The Oregon Experiment

Can a health information exchange that puts patients at the center of the equation succeed? That is what the state of Oregon hopes to find out in the next year as it launches the Health Record Bank of Oregon (HRBO).
Oregon defines a health record bank as an organization that provides a secure centralized electronic repository for a consumer’s lifetime personal health record from multiple sources and assures that the consumer has complete control over who has access to the record.
With a Medicaid Transformation Grant of $5.5 million, Oregon hopes to get approximately 30,000 of the state’s 430,000 Medicaid recipients to sign up as health bank members. In the next few weeks HRBO expects to choose a vendor partner to handle both the technology project and community outreach and marketing. The go-live date is set for Jan. 1, 2010.
As soon as patients sign up, the state Medicaid Management Information System should be able to provide much of the baseline data about them. The system will be designed so that patients can enter notes about their own health.
The health record bank will be open to any Medicaid beneficiary, but the outreach effort will emphasize children in foster care, people enrolled in chronic disease management programs and pregnant women, said Barry Kast, HRBO’s project director. “With the foster care population, these kids may have five or more changes of ZIP code in the two years they are in foster care,” Kast explained. “That means a lot of health data can get lost. And many of these kids have behavioral and developmental issues, so the state organizations that work with these children were very receptive to the possibilities.”
Interestingly, the project envisions patients printing out their records and carrying them to face-to-face meetings with clinicians, rather than physicians looking them up via web browser, although the system will offer that capability. “We absolutely did not want to do anything to engineer work flow in the physicians’ offices,” Kast said. “We are working largely with safety net clinics and many of those are still paper-based, so we chose this print-and-carry model as the default option. Many of these patients will go to the library and use a computer to print out their personal health record data.”
HRBO hopes to measure how people access their records, gathering data on the average number of log-ins, how long they spend on the site, and if it is used in the clinical environment. But whether it actually has any impact on patient outcomes and health status may be too large and complex a question to answer in the initial phase of the project, Kast said.
Oregon state government healthcare leaders have expressed the hope that HRBO could become one of the building blocks of a larger health information exchange in the state.
“We have reached out to the best consultants we could find on health information exchange to have the maximum opportunity to make this work,” Kast said. “If it doesn’t get used, we will have learned something from that. If it does get used, then perhaps it can be a model for other states.”