Communities across the country have encountered structural and technical challenges…
The Massachusetts eHealth Collaborative provides an instructive success story.
Communities across the country have encountered structural and technical challenges in their efforts to adopt health information exchanges (HIEs). Many organizations either find implementation unattainable or determine it a project with little benefit. The Massachusetts eHealth Collaborative (MAeHC), a pioneer from the earliest era of HIE implementation efforts, provides an instructive success story through its North Adams eHX (electronic health exchange) program. By following a community-based collaborative model, a small, rural community can develop centralized processes to successfully implement and synchronize HIE among all stakeholders to achieve measurable success.
A non-profit company launched in 2004, MAeHC received a $50 million financial commitment from Blue Cross Blue Shield of Massachusetts to build a coalition of 34 nonprofit organizations and launch three pilot projects to demonstrate the costs and benefits of wide-scale EHR deployment, understand the barriers to adoption of EHRs and HIEs and test an organizational model for managing and executing community-wide use of EHRs and HIE.
These three pilot projects ended in 2009, at which point the most successful HIE of the three communities was the North Adams project. This included North Adams Regional Hospital and 14 local affiliated physician practices, totaling roughly 46,000 patients in a primarily rural and underserved part of Massachusetts.
Creating sustainability and improving the quality of care in a cost-effective manner was the primary challenge of the North Adams HIE project. A centrally hosted architecture was developed to obtain a high level of interoperability utilizing both physical and virtual server technologies attached to local, clustered and SAN storage technologies. Microsoft clustering and VMWare virtual machines provided the necessary failover redundancy in the central data center, which was supported by the community hospital (North Adams Regional).
The project initially determined that the successful HIE would require highly reliable, high-bandwidth wireless connectivity between and among the central “clearinghouse” system and the off-site practices.
The centralized infrastructure allowed hospital IT departments to assume a support-services role with local community practices. This provided local community practices with access to advanced support and sophisticated technological capabilities at a fraction of market costs. A common network and security infrastructure allowed the hospital to serve as the central hub for the community HIE, which greatly facilitated the interoperability and exchange capabilities between the hospital and the community practices.
The project achieved a very high level of success and has been widely recognized as one of the earliest, yet most effective, HIE projects to date. Success of the project can be largely attributed to extremely high levels of patient adoption and the quality of interoperability and information sharing among the North Adams community.
One-hundred percent of providers identified in this project adopted use of the HIE initially and sustained usage of it going forward. Ninety-three percent of patients opted in for the program and, though a lower percentage of patients re-opted after the first 24 months, patient participation remains high.
This local HIE experienced additional points of success during implementation, including:
• Integration of laboratory results between hospital MEDITECH system and eClinicalWorks systems;
• Inbound CPOE for labs;
• Ability to view PACS images embedded in radiology results; and
• Summary record of all patient visits with participating providers via continuity of care records (CCR) document.
Another key measurement of success for a project at this stage is the anecdotal evidence. In interviews, providers felt that the HIE “saved them time” and “helped deliver better quality care.” Notable efficiency improvements were evident from the “expedited verification of the medication and allergy list,” which “reduced the need to ask patients questions” and “expedited documentation.”
As the project continues, the North Adams community plans to undertake a number of improvement initiatives for interoperability. These include merging hospital clinical summary (CCD) with CCR, creating a continued merged view of comprehensive clinical summary, and bi-directional exchange of the CCD between the hospital and the community health record.
A survey of project participants yielded some very interesting insights into what factors providers believed drove their adoption of HIE services. The pie chart (right) demonstrates the most frequent reason providers accessed the HIE.
The key factor for this project’s success can largely be attributed to the proper cooperation amongst the constituency. The establishment of a single governing body provided representation for all stakeholder groups, allowing for the organization to effectively administer policies and ensure sustainability through interoperability. The development of strong and effective policies in compliance with federal and state privacy regulations also contributed to the smooth transition to a fully integrated, electronic system.
Dave Delano is project director with the Massachusetts eHealth Collaborative.
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