A consultant from the Washington, D.C., area is no longer the director of Idaho’s central health records repository, the Idaho Health Data Exchange.
Hans Kastensmith — managing partner of Capitol Health Associates, a consulting group based in Washington, D.C. — became executive director of the Idaho Health Data Exchange in October 2019. Jesse Meldru, who had been serving as director of finance, has replaced Kastensmith in that position, according to court records filed this month.
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The exchange filed for Chapter 11 bankruptcy last August, as the Idaho Capital Sun first reported. The organization said at the time that it owed $4 million to creditors.
The bankruptcy has prompted questions from legislators and others about how the exchange will move forward, after receiving more than a decade of government support and millions of patient records.
It is now the subject of an Office of Performance Evaluations inquiry that the Idaho Legislature ordered in its 2023 session.
In response to questions from the Sun, Meldru said that Kastensmith’s last day with the organization was April 30.
“Hans came to (the Idaho Health Data Exchange) during a period of rapid innovation in the underlying technology of the exchange, which is his specific area of expertise and the primary focus of his consulting business,” Meldru wrote in an email to the Sun. “Now that IHDE is transitioning toward a stronger focus on the exchange’s day-to-day operations, Hans decided to move on to other projects through his consulting practice that align with his passions and expertise.”
Meldru said he plans to continue in his role as the exchange’s chief finance officer in addition to executive director.
The road to financial crisis for Idaho’s health information exchange
The exchange is a private nonprofit that launched its medical records portal in 2009, using millions of dollars in seed money from federal grants and ongoing federal funds for operations and improvements.
The federal income stream did not last forever, though. The exchange had to shift toward relying on user fees — memberships from health care providers large and small, who would pay to use its infrastructure to share their patients’ medical records in a streamlined portal.
The HITECH Act, a 2009 law, expired in 2021, which took away a major source of revenue for the exchange.
Kastensmith told the Sun last August that the exchange’s management was working to identify a new source of income to keep the repository alive.
“We have been working to increase revenue while reducing costs,” he said.
The exchange had three employees and 10 to 12 outside contractors, he said at the time.
“We had done a lot of work to right-size the company and keep it moving so it can deliver the service that’s expected of it,” Kastensmith told the Sun.
What is the Idaho Health Data Exchange?
The exchange is not a state-run agency, though it has roots in state and federal government. The Idaho Legislature passed a bill in 2006 to codify Idaho’s intent to improve health care through use of technology.
Medical records at the time could be painstaking or impossible to transfer quickly if a patient needed to see a specialist, change doctors or get emergency care in another part of the state.
The goal of the Idaho Health Data Exchange — like similar health records repositories in other states and regions — is to make all patients’ health records accessible to all Idaho health care providers, all the time.
The exchange’s medical director told the publication Healthcare Innovation in 2021 that the exchange was taking in about 100,000 medical records per day.
According to Healthcare Innovation, the health data exchange held medical records of more than 3 million people as of September 2021.
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