The WNC RHIO is Making a Difference

HIMSS News: HIE Lays Foundation for Longitudinal EMR in Western North Carolina

By Gary Bowers

Whenever the approximately 800,000 people spread across the 16 far western counties of North Carolina need hospital services, they visit one of the 16 independent hospitals serving that region.  For a variety of reasons including relocation and transfer, they commonly seek treatment at different facilities, posing a significant challenge for providers who often have minimal information about these patients. 

To improve quality of care and patient outcomes, the 16 hospitals in 2006 launched the WNC Data Link system to securely and efficiently exchange patient data via a physician portal.  MEDSEEK provides the portal and interfaces; IBM provided the project management services for the implementation, and Peak10 supplies the hosting services.

In June 2008, 103-bed Park Ridge Hospital, Fletcher, N.C., became the 16th hospital to go live on the system, which completed the first phase of this health information exchange (HIE).  Data Link now links the inpatient, outpatient and ER systems of all 16 hospitals in Western North Carolina and allows clinicians to access most patient records such as patient demographics, laboratory and radiology results, discharge summaries, history & physicals, and medication lists from any of the 16 hospitals.  The HIE is currently embarking on Phase II: connecting physician office EMRs to the portal.  Select participants will pilot test data exchange between physician offices and hospitals in fall 2008.

   

WNC Data Link’s start-up costs were funded by $3.5 million in grants, including $2.5 million from the federal government and $1 million from The Duke Endowment.  The participating hospitals proportionately divide the ongoing operational costs.  The immediate goal of Data Link is to exchange patient records across the region, but the long-term objective is to create a longitudinal electronic medical record for every Western North Carolina resident that can be accessed and updated in real time by any authorized provider. 

Implementation Hiccups

Integrating hospital information systems from 16 independent hospitals proved to be a challenge, even though all had an inpatient system from one of five major vendors. Each, however, not only used a different version of the system, but also had installed it differently.

Two hospitals were also replacing their I.T. systems at the time of the Data Link launch, which meant that we couldn’t connect them to the HIE until their individual I.T. projects were completed.

Developing policies and procedures was another hurdle.  There were few operational HIEs when we first began planning the HIE; therefore, there wasn’t an established road map for us to follow.  It also took time to reach consensus because our hospitals are all independent entities.  Fortunately, although these hospitals are competitors, they have a long history of collaboration and trust on several initiatives including group purchasing.  They universally agreed that it was critical to exchange data regionally, creating a common goal that united them.

Data Link is one of the nation’s few operational HIEs or regional health information organizations (RHIOs).  Approximately 20 RHIOs are operating across the U.S., according to a study Harvard University researchers published last year in Health Affairs. Unfortunately, market competition, time, limited internal resources, and financial concerns often preclude regional entities from embarking on the ambitious task of establishing a RHIO despite the obvious medical benefits to the communities served by the network.

ROI

Over the past two years, Data Link has fundamentally altered care delivery in Western North Carolina by enhancing clinical decision-making across the region. Prior to Data Link, for example, emergency room (ER) clinicians had to obtain a release from the patient, fax it to the medical records department of the referring facility, and wait for someone to be available to locate and fax the records back to them.  The process was slow and often unreliable, routinely forcing physicians to make clinical decisions with limited information about the patient.  Today, providers access most of the information they need from Data Link within seconds instead of waiting hours or days.  The results are enhanced patient care, physician satisfaction, and productivity.

Additionally, Data Link is helping providers to better control healthcare costs by eliminating redundant and unnecessary laboratory and radiology tests, as well as reducing the potential for medical errors and extended hospital stays or re-hospitalization.

Next steps

As Data Link moves to integrate physician office EMRs, it initially will target practices that either own or use a hospital-hosted EMR, which will hasten the implementation process. Additionally, Data Link will focus upon recruiting practices to join the HIE that have the biggest foot print in the region, as well as specialty practices—cardiology, gastroenterology and pulmonology—that receive a high volume of referrals from rural facilities.

As Data Link builds out its network over the next several years, it is working to solicit operating funds from additional stakeholders, particularly the payors.   It’s in the payors’ best interest to ensure Data Link remains operational.  Up-to-date patient records and easy access mitigate medical errors, re-hospitalizations and duplicate tests—costly expenditures for payors.  In our region, WNCHN is the only entity in a position to provide that level of data and access.

Gary Bowers is Executive Director of the Western North Carolina Health Network, which developed and operates WNC Data Link.