HIMSS Preview: How R.I. HIE Expanded Real-Time Notifications

Feb. 18, 2017
The Rhode Island Quality Institute (RIQI) is expanding the statewide HIE's capacity to deliver real-time notifications for care transitions from and to emergency departments and hospitals for providers' attributed patients.

HIMSS provides an opportunity for health information exchanges to showcase some of their valuable contributions to population health. At HIMSS 17, the Rhode Island Quality Institute (RIQI) will explain how it leveraged the infrastructure of the statewide HIE to deliver real-time notifications for care transitions from and to emergency departments and hospitals for providers' attributed patients.

Healthcare Informatics spoke to Elaine Fontaine, RIQI’s director of data quality and analytics, to preview her HIMSS talk. She said that by 2014 RIQI had established an HIE with about 470,000 of the state’s 1.2 million citizens actively enrolled. (Rhode Island is an opt-in state.) It also had developed a provider portal. Primary care doctors could sign up to get hospital alerts to support care transitions, but the patients needed to opt in and identify their primary care physician at the time of admission. Also, the doctor had to be subscribed to alerts for that patient.

“With that system, we saw meaningful reductions in readmissions and ED 30-day returns,” Fontaine said. “We heard from providers that these alerts were great, but they didn’t cover all patients, so it created multiple work flows in the office.”

In 2015, RIQI spent a lot of time working with legal counsel and providers and it was decided they could leverage the same infrastructure and provide HIPAA-compliant information on patients who are not enrolled in the HIE to nurse care managers.

“We have a business associate agreement with the hospital and the provider organization and the provider identifies the patient for whom they want notification,” she explained. They might choose just high-risk patients or all their patients or patients who are 90 days-post discharge.

Hospitals were already sending this information via fax machine. But there were many ways in which this data was falling through the cracks, she said. “We did a survey of practices before we rolled out these dashboards and were stunned by how much time nurse care managers spent hunting for data as opposed to taking care of patients.”

The new dashboards have been in place for a handful of sites since November 2016, and anecdotally they are very popular, she said. RIQI is currently working through contracts with other entities to get the dashboards up and running statewide. She predicted that by the end of the year, more than half of the state would be covered.

What challenges did they face along the way? “We had the most restrictive state HIE law, so there was a lot of legal work that needed to get done to conform to law and provide community transparency about how this was working,” Fontaine said.

Creating real-time updates was not a small technology challenge, she added. 

“We have created a great tool. I am excited about it,” Fontaine said. “It is about getting the right information at the right time to the right person. Currently they are spending enormous amount of time hunting for data points to try to pull together to create a picture of the patient.” (To hear more detail at HIMSS, go to Room W304A on Tuesday Feb. 21 at 10 am.)