting convener. There is no job exactly like it in any other state, Franklin says.
"I give California credit for seeing importance and value of a position like mine," he says. "Recognizing that at this critical time goes to the heart of why California is the great state it is."
Franklin has worked through formal and informal channels. Quarterly meetings and steering committees have brought the Department of Health Care Services, the California Department of Corrections and Rehabilitation and many others together to the table. Franklin also has had countless one-on-one conversations, where he gathered intelligence and identified possible areas for collaboration.
"I think because of those various efforts and ‘touches,’ there has become a greater awareness of what’s going on across these various agencies and departments," Franklin says.
With the fall deadline near for California’s health benefits exchange, Franklin says the heavy lifting will be done. He is ready to step aside and plans to retire from the state in government in September. He’ll be a spectator when the system goes live for the first time in October.
Ultimately, the rollout in California of the exchange and electronic health records might be reminiscent of work he’s done over the years in the military. Since 1996, Franklin has served as the senior health administrator for the United States Air Force Reserves. For the past decade, Franklin has been managing technology projects that allow military service members to enroll in a health plan online or by phone, as well as computer-based training systems and web-based health risk assessments.
"Introducing those systems to the military — knowing what the uptake was initially and driving toward 100% participation – is the same type of effort that’s going to have to occur not only with California’s exchange, but others systems that are provider-centric," Franklin says.
He says there’s no big mystery about the technology that drives electronic health records and the benefits exchange. The public has shown they will use these new services if they are presented in a clear and simple way. "I think the public will be able to grasp it," he says.
The bigger unknown and complexity for the state is the governance piece, Franklin says. Will Covered California bring in enough revenue to be self-sustaining, and can a variety of health record forms be integrated all in one place?
"The question is, what are those parts and pieces that are important? And then from a governance standpoint, what systems are accepted or rejected, or [found to be] putting a burden on a provider or provider group?"
Those questions will only be answered in time, but Franklin has worked the past two years so that the state is in position to be successful. Still, California is doing something it has never done before.
"We’re definitely walking by faith and not by sight because we don’t have the visibility that we would have in a usual project," Franklin says.
This article was originally published in the summer issue of Techwire Magazine.