Axolotl in the News

East Tennessee HIE Selects OptumInsight

ewatts@axolotl.com (Elvia Watts) — Mon, 02 Jan 2012 07:00:00 +0000

CMIO Magazine

The East Tennessee Health Information Network (etHIN), a regional health information exchange (HIE) initiative based in Knoxville, will use the Axolotl HIE platform from OptumInsight to connect healthcare providers in 17 Eastern Tennessee counties to the statewide HIE run by the Health Information Partnership for Tennessee.

According to the Eden Prairie, Minn.-headquartered OptumInsight, etHIN Executive Director Leigh Sterling hopes that the move will improve care coordination in the region.

Marketing for HIE Success…but to whom?

ewatts@axolotl.com (Elvia Watts) — Tue, 20 Dec 2011 00:31:06 +0000

Healthcare-Exchange

By Glenn Keet

President, Axolotl
SVP, Business Development, OptumInsight

In our last post of the HIE patient consent series, we described why attaining patient consent is necessary to the success of an HIE. But to the average patient - you know, the one who isn't a hospital CIO in their downtime - the concept of an HIE can raise privacy concerns. To overcome this, healthcare organizations need to educate patients on how HIEs work, assure them that their information will remain confidential and secure, and explain to them the benefits of electronically sharing patient information via this exchange.

According to the American Medical Association and the Markle Foundation, four in five American consumers believe that using an online patient health record (PHR) would yield major benefits to them in managing their health care. In spite of this, the usage of PHRs has been very low to date, due in some part to patient concerns about privacy of their personal health information.

There are similar privacy concerns with an HIE. However, the HIE plays a critical role in the population of PHRs with clinical data from sources around the health care community. HIE stakeholders - such as hospitals, health plans, individual practice associations, etc. - should consider sponsoring or supplying a PHR to patients that is not only already pre-integrated to the HIE, but also empowers patients by allowing them access to the PHR on their own terms. By letting patients set the consent policies and access rules for their records on the HIE, the HIE potentially is helping to quell these patient concerns.

Effective patient education is key to increased patient involvement and empowerment, and this can be achieved by PHRs connected to the HIE. Doing so enables them to send and receive health care information to their own PHR and share it efficiently with the professionals providing care. But how do you promote this participation successfully?

One way is to go directly to the patient. They need to be presented with the facts about HIEs when they are registering. Registration personnel should be well-trained to explain the exchange and its benefits in layman's terms, and address any questions from patients.

Beyond just the patient visit though, HIEs can implement broader, community-wide consumer education programs to help garner patient participation. These campaigns often include radio or TV commercials/appearances, direct mailings, billboards, presentations at local community meetings, and/or fact sheets, and can serve as resources for patients who have questions about an HIE or concerns about participating in one.

Alternatively, making clinical staff aware of the exchange and explaining the benefits of their participation allows them to advocate for an HIE and encourage patient participation. Physician champions can lead to increased buy-in from patients, peers, and community leaders.

The best marketing program for each HIE will depend on its unique market, but at the heart of it all is the educated consumer. Informed consumers are engaged consumers, and engaged consumers are satisfied consumers. As the health care industry becomes more competitive and moves toward coordinated care and market-based economics, business models that place the consumer at the center of the health care universe will be in positions of strength.

Up, Up and Away! Healthcare’s Future “In the Clouds”

ewatts@axolotl.com (Elvia Watts) — Wed, 14 Dec 2011 07:00:00 +0000

Anand Shroff
VP, Product Management
OptumInsight

Healthcare-Exchange

By Anand Shroff

It's no secret that healthcare has historically been slow to adopt the latest and greatest in technology and even slower to embrace technological paradigm shifts, as evidenced by the continued presence of client-server computing in healthcare in the age of the Internet. While strides to catch up have been made in recent years - with shifts toward electronic health records (EHR), advanced health information exchange (HIE), and mobile computing devices - the world of business is changing rapidly, and the industry needs to do a better job of keeping pace.

Cloud computing is one such paradigm shift. Like other advances before it, cloud computing took root with consumers - think Apple's iCloud and Google's Gmail services - and has since triggered a shift in the way enterprises think about doing business. What began as a simple question of whether files could be stored in the cloud quickly shifted to a discussion of whether business processes could be hosted there as well, e.g. Salesforce.com. Now, entire business processes have been moved to the cloud and previously unthinkable workflows are achievable because of private (and public) cloud integrations made possible by secure cloud communications. Salesforce.com has built an entire ecosystem of extended business processes through its force.com platform, which relies on cloud-to-cloud integration.

Healthcare presents unique challenges to cloud infrastructures, operating under some of the most stringent data privacy and security regulations, but that doesn't mean cloud is completely out of reach. As hospitals and health systems continue to adopt technologies to capture data and share it over an increasing number of miles, they'll also need to think about how to store and access that data most efficiently, and cloud solutions could be the answer. Public cloud environments - where information is accessed entirely via the Internet and hosted outside the organization - may be too risky, but private cloud environments, which exist in healthcare today, can offer similar benefits and efficiencies with less risk. It's also possible to take a hybrid approach, which is what I envision will work best in healthcare. For example, consumers could use their OpenID (public cloud technology) to authenticate with providers after passing additional levels of verification (private cloud offering).

Whether or not patients care about cloud, providers will have to care as their EHRs grow, but they aren't the only constituencies that should pay attention. Vendors too will need to consider cloud infrastructures, privacy and security for its hospital customers. They'll need to start with bolstering security, paying close attention to special certifications and solutions available to help instill confidence in cloud. Payers - given that they have such influence on the industry itself - are sure to capitalize on cloud computing as well.

Silicon Valley receives the attention it does for good reason. Whether it is business or consumer facing technology, human lives are transformed by the innovations made here. Healthcare can recognize the benefits of improved agility and efficiency by keeping closer tabs on how its technology industry counterparts are propelling the world forward.

Enterprising Organizations

ewatts@axolotl.com (Elvia Watts) — Thu, 08 Dec 2011 18:18:59 +0000

Healthcare Informatics

By Jennifer Prestigiacomo

The Latest Hospital Organizations to Reach HIMSS Analytics Stage 7 all have Something in Common: An Enterprising Spirit and Set of Systems.

To measure electronic medical record development in hospitals and health systems, HIMSS Analytics, a division of the HIMSS organization, created its HIMSS Analytics EMR Adoption Model, an eight-stage schematic (encompassing Stages 0 through 7) that helps healthcare IT leaders assess their progress in EMR implementation. Since HIMSS Analytics created the model in 2005, it has formally recognized 61 hospitals as reaching Stage 7-61 in the U.S. and one in Seoul, South Korea (as of press time).

Becoming a paperless enterprise is a long and winding road, as the latest Healthcare Information and Management Systems Society (HIMSS) Analytics Stage 7 healthcare organizations-Tucson Medical Center; University of California, San Diego Health System; and Nemours Children's Health System-can attest. It is one fraught with hard work and challenges, but ultimately rich in patient care benefits and financial payoffs.

EXECUTIVE SUMMARY:

Here's an inside-and detailed-look at how three hospital systems achieved HIMSS Analytics Stage 7, an objective measure of progress toward EMR implementation.

The commonalities among the latest winners, says John Hoyt, executive vice president, organizational services, HIMSS, are medical staff adoption and the energy to accept the organizational change to make the “best of a new world.” He also notes that having an enterprise system for clinical and financial information doesn't hurt, either. “It's not the only way to do it,” he says. “But it seems to be the most effective for enterprise adoption and the fastest route to goal achievement, which is process redesign and quality improvement.”

The Stage 7 criteria are rigorous, with contenders being analyzed against a 12-page checklist that includes such elements as disaster recovery, quality improvement, deployment methodology, training methodology, governance, HIE, and data warehousing. Hoyt conducts a phone interview before the site visit to ensure the organization is ready for Stage 7. During the day-long site visit, the organization gives a 60- to 90-minute presentation on its IT strategy, and then Hoyt walks the floors (medical imaging, pharmacy, ED, the med/surg floors, and the HIM department, among others), accompanied by two CIOs and a CMIO to evaluate the organization's paperless-ness. The team then makes its decision onsite.

As of yet, there is no Stage 8, but additional stages involving HIE and accountable care readiness are likely to be created. There will however be an ambulatory adoption model rolled out in next few months that will assess patient engagement strategies, as well as other meaningful use criteria. What follows are stories from the latest organizations to reach Stage 7.

TUCSON MEDICAL CENTER

On its way to becoming an accountable care organization, Tucson Medical Center (TMC), a 612-bed community hospital, reached HIMSS' highest level of EMR adoption. In late 2008, the organization took a concerted approach to move to an enterprise electronic health record (EHR) its leaders have dubbed OneChart. Starting in 2001, TMC replaced its order entry system and pharmacy module (with software from the Verona, Wis.-based Epic Systems Corp.), and in January 2009, implemented the rest of the Epic modules, including revenue cycle management.

Frank Marini, vice president and CIO, says TMC began to see improvement in cash collections and denials, as well as improvement in turnaround times, from the ED to inpatient admission. Brian Cammarata, M.D., CMIO, an anesthesiologist by trade, says that medication turnaround time dramatically reduced from an average of 166 minutes to under 10 minutes. Further improvements came when TMC went live with its bar code medication administration (BCMA) in a big-bang approach in June 2010; the hospital averted 6,000 medication errors within the first six months.

Hoyt is impressed by the lack of clinically oriented paper at TMC and with the fact that its electronic medication administration record (eMAR) is the one place to look for all patient medications. Clinical information at TMC is reviewed by the medical executive community via dashboards that are customized for cardiac, neurosurgery, nursing, and other areas, in addition to specific reports for the quality care committee of the board of directors.

Even though the hospital is waiting till 2012 to apply for Stage 1 meaningful use, at this point, it is compliant with most, if not all, of the Stage 1 measures. The hospital is currently looking at Stage 2 requirements across the board and performing a readiness assessment to focus on problem list usage.

Beyond meaningful use, TMC is engaged in many ACO preparation activities like information exchange, which happens rather seamlessly, says Marini, in the OneChart program which operates on a common patient database. TMC's employed physician group, Saguaro Physicians, also uses it and is able to see all inpatient information. TMC intends to connect the hospital to a number of practices, specialty and primary care physicians (PCPs), and ancillary services like laboratory and radiology using the Axolotl exchange technology. TMC has also agreed to participate in the recently announced statewide exchange Health Information Network of Arizona (HINAZ) linking all payers and providers.

The second core element to TMC's ACO foundation is a robust analytics engine (provided by the Eden Prairie, Minn.-based OptumInsight) that will allow clinicians to analyze clinical data, with future advanced capabilities to support clinical activities over the continuum of care and transitional care services. “The real objective is to utilize this data and get it into the hands of physicians in the community caring for these patients, so as an organization we can provide the most cost-effective, high quality care to everyone in the community,” says Cammarata.

Beyond moving forward on its ACO initiative and meaningful use, TMC is focused on its transition to ICD-10. Like its OneChart implementation, it will encompass the whole hospital, but fortunately for this single-platform organization, IT challenges will be mitigated moving forward.

Reaching Stage 7 is not easy, and involves much change management, says Marini. “For something as big, expensive, and risky as an electronic medical record implementation you absolutely need to have your executive team and your CEO on board, fully engaged and committed for the long haul,” he says. “Getting the organization to understand that an initiative like this is not an IT project [is key]. The minute it is looked at as an IT project, you know you're headed in the wrong direction. This is really an organizational initiative; it needs to have leadership from the medical staff, as well as the nursing and operational staff.” Hoyt was impressed by the scope of TMC's IT team, which includes about 100 IT personnel and 20 informatics professionals. “It's clearly a multi-disciplinary effort,” says Hoyt.

Marini acknowledges the importance of Stage 7 achievement, but says it's really a byproduct of what TMC is trying to pursue. “We didn't think about Stage 6 or Stage 7 when we set out to do this. It was really about the realization that patient care requires better tools; our clinicians require better tools, and that's really what we pursued,” he says. “It was gratifying and validating to use HIMSS Analytics as a benchmark to see that we are on the right track.”

UCSD HEALTH SYSTEM

The story of the University of California, San Diego Health System (UCSD) is one of iterative change, says its CMIO, Josh Lee, M.D. The health system has made many early important decisions that helped it reach Stage 7. The organization, which is comprised of a few specialty centers and two hospitals, UC San Diego Medical Center and Thornton Hospital, operates under one license, with a combined licensed capacity of 552 beds. UCSD has been focused on increasing patient care quality and patient safety through health IT for the last 12 years.

Recently, the system has been transitioning its hybrid systems into a more streamlined, enterprise approach. "We believe that all information that is needed for provision of patient care is best to be in one environment, so that care providers don't have to go to multiple, different areas to get that information," says Ed Babakanian, who has a team of more than 200 people and has been the system's CIO for 16 years. "That system is supported by these specialized systems like labs, pharmacy, cardiology, imaging, but you have to deploy those in a way like a human body, in that they are integrated and transparent in what they need to do-so a pharmacy system can't be an island of automation all by itself."

It was UCSD's transition to a unified inpatient EHR that struck Hoyt when he was reviewing the system for Stage 7. In February 2011 the system transitioned its Siemens inpatient system to match its ambulatory system (Epic Systems), so patients could benefit from a centralized registration system and have a record that followed them throughout their care. "I don't think we've ever had a hospital achieve Stage 7 in 12 months of go-live, but that's because they had previous experience, and they were probably at a Stage 5 with their previous system. So they knew what they needed to do, and they put their heads down and did it," says Hoyt.

Lee says a novel decision that made its inpatient transition smoother was asking clinicians what they felt was the most important element to preserve; their overwhelming response: transitions of care. About 10 months before the big bang go-live, the IT team brought up the medication reconciliation module, which was a new discharge summary system that forwarded certain communication internally and externally.

On the ambulatory side during medication reconciliation, Lee says his team facilitated workflows for vaccinations at time of discharge, so it could happen at a logical time for clinicians. "We recognize that people need to be introduced to things that clearly meet a demonstrated business need, and we delivered on that early, and they were happy," says Lee. "Nurses and doctors started to see the inpatient presence of our new EMR, so by the time the change happened, it was already a familiar part of [their work environment]."

UCSD provides its staff with complex dashboarding to give clinicians quality report cards, short-term retrospectives, and over time trending to develop practice-based and evidence-based care approaches. For instance, to improve frail patients' risk of fall, a real-time audit is generated for each patient to see if all the appropriate interventions have been taken.

The health system is currently migrating its entire ambulatory and inpatient revenue cycle/billing and appointment schedule system to its enterprise vendor, as well as other modules like its health information management system, ED, perioperative and anesthesia system, and imaging. UCSD is also refreshing its clinical decision support system, as well as implementing a clinical trials system, research informatics for genome sequencing, and a medical education system to train clinicians. "We have a unique combination of talented IT professionals who move beyond simple IT configuration," says Lee. "But really do workflow analysis almost to the point of becoming an internal consulting agency for the enterprise."

UCSD has a robust patient portal, which is used by 30,000 patients to send clinical messages, request refills and appointments, complete health maintenance activities like setting reminders for care activities, and update problem lists. In October, patients will be able to download a free MyChart app to manage their health via mobile device. Soon, Lee says that the portal will be able to capture non-urgent medical images, like a photo of a rash, so patients can provide more information to their providers.

Another way UCSD connects with its patients is through telemedicine. Approximately 10 specialties are doing doing telemedicine amounting to approximately 40 distinct contracts, and 10 to 20 more specialties are in the pipeline to begin telemedicine use soon. UCSD is now preparing to see stroke and psychiatry patients remotely, as well as constructing a new telemedicine building to train future physicians. In September UCSD expanded its outreach to rural communities and launched its eVisits program.

UCSD has been recognized nationally for its outreach efforts by becoming one of the 17 Beacon Communities. A year and half ago UCSD obtained the Beacon grant in large part, Babakanian says, because several clinicians on his team started integrating UCSD with several hospitals across San Diego and linking and interfacing community physician practices through an internal HIE to provide for patient-centered medical homes.

The Beacon project, called the San Diego Safety Net Health Information Exchange (HIE), will allow physicians to electronically make follow-up appointments at participating community clinics for patients being treated in the hospital or emergency department who don't have a PCP. Other Beacon activities include expanding pre-hospital emergency field care and electronic information transmission to improve outcomes for cardiovascular and cerebrovascular disease, patient engagement through web portal and mobile technology, and improving continuity of care for veterans and military personnel through the Veterans Affairs/Department of Defense Virtual Lifetime Electronic Record (VLER) initiative.

"I view Stage 7 as our start," says Lee. "It's really not a finish; I think you have to achieve this stage to now move into the real exciting part of patient engagement and interoperability, but you have to reach this stage first."

URMC Joins Medical Image Exchange

ewatts@axolotl.com (Elvia Watts) — Mon, 05 Dec 2011 07:00:00 +0000

Rochester Business Journal

The area's largest health care provider, the University of Rochester Medical Center, has joined the Rochester Regional Health Information Exchange's medical image exchange, officials said Monday.

The addition of URMC, which runs nine area medical-imaging sites, to the image-exchange system means that the majority of X-rays, MRIs, CAT scans and other diagnostic images are instantly available to some 1,200 doctors and 13 hospitals in 13 counties, said Ted Kremer, the local RHIO's executive director.

In addition to images, RHIO participants can electronically share patients' test results and medical histories, cutting the chances of physicians ordering duplicate tests or making prescribing errors.

Technology to transmit images among RHIO members is provided by Brighton-based eHealth Global Technologies Inc., which provides electronic medical retrieval services to hospitals and RHIOs nationally.

Blue Shield of California grant to expand Santa Cruz HIE

ewatts@axolotl.com (Elvia Watts) — Mon, 07 Nov 2011 17:43:59 +0000

Santa Cruz Sentinel

Physicians Medical Group has been awarded $475,000 from Blue Shield of California to bolster efforts to track patient care.

It's one of 18 grants totaling nearly $20 million Blue Shield awarded to California hospitals, health systems, clinics and physicians to help them participate more effectively in "accountable care organizations," a payment model expected to become more common under federal health care reform.

"Blue Shield will be working closely with PMG and Dominican Hospital, providing metrics and reporting to track the effectiveness of the clinical initiatives which are designed to improve quality and cost effectiveness." said Dr. Nancy Greenstreet, medical director of Physicians Medical Group.

The initiative will require two new positions, a program manager and a care transition manager, coordinating care provided by Dominican Hospital's staff, hospitalists and Physicians Medical Group's more than 400 providers during and after inpatient or emergency department care.

Part of the funding will be used to expand Santa Cruz Health Information Exchange, an electronic network used by doctors, hospitals, labs and clinics in the county.

The goal is to give physicians more information at the point of care and eliminate data redundancy according to Dr. Satish Chandra, board president of Physicians Medical Group, lead organization of the network.

More than 1 million web transactions occur each month as well as thousands of electronic prescriptions and refill requests, pre-treatment authorizations, referrals and transcribed documents.

Rochester General Hospital Medical Records Go Electronic

ewatts@axolotl.com (Elvia Watts) — Mon, 07 Nov 2011 17:38:25 +0000

Democrat and Chronicle

By Patti Singer

Rochester General Hospital switched to electronic medical records today, potentially linking providers and patients to a wider network designed to improve care.

"The big thing patients will notice is a lot more computers," said Dr. Robert Biernbaum, chief medical information officer for Rochester General Health System. "We'll be using (laptops), iPads and desktop computers to do the documentation instead of flipping through charts."

Seven doctor offices in the Rochester General Health System also went online today. More practices will be wired in the next few months, Biernbaum said.

The move to EMR is part of federal health reform, and hospital systems receive incentives for meaningful use that improves patient safety and quality of care.

The hospital systems are linked to the Greater Rochester Regional Health Information Organization, a secure health information exchange. Patients give permission to have their test results, medications and other health facts shared electronically with providers who are part of the RHIO. The goal is to avoid duplication and reduce errors and get information to doctors more quickly, which is crucial in an emergency.

Having EMR puts the health systems in good position for other aspects of health reform, such as medical home models and accountable care organizations, said Ted Kremer, executive director of the RHIO.

Approximately 4,000 doctors and other health care providers have been using the RHIO. More than 500,000 people in an 11-county area have given permission for their doctors to share that information among themselves.

Unity Health System also uses EMR, as does Lakeside Health System, according to its website.

Rochester General and the University of Rochester Medical Center are more closely connected - they bought EMR from the same company. Patients at either Rochester General or URMC can give their permission for providers to view treatments they have received in either system.

Biernbaum estimated that about 75 percent of Monroe County residents go either to Rochester General or URMC. According to the RHIO, more than 230,000 people have provided consent for it to share their information with Rochester General or URMC.

Sharing of information with patient permission isn't new. The electronic transfer replaces the fax that someone invariably would have to wait for.

"If a patient came to Rochester General Health System who had been seen at the URMC emergency department and we had patient consent, we would do a search ... and we would be able to pull that visit information right up," Biernbaum said. "It's invaluable."

The same procedure would take place if a person came to Strong or Highland and said they'd been seen at Rochester General.

While consent to the RHIO is in effect until the person revokes it, permission for Rochester General and URMC to share information is only for that specific instance.

"We can't browse information in other systems," said Jerry Powell, chief information officer for URMC.

In or Out? HIE Patient Consent 101

ewatts@axolotl.com (Elvia Watts) — Mon, 24 Oct 2011 07:00:00 +0000

Healthcare-Exchange

By Glenn Keet

In this three-part series on Healthcare-Exchange, we'll explore some of the issues around patient consent for HIEs and propose some tips to help organizations and providers collaborate to promote patient participation.

As healthcare organizations continue to implement HIEs, task forces are challenged with determining how to best attain the keystone of the operation: patient consent. For an HIE to be successful, patient data is critical, but it's not as simple as just collecting it. Here are some things that healthcare organizations need to keep in mind in order to populate a successful HIE with the right data, while simultaneously maintaining patient privacy and ensuring patients' comfort:

Know the options. HIE access can be controlled, so make a decision and stick with it.

No Consent: All patient health information is available, and patients are unable to opt out.
Opt Out: Patient health information is available unless a patient explicitly chooses to opt out.
Opt Out with Exceptions: Similar to opt out, but the patient can selectively exclude certain categories of data, certain providers, or the use of his/her data for specific purposes.
Opt In: Patient health information is available to clinicians if and only if the patient has specifically opted to make it so.
Opt In with Restrictions: Similar to opt in, but the patient is able to refine his/her consent in one or more ways: by provider, data type, intended use of information, date, etc.
Hybrid: This model blends capabilities from two or more of the models above. For example, the organization may choose the opt-out model for "consent to access" and the opt-in model for "consent to disclose."

Understand local laws. Federal and state laws guide how patient information must be treated, and since some laws can seem to conflict or be open to interpretation, it is important for HIE implementors to work within the regulations of each state they operate in.

Research the exceptions. Sensitive health information - such as substance abuse and mental health treatment, HIV/AIDS status, and abortion services - may fall under separate confidentiality regulations that impact how and by whom it can be accessed. Health information for minors can also be more strictly regulated. Addressing these special cases with the consent model prevents tricky privacy disputes down the line.

Consider emergencies. Because emergency situations can and will arise with patients who have opted out or not opted in, organizations must determine under what circumstances, if any, healthcare personnel can "break the glass" to obtain the patient's health information in an emergency.

Talk to other HIE implementors. Other HIEs have been there before. Other providers have gone through the patient consent model selection process and know what has worked and what hasn't. Using others as a resource can help providers refine their selection and reap the maximum benefits.

Don't forget the patients. Access to data is important for deriving the benefits of HIEs, but no one should forget whose data it is. Patients need to be educated on an HIE and what it all means to them. Whether the HIE communicates with patients directly or through providers, patients need to feel confident that their privacy is ensured if the HIE is to be successful.

14 critical access hospitals link to Nebraska HIE

ewatts@axolotl.com (Elvia Watts) — Fri, 14 Oct 2011 07:00:00 +0000

Healthcare IT News

Within the past month, 14 critical access hospitals have joined the Nebraska Health Information Initiative (NeHII), Nebraska's statewide health information exchange.

Powered by the Axolotl HIE platform from OptumInsight, NeHII electronically delivers clinical information at the point of care, integrating a wide variety of patient clinical data including laboratory results, ER reports, discharge summaries, radiology reports, progress notes, transcription, medications and other medical information.

The hospitals that recently joined NeHII are:

Antelope Memorial Hospital, Neligh
Avera Creighton Hospital, Creighton
Avera St. Anthony's Hospital, O'Neill
Chase County Community Hospital, Imperial
Cherry County Hospital, Valentine
Community Hospital, McCook
Community Medical Center, Falls City
Community Memorial Hospital, Syracuse
Lexington Regional Health Center, Lexington
Memorial Health Center, Sidney
Perkins County Health Services, Grant
Plainview Area Health System, Plainview
Providence Medical Center, Wayne
Tri Valley Health Center, Cambridge

"Memorial Health Center is committed to providing the highest quality care possible, from the latest in technology and equipment to electronic information accessibility," said Kelly Utley, Memorial's chief financial officer. "Being able to exchange health information electronically between providers is the latest step toward achieving that high quality. We are very excited to be a part of this information exchange because it keeps our hospital on the leading edge, not only in the state of Nebraska but in the country."

Small hospitals may be certified as critical access hospitals to help implement initiatives to strengthen the rural healthcare infrastructure. The Medicare Rural Hospital Flexibility Program was established in 1997 to promote regionalization of rural health services in the state and to improve the quality of healthcare and access to hospital and other health services for rural residents of the state.

Among other requirements, critical access hospitals (CAHs) must be located in rural areas separated from other hospitals by at least 35 miles or less in mountainous terrain or areas with only secondary roads available, and are required to provide emergency services 24 hours per day. Nebraska has among the most CAHs in the nation, with 65.

Physicians working with the HIE-linked CAHs will have secure access to electronic exchange and share clinical patient information and medication history with other hospitals and healthcare providers across the state who care for their patients.

"This is a thrilling announcement for Nebraskans," said NeHII Executive Director Deb Bass. Because of the extensive rural populations in the state, the CAHs play a critical role in the delivery of quality healthcare. With the CAHs participation in NeHII, they will be able to retrieve information on their patients returning from larger referral health systems across the states. With the implementation of health information technology and telehealth, there will be opportunities for the patient to remain at the CAH and recover in familiar healthcare settings surrounded by their families."

14 Rural Hospitals Join Nebraska Health Data Exchange

ewatts@axolotl.com (Elvia Watts) — Fri, 14 Oct 2011 01:15:09 +0000

InformationWeek Healthcare

By Marianne Kolbasuk McGee

Nebraska Health Information Initiative adds more than a dozen critical access hospitals while some U.S. health information exchanges struggle.

The Nebraska Health Information Initiative has signed 14 critical access hospitals to its statewide health information exchange in recent weeks, with others expected to join as more hospitals roll out digital health record systems.

Nebraska, which has a population of about 1.8 million, is one of the most rural states in the U.S., and with 65 critical access hospitals, or CAHs, has more of these facilities than most other states.

And while more than a dozen CAHs just joined the Nebraska Health Information Initiative, many of the remaining CAHs in Nebraska "are still implementing e-health records," said Deb Bass, a former nurse and NeHII executive director.

"Until these other hospitals get that work done, having all of them part of NeHII is still a pipedream," she said. There are many constraints on CAHs rolling out EHRs, including "a lack of technology skills," she said. "Many have only a part-time IT person," she said. Some of those hospitals in Nebraska are so small that they treat fewer than five patients a day, she said.

Still, having the state's CAHs part of NeHII is vital, she said in an interview with InformationWeek Healthcare.

Among other government requirements, CAHs must be located in rural areas and separated from other hospitals by at least 35 miles, or less in mountainous regions.

For many people in Nebraska, there may be a four-hour or more drive to the nearest hospital, said Bass. "That's why HIEs are so critical, especially in very rural areas like this," she said. "When a doctor refers a patient to a hospital, information about that patient need to be sent back and forth," including upon discharge from a hospital, she said.

Among the data exchange services supported by NeHII are the sharing of patient information such as medication and allergy lists, problem lists, pathology and radiology reports, progress notes, and instructions related to transition of care.

NeHII is powered by technology products and service provided by Axolotl, which is part of United Health Group's OptumInsights unit.

To date, NeHII supports data sharing for 1.9 million patients, including some who live in neighboring states but have received care by healthcare providers in Nebraska. Approximately 1,400 healthcare professionals have signed up to use the NeHII service, which costs physicians a monthly license fee of about $51.66, Bass said. "That's cheaper than cable TV service," she quipped.

NeHII received a $4.9 million grant as Nebraska's statewide integrator for its HIE. So moving forward after its grant money is spent, for NeHII like most other HIEs that received grants, a sustainable business model will likely depend on subscriptions.

The momentum at NeHII comes during a time when the HIE landscape is in great flux. There are more than 200 HIEs in the U.S., many launched over the last year or two.

Some efforts are struggling to maintain sustainable business models after seed money or grant funding dries up. Others are consolidating into larger HIEs in their communities or states.

Among those HIEs recently closing up shop was CareSpark, a regional HIE in Tennessee, and also the Minnesota Health Information Exchange, the latter which consolidated with the Community Health Information Collaborative.

In a brief issued earlier this month, the National Association of State Chief Information Officers (NASCIO) urged state CIOs who are developing HIEs to improve their business strategies, including mapping out ways to generate revenue to cover operating costs before public funds they already received run out.

The 14 CAHs that have joined NeHII are Antelope Memorial Hospital in Neligh; Avera Creighton Hospital in Creighton; Avera St. Anthony's Hospital in O'Neill; Chase County Community Hospital in Imperial; Cherry County Hospital in Valentine; Community Hospital in McCook; Community Medical Center in Falls City; Community Memorial Hospital in Syracuse; Lexington Regional Health Center in Lexington; Memorial Health Center in Sidney; Perkins County Health Services in Grant; Plainview Area Health System in Plainview; Providence Medical Center in Wayne; Tri Valley Health Center in Cambridge.