When sitting down with Dedra “Dee” Cantrell a number of months ago for an article in the Georgia HIMSS Newsletter, I had the pleasure of talking with someone who had risen to the C-Suite and still “kept it real” by having signed Star Trek and Star Wars photos on her office wall. Naturally, her Star Trek photos were higher on the wall but she had successfully meshed the two realms at a time when many of us were still entrenched in one camp or the other.
It came as little surprise, then, when Dee was honored with CHIME’s 2011 Innovator of the Year Award. During the course of our conversation in late 2010, Dee had made a statement about HIEs that seemed a bit blasphemous. Specifically, she said, “One size HIE does not fit all.” – At that point in time, many of us in health IT assumed that each state should/would have one HIE and that would be that. After all, CHINs and RHIOs had already come and gone and despite some start-up monies from the federal government, many of us were quite skeptical about the ability of even one HIE in each state making a successful go of things.
Well, that was a year ago and my how the times have changed. Dee’s plain words of wisdom have come to fruition all the way across the country. The following article provided by the Skagit HIE offers a detailed overview of how an HIE in the northwest corner of the northwest state of the United States is making a strong showing interconnecting the healthcare information of patients in a primarily rural setting of Washington state. Take a look – this is “real” healthcare technology happening close to home.
Health Information Exchange in Rural Skagit County
Even before passage of the 2009 American Recovery and Reinvestment Act (ARRA), the healthcare information technology industry was developing systems for creating, reporting and sharing healthcare data. Washington’s statewide effort, led by One Health Port, is sponsored and overseen by the Washington State Health Care Authority (HCA) and the Foundation for Health Care Quality (FHQC), eventually leading to a nationwide health information network. Washington-based regional efforts, each with a different approach to information sharing, include a centralized management services organization Inland Northwest Health Services (INHS), Swedish Hospital with a growing network of facilities and practices on a common EMR, and Medical Information Network-North Sound (MIN-NS), a non-profit partnership sponsored by three Skagit County public hospitals. This article details MIN-NS’ goals, efforts and accomplishments.
MIN-NS founded to create local HIE
Recognizing the interdependence of their facilities and patients, Skagit Valley Hospital, Island Hospital and United General Hospital sought a cost effective way to share information and provide comprehensive care to patients in their communities. In 2008, hospital leadership decided to pursue a Health Information Exchange (HIE), rather than point-to-point integration. Medical Information Network-North Sound (MIN-NS) was founded to develop an affordable entry point for all facilities and practices wanting to share and benefit from information in the hospitals’ systems.
Working independently, MIN-NS’ focus on creating an HIE by working with technology and healthcare data specialists allows hospital IT staff to pursue HITECH and other immediate project goals. The leadership team of Executive Director Mark Quenneville and Duncan West, Director HIE Realization, have decades of technological experience with complex enterprise systems, as well as direct health care industry accomplishments.
Provider offers right-sized solution
MIN-NS’ leadership evaluated potential HIE vendors for the right balance of functionality and connectivity. Two rounds of proposals and 30 candidates led the team to contract with Bellevue-based HIE provider HealthUnity. “We wanted a complete solution with modern web and XDS.b technologies and room for growth as the needs of our customers changed,” said Quenneville. “HealthUnity’s status as an OEM technology provider for Microsoft’s healthcare products was an important factor providing easy connections to HealthVault and Amalga should MIN-NS customers chose those solutions.”
Subscribers can access the Skagit public health portal, search for patients, display results, view documents and communicate with other subscribers via secure email through a web client, providing immediate value to physicians and facilities not wishing to pursue integrated solutions either due to conflicting HIT priorities or lack of resources. Essential care providers, like those in long-term care and behavioral health, can read and post to longitudinal patient records even without HITECH compliant EMRs.
Choosing a local HIE vendor provides MIN-NS leverage for future connectivity to Seattle’s major medical centers including Childrens’, University of Washington and Harborview. MIN-NS’ vision extends to connecting to and through the Washington State HIE, and NwHIN Direct connections to Arizona and California providers caring for our local snowbird population.
First stage efforts
After loading a year of data from the three sponsor hospitals, MIN-NS confirmed what they already suspected. The hospitals share a large proportion of their patients with each other. One hospital shares nearly 80% of its patients with the other two. Currently, 315,000 patient records from all three founding hospitals have been populated including labs from United General, and dictation and radiology reports from Skagit Valley.
First stage efforts include:
• delivering electronic routing and distribution of Admit/Discharge/Transfer (ADT), labs (LIS), radiology (RIS), and dictation reports;
• integration of existing HL7 message traffic from each facility;
• and support for the Continuity of Care Document (CCD).
After months of successfully loading data into a test environment, we are now flowing live data into production systems for use in the actual delivery of care. Members of a physician’s advisory board will use the live data in their clinical workflows and provide feedback to help shape the HIE’s functionality and usability. This paced implementation provides user feedback, delivery of incremental value to customers, and time for hospital IT staff to get systems and processes in place for generating CCDs with the required content. MIN-NS is also exploring a connection with EDIE, a regional HIE focused on emergency department use.v
Working toward value-added HIE
Adding value beyond the exchange of HL7 documents, MIN-NS is creating online tools that support care management outside the hospital setting. This includes exploring bi-directional connectivity to the Child Profile (preventive care and immunization registry) through the state HIE, and working with public health departments to bring local infectious disease reporting and case management activities online. MIN-NS is working with Skagit County Alliance for Healthcare Access (SCAHA) developing an online resource for hospital, provider and payer case managers whose goal is connecting patients with community resources in order to keep them out of the hospital and on the path to a healthful outcome.
MIN-NS is also using patient data and geo-mapping to help pinpoint areas of the community where medical need is the greatest. The belief is better data will lead to more effectively placed clinics offering immediate delivery of quality health care where it is needed most, and reduction of unnecessary ER visits to the three sponsor hospitals.
Local solutions are best
In Skagit County, MIN-NS is listening to its broader community’s needs and aligning with customer efforts around reducing ER use. MIN-NS is also committed to building a public health portal supporting online form filling and care flow management leveraging its HIPAA compliant medical records storage, business associate agreements and provider registry. No single EMR or HIS so dominates today’s market that it can stand as a single integration standard weaving together all facilities, providers and communities. Solutions grown out of shared experience in Washington’s communities, rather than those proposed by outside vendors, help local facilities and groups devise the best way to communicate among themselves and their patients.
In addition to working with the three sponsor hospitals, their clinics and physicians, MIN-NS is seeking other hospitals and medical groups desiring a community-based foundation for sharing patient data and delivering healthcare services. For more information, please contact MIN-NS at hieinfo@min-ns.org or 360-982-2415.
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