A special thanks to Laura Adams, President & CEO of the Rhode Island Quality Institute; Chuck Jones, President & CEO of Thundermist Health Center; Matthew Roman, Chief Operating Officer of Thundermist Health Center; and Jane Hayward, CEO of the Rhode Island Health Center Association for their contributions to this post.
By Thao-Chi Tran
Health information exchanges (HIEs) are entities that facilitate the access and sharing of patient information electronically, and are emerging as key tools in the drive to achieve the Triple Aim (improving patient experience and population health while reducing system costs). States have been active in developing and facilitating HIEs through various federal grants and state legislation. Since the passage of Rhode Island Health Information Exchange Act of 2008, the state has been working to improve health care coordination through its statewide HIE known as CurrentCare.
CurrentCare in Rhode Island
CurrentCare is owned and operated by the Rhode Island Quality Institute (RIQI), a 501(c)3, and the state-designated Regional Health Information Organization. RIQI’s board consists of CEO-level leaders representing health plans, hospitals, physician groups, health centers, consumers, employers and state government. In 2015, over 490,000 patients were enrolled in CurrentCare, and now even more patients are being served through HIPAA-compliant agreements to share data among providers. Patients are enrolled through their physician offices, at hospitals, free-standing labs, long-term care facilities, etc. Enrollment is voluntary and allows health information including medication histories, laboratory results, diagnostic reports and clinical summaries to be shared and accessed electronically among providers. Rhode Island was the first statewide HIE in the nation to upload alcohol and substance abuse treatment information from 42 CFR Part 2 mental health providers. A provider must have a treating relationship with the patient to access the patient’s health information. Health centers in particular have played a major role in educating patients about CurrentCare and enrolling them into the HIE.
CurrentCare was implemented with federal grant funds from the HITECH Act. To ensure the sustainability of CurrentCare, RIQI and its partners in state government and the private sector implemented a voluntary contribution where multiple entities agreed to contribute to a $1 per member per month (PMPM) operate and scale the system. The $1 PMPM is based on the number of “covered lives” for whom each of the entities provides health insurance. These payers include Medicaid, the State as an employer, all major commercial insurers in the state, and self-funded employers, such as CVS, Brown University, AAA and Amica. RIQI also has other funding streams from fee-based products and services and grants.
Today, RIQI is piloting a dashboard that alerts primary care providers, in real time, of patients’ emergency department and hospital admissions and discharges. The dashboard enables them to immediately see the reason for the admission and the pattern of admissions, and to view clinical summary reports as well as identify the hospital system in which their patients were admitted. The pilot group has observed lower hospital readmission and emergency department return rates compared to providers in CurrentCare that lack the dashboard. This function exhibits the potential to improve care coordination between hospitals and primary care practices and to reduce health care costs. Analysis of the data for the basic alerting function shows an approximate 12% relative reduction in hospital readmissions and a 22% relative reduction in ED visits for patients whose providers receive alerts versus patients whose providers do not, a trend that is consistent over more than 18 months.
The Health Center Experience
Thundermist, a health center serving nearly 43,000 patients in Rhode Island, is piloting the dashboard and is also using CurrentCare as a resource to gather information on patients that do not meet quality of care measures. Through the state HIE, staff have been able to find patients’ prior health screenings and tests that are not recorded in the health center’s electronic health record (EHR). This allows Thundermist to prevent duplication of health care services and improve patient care and outcomes without having to invest significant amounts of time in tracking down this information. This has also has implications for the health center’s performance measures. The next phase for CurrentCare includes levering its analytics capabilities for prediction and early intervention, and developing more real-time care summaries served up inside of the clinician workflow based on clinician-derived preferences.
Until a basic level of interoperability is reached, the use of HIEs will still need to be complemented by separate access to various existing electronic health records. The formatting of clinical reports retrieved from a HIE may not include specific details that certain providers need to treat patients. The inconsistency of EHR types utilized by different health care settings and the lack of technology that would allow different EHRs to communicate are other major barriers to exchanging health information electronically. While this is exactly the challenge that CurrentCare solves by collecting, normalizing, organizing, and storing the data regardless of the EHR platform from which it originated, not all states have a CurrentCare-like infrastructure in place.
Despite the challenges, there are opportunities for health centers to improve patient outcomes as well as performance. By participating in a HIE a health center is able build stronger relationships with other providers and better understand and respond to their patients’ experiences beyond the health center’s walls. Although states and providers may assume additional financial costs to operate and engage in HIEs, patients’ health care quality is increasing as a result. In addition, better care management via HIEs can potentially reduce health care costs. HIEs, such as CurrentCare, have made noteworthy strides in the field of health information technology. As HIEs develop and interoperability increases, there will be more opportunities to improve care coordination and effectively address the needs of patients.
Learn More About HIEs
To learn more about the different types of HIE’s and the challenges and barriers associated with each, checkout NACHC’s new publication Health Information Exchange: Opportunities and Challenges for Health Centers on MyNACHC.
 Providers in CurrentCare can send data to the HIE, but do not receive data other than alerts, and have to access various health systems to retrieve certain health information.