As health information exchanges (HIEs) are coming to terms with creating viable roads to financial sustainability, SAFEHealth, a central Massachusetts HIE, is focusing on patient consent management, automatic data management, and low operating expenses to keep the lights on. SAFEHealth connects Fallon Clinic, a large multi-specialty medical group practice with more than 20 practices, and HealthAlliance Hospital in Leominster, Mass. SAFEHealth has been live since June 2009.SAFEHealth got its start from a $1.5 million Agency for Healthcare Research and Quality (AHRQ) HIE Grant in 2004 and a $4 million donation from Fallon Clinic, Fallon Community Health Plan, HealthAlliance Hospital, and UMass Memorial Medical Center (Worchester).“In order for health information exchange to be successful, it has to do three things: first, your costs have to be less than the value you’re getting out of it, in order to show value; second, it has to be usable by fitting into workflows of live healthcare; third, you have to develop trust among stakeholders,” says Larry Garber, M.D., medical director of informatics, Fallon Clinic, and principal investigator for SAFEHealth.
Larry Garber, M.D.With a focus on reducing operating expenses, SAFEHealth bypassed a formal third-party organization or regional health information organization (RHIO), and instead hosted the core server in Fallon Clinic’s data center and internally-developed software to connect Fallon Clinic’s electronic health record (EHR), (from the Verona, Wis.-based Epic Systems), to HealthAlliance, which operates on a Siemens (Malvern, Penn. ) EHR.Patient Consent ManagementGarber points out that one of the main reasons for SAFEHealth’s success is its patient consent model, which fits into normal workflow processes at patient check-in. Since the patient’s information is stored behind the firewall of each organization on the Intranet, there is direct access to local printers. When the registration person signs in the patient for his appointment and enters information via a Web portal, in the background a local server notes if the patient has signed a consent form or not. If consent has not been given, a form will auto-print at the registration desk. Also via the portal, the registration person can manage the consent process by entering in what the patient notates on the form, which is cached permanently on the organization’s edge server for future sharing with the other organizations.“The beauty of that is that if you have an EHR, you don’t need to buy an extra box. All the consent processing is incorporated directly into the EHR and fits right into our workflows, and that data flows directly into the EHRs, so physicians and nurses can look there when they want to see something,” says Garber. “[The industry] really is evolving toward this architecture.”SAFEHealth has borrowed some lessons learned by the Waltham-based Massachusetts eHealth Collaborative (MAeHC), a nonprofit that promotes health IT, that also serves as the regional extension center (REC) of New Hampshire. MAeHC led a pilot project that set up exchanges in three cities, Brockton, Newburyport, and North Adams, with all the providers using the Westborough, Mass.-based eClinicalWorks to share information. What was learned from this pilot was that with proper patient education and marketing, the benefits of HIE were understood. A study of the pilot found that 95 percent of patients get their peace of mind knowing that their clinical data is always where they need it to be without hassles, and only 5 percent want complete control over their data.Direct Information Flow to EHRsGarber says that having patient data flow directly into the organization’s EHR is another key to the usability of the exchange. He remembers the levels of discomfort in the past when the community health information networks (CHINs) were coming up, which brought up a number of questions like about who owns and is responsible for the data, and who absorbs the costs for taking care of it. Garber views a federated architecture, like that of SAFEHealth, as a good solution, since the information doesn’t have to reside in a central place and can just be pushed out to edge servers.Currently, Fallon Clinic shares medication lists, allergies, problem lists, immunization history, code status, advance directive status, PCP and phone number, vital signs, and recent lab/radiology results. SAFEHealth doesn’t share sensitive notes, which are not even loaded in the organization’s edge server.Before more organizations join SAFEHealth, Garber wants to make sure its agenda fits in with current state HIE efforts. He is also the principal investigator for the $1.7 million HIE Challenge Grant project seeking to improve Massachusetts post-acute care transfers. Once that pilot is off the ground, there will be efforts to connect those pilot organizations (11 hospitals and six nursing facilities in central Massachusetts) to SAFEHealth.