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January 7, 2008

Maine Objective
By Laura Gater
For The Record
Vol. 20 No. 1 P. 16

An ambitious statewide initiative is underway that someday hopes to provide connected healthcare organizations with seamless, easily accessible data.

The state of Maine is moving forward with HealthInfoNet, a health information exchange (HIE) operated by a nonprofit collaborative of government, public health officials, physicians, insurers, consumers, health executives, and employers. 3M Health Information Systems, along with its partner OrionHealth, will provide the software for the project. In particular, 3M will furnish a data repository, master patient index (MPI), and data dictionary, while OrionHealth will supply the secure, Web-based portal, exchange interface engine, and integration services to support delivery of clinical content into participating providers’ electronic medical record systems.

HealthInfoNet, which is expected to be one of the country’s first statewide electronic information-sharing systems, will give authorized healthcare providers secure, instant access to their patients’ medical records. First, a statewide index of health records will be compiled from Maine’s four largest hospital systems, a large independent group practice, and an independent rural community hospital, which together serve approximately 60% of Maine’s 1.3 million residents. This MPI will serve to support implementation of the network’s clinical dataset.

Statewide integration is expected to start next year, a relatively quick rollout made possible because the state has only two major insurers and a relatively small population. “HealthInfoNet will show physicians how incredibly useful it is to bring data together in one place to understand the full range of care that people are receiving,” says David Howes, MD, the HIE’s vice chairman of the board of directors. “Right now, each healthcare entity has its own data, so it’s very difficult to have a comprehensive picture of a patient’s healthcare record. Physicians will have an accurate record of medications dispensed to their patients, and lab and imaging studies will be widely available.”

Current Status
Installation work is about to begin on HealthInfoNet’s demonstration/pilot phase, which involves six provider organizations and the Maine Center for Disease Control and Prevention (CDC), and will cost approximately $6 million and last 24 months, according to executive director Devore S. Culver. All the participating organizations have made significant investments in health information system technologies that offer a critical foundation for making the implementation of a statewide HIE possible.

Implementation of the demonstration phase will take place over a 12-month period and will involve connecting four of Maine’s largest hospital systems, an independent rural community hospital, a large independent group practice, reference labs, and the Maine CDC to a clinical data repository managed by HealthInfoNet. Using the continuity of care record (CCR) dataset as the project’s starting point, HealthInfoNet will standardize and aggregate the clinical content supplied by the participating organizations so that it may be served back to clinicians at participating organizations through a secure Web-based portal in a patient-centric format. The categories of clinical content to be managed through the exchange during the demonstration phase will include prescription medications, allergies, and laboratory and diagnostic study results.

The second 12 months of the demonstration phase will evaluate the HIE’s impact on patient safety, provider satisfaction, and cost modification. “We anticipate that focusing on improved coordination of prescription medication management between providers will have the most significant impact in the near term relative to patient safety and cost modification,” Culver says. “However, enabling providers to easily access laboratory and diagnostic study results from other organizations should also diminish redundancies in testing, which could save Maine residents as much as $15 million to $20 million a year once the exchange is fully implemented across the state over the next five years.”

Patient Safety
The mean age of Maine residents is the oldest in the United States, which means a greater possibility of bad outcomes resulting from managing multiple prescriptions on an individual basis. In 2006, Culver says approximately 7,700 hospital admissions in the state were a direct result of bad outcomes managing prescription medications on an ambulatory basis. Many of these cases were the result of patients having multiple providers involved in prescribing medications. With HealthInfoNet, physicians will be able to review their patients’ prescription medication profiles electronically in one place at the time of care.

“This is a huge opportunity for Maine to address this public health issue that has not gotten a great deal of attention until recently,” says Culver. “Patients’ treatment is often suboptimized because individual physicians don’t know all of their patients’ prescription medications.”

Howes emphasizes millions of dollars are spent annually on medication errors and conflicts due to providers being unaware of all medications a patient is taking. “The lack of information about medications that doctors are providing is an enormous danger to patients,” he says. “It happens with much greater frequency than I realized. HealthInfoNet will provide physicians with a warning that will indicate that certain medications are contraindicated.”

MPI’s Role
“Healthcare information management is often fractured today because it is based on where patients receive care or who their insurance carrier is. In a health information exchange, data is organized around the individual person regardless of where the care was rendered or what insurance is involved,” explains Culver. “What we are attempting to do by building a statewide health information exchange is remove the built-in boundaries to health information integration created by care being delivered over multiple independent organizations.”

One of the most critical challenges facing healthcare today is reliably identifying the same person over multiple locations of care in order to build a single person-centric record of the patient’s health information. Developing and maintaining a statewide MPI is a critical first building block toward leaping that hurdle.

“An MPI allows us to aggregate information in a tidy way,” says Howes. “It’s a critical first step in a project like HealthInfoNet. One of the key characteristics of the system is to identify system users in order to eliminate duplicity and assign each user an identifier to allow care data to be aggregated from different systems. The first piece of work in this project was to aggregate all of the patient care information that was available.”

This is where the project leaned on HIT. “Working with HealthInfoNet is an opportunity to take part in shaping the future of healthcare information technology. The project is a good fit with what we do,” says Kasey B. Poon, MD, program manager at 3M. “Our customers are integrated delivery networks [IDNs], so we saw this project as a larger scale version of an IDN.”

An MPI uniquely identifies patients in the system database, which is the first step in managing clinical data, according to Poon. Each patient is assigned an enterprise number, which is a unique identifier. Patient name and address are two factors used in 3M’s matching algorithms.

“The next step is getting data into the system, which we are doing through our partners, using Health Level Seven standards to integrate patients’ health information,” Poon says. “Duplicate patient records are being merged, and data from various sources are being imported into HealthInfoNet’s system.”

Objectives and Impact
HealthInfoNet has a simple set of objectives during the demonstration phase, according to Culver. It will show that it is possible to collect and effectively manage clinical content from multiple unaligned provider sources to improve the clinical care process. The project will also seek to educate consumers on the risks and benefits of electronic HIE to encourage their participation in HealthInfoNet, which is “very pivotal in the demonstration phase.”

It is also critical to deliver a highly reliable, accurate, and accessible clinical dataset to providers. “The minute this dataset becomes perceived as unreliable, inaccurate, or too hard to access, healthcare providers won’t use it,” Culver says.

Depending on the success of the demonstration phase, a subsequent build-out for a statewide HIE is planned that will look to encompass physician practices, clinics, and the state’s remaining hospitals (approximately 38 total). In addition, a consumer portal is being developed to be introduced at this stage.

“We hope this project will improve patient care, make information retrieval and information sharing easier among providers, and provide some cost savings,” says Poon. “We want more involvement by consumers in their healthcare, and we hope that HealthInfoNet will eventually use a Web-based system for patients to access their healthcare records.”

Culver’s concerns for the demonstration phase implementation include the “sheer challenge” of managing large volumes of disparate data, delivering a service product that is effective within the clinician’s workflow, and securing trust in the HealthInfoNet system among consumers.

Project Values
Because of its partnership with the state’s public health system, Howes believes HealthInfoNet will provide significant values, such as its potential application in the case of a public health crisis, providing an understanding of population health issues such as concentrations of cardiovascular disease or diabetes, enabling the evaluation of regional care patterns, and improving regular healthcare patterns.

“Whatever is being done now [regarding the application of technology to manage medical records] is nowhere near as sophisticated as it can be,” says Howes. “Although physicians are positive and pretty excited about the project, the pilot will demonstrate how incredibly useful it is to bring data together in one place to understand the full range of care that people are receiving.”

The project has brought together healthcare entities that would otherwise be considered competitors. “HealthInfoNet has created a neutral environment where organizations with potentially competing objectives have come together to collaborate on accomplishing a common goal,” explains Culver.

A handful of other state initiatives are launching their own HIE systems. New York, for one, is supporting multiple exchanges, making it a more complex example. Approximately 28 different exchanges in that state are now organizing into a state health information network.

“This is a concept that really will, once it is established, become an indispensable care tool. We will wonder someday how doctors ever practiced without it,” says Howes.

Culver acknowledges that although HealthInfoNet is a good example of an initiative attempting to deal with a weakness in the current healthcare delivery system—integrating person-centric health information across points of care—the development of HIEs could be a piece of a much larger picture.

“Whether health information exchanges are a step toward something else or a long-term solution in and of themselves is too early to tell at this moment. Regardless, it is the right thing to do now to move the transformation of healthcare delivery forward in a meaningful way,” he says.

— Laura Gater’s medical and business trade articles have been published in Healthcare Traveler, Radiology Today, Corrections Forum, Credit Union BUSINESS, and other national and online publications.