Fact Sheet
The Agency for Healthcare Research and Quality (AHRQ) awarded projects for supporting statewide data sharing and interoperability activities on a State or regional level aimed at improving the quality, safety, efficiency, and effectiveness of health care for patients and populations.
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Contents
Introduction
State and Regional HIE Projects
More Information
Introduction
In 2004, the Agency for Healthcare
Research and Quality (AHRQ) awarded
five "State and Regional
Demonstrations (SRDs) in Health
Information Technology" contracts to
organizations in Colorado, Indiana,
Rhode Island, Tennessee, and Utah. A
sixth contract, awarded to Delaware,
was added in 2005. The 5-year, $5
million projects were aimed at
developing data sharing at the regional
or State level, with the overarching goal
of improving the quality, safety,
efficiency, and effectiveness of health
care for patients and populations.
Although the six SRDs each completed
a common set of deliverables, over the
course of the contracts, they also
developed a variety of approaches with
different technical, business, and
governance models. The results of the
SRDs' work have informed the types of
organizations that may serve as data
sharing partners, the policies that
pertain to this work, and the
sustainability plans for health
information exchange (HIE) in their
States. The SRDs are involved with
some aspect of the statewide HIE,
Regional Extension Center, and/or
Beacon Community cooperative
agreements, which are supported by the
Office of the National Coordinator for
Health IT, as funded under the Health
Information Technology for Economic
and Clinical Health Act of the 2009
American Recovery and Reinvestment
Act. An overview of each project and its
key achievements is provided here.
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State and Regional HIE Projects
Colorado Regional Health
Information Organization
(CORHIO). CORHIO began as a
nonprofit organization aimed at
building a prototype federated data
exchange among its four initial partners:
Denver Health, Kaiser Permanente of
Colorado, The Children's Hospital, and
University of Colorado Hospital.
CORHIO and its partners went live
with a 1-year data exchange
demonstration on December 1, 2008.
The system offered the authorized emergency department (ED)
practitioners at three sites and call center
employees at one site access to the most
common radiology reports, laboratory
results, prescribed and dispensed
medication information, registration
information, electrocardiogram images
and/or reports, and problem lists
aggregated from all sites. CORHIO's
achievements include the development
of a useful enterprise Master Patient
Index (MPI) and a robust set of policies
that can be applied to future HIE
efforts. Following the conclusion of its
SRD contract, CORHIO has
contracted with a new vendor and will
be implementing a clinical messaging
service. CORHIO is also developing a
multiyear plan to bring services to
multiple communities across the State.
Delaware Health Information
Network (DHIN). DHIN was created
by an act of the Delaware General
Assembly, which was signed into law in
1997 to advance the creation of a
statewide health information and
electronic data interchange network for
public and private use. In 2007, DHIN
became the first operational statewide
clinical HIE. Four of Delaware's hospital
systems currently provide data through
the DHIN (a fifth will be added in fall
2010), along with LabCorp, Quest
Diagnostics, and Doctors Pathology
Services, a local pathology laboratory.
Taken together, DHIN's data senders
provide more than 85 percent of
laboratory tests and 81 percent of
hospital admissions performed in the
State of Delaware. Since going live,
DHIN has worked to add value for
Delaware's health care community by
providing new data types (e.g.,
transcribed reports) and new functions
(e.g., medication history). As of July
2010, DHIN's users include 65 percent
of the State's health care providers
working at more than 230 practices around the State. DHIN is currently
transitioning to a new nonprofit,
public/private governance structure that
will support ongoing operations and the
expansion of services.
Indiana Network for Patient Care
(INPC). The INPC was created by
Regenstrief Institute in 1994, with the
goal of providing clinical information at
the point of care for treating patients in
the ED. For the SRD project,
Regenstrief Institute expanded its
activities by bringing on new data
sharing partners, provided additional
interfaces for laboratory and pathology
data, and expanded its activities outside
Indianapolis to other surrounding
geographic areas. They are also seeking
to resolve issues related to scalability and
data normalization, given the huge
volume of data and number of
transactions (INPC processes an average
of 2.5 million Health Level 7 messages
per week). INPC captures data from a
wide range of sources, including over 50
hospitals, physician practices, public
health departments, laboratories,
radiology centers, pharmacies, pharmacy
benefit managers (via SureScripts®),
payers, convenience clinics (e.g., those
attached to a pharmacy), and long-term
care facilities. As of July 2010, the
INPC included more than 3 billion
coded results, 526 million encounters,
and over 53 million text reports. As part
of its evaluation, Regenstrief Institute is
measuring the value of aggregated
clinical data delivered by the INPC for
quality improvement. The expected
outcome is improved provider
compliance with selected clinical quality
measures.
Rhode Island: currentcare.
The Rhode Island Department of Health
(HEALTH) applied for and received the
SRD contract from AHRQ on behalf of
stakeholders across the State. Development of the statewide exchange,
known as currentcare, has been a
collaborative effort between HEALTH
and the Rhode Island Quality Institute
(RIQI). Project governance has been led
by RIQI, which became the State-designated
health information
organization in 2008 and which
received contractual and operational
responsibility for currentcare in July
2010. The project's goals are to design,
develop, test, deploy, and evaluate an
initial health information network to
support the secure and reliable exchange
of health information, beginning with
laboratory results and medication
history information. The system is
envisioned to link longitudinal patient-level
information from source data
systems using an MPI, provide a Web-accessible
viewer to authorized users in
any setting, and interface with electronic
health record systems. One of this
project's most important achievements is
the development of a broad set of
governance, management, and operating
policies for currentcare. These policies
are integral to ensuring compliance with
the RI HIE Act of 2008, which
stipulates privacy and confidentiality
protections for currentcare that are
stricter than some State and Federal
health information privacy laws. The
project's evaluation will focus on the
development of those policies.
Tennessee: MidSouth eHealth
Alliance. The MidSouth eHealth
Alliance was formed as a policy-setting
body to govern the HIE in Memphis,
TN, sponsored by the State of Tennessee
and managed in its first 4 years under a
sole subcontract to Vanderbilt
University. During the initial years, all
technical and administrative functions
were provided by Vanderbilt. Complete
control of the Exchange has been
transferred from Vanderbilt and the
State to the MidSouth eHealth Alliance. Data services have migrated from
Vanderbilt Medical Center to an
independent corporation—Informatics
Corporation of America. The Exchange
began serving clinicians in May 2006
and, as of March 2010, data from 14
hospitals (inpatient and outpatient), 14
primary care safety-net clinics, and the
University of Tennessee Medical Group
were available to several hundred
clinicians working in 14 EDs, 14
primary care clinics, and in hospitals.
The overall data are composed of
admission, discharge, and transfer data
(patient registration data), encounter
codes, and clinical data. The latter
include laboratory results, diagnostic
imaging reports, cardiac study reports,
discharge summaries, dictated ED notes,
operative notes, history and physical
exams, diagnostic codes, patient
demographics and other identification,
and encounter data. Clinical data,
particularly hospital discharge
summaries, are most widely used. In the
EDs, data are accessed on approximately
7 percent of ED visits.
Utah Health Information Network
(UHIN). UHIN is a nonprofit whose
partners include physicians, hospitals,
laboratories, payers, local health
departments, and health centers.
UHIN's project initially involved
enhancing the existing gateway for
administrative exchange to build clinical
information exchange. Ultimately,
UHIN and its stakeholders decided to
purchase a clinical platform to facilitate
clinical exchange, which they call the
Clinical Health Information Exchange
(cHIE). The cHIE has a modest
electronic medical record (EMR),
commonly referred to as "EMR lite," if
needed by the clinician (most clinicians
in Utah have an EMR); an MPI; results
delivery; e-prescribing; and virtual
health records query functionality.
UHIN is enrolling key data sources and building support among health care
providers for participation in the cHIE.
As of June 2010, laboratory data is
being supplied by two data sources and
seven clinics are connected to the cHIE.
UHIN has developed a patient consent
policy for use with the cHIE. As part of
its evaluation, UHIN is analyzing
providers' workflow before and after
they implement use of the cHIE at their
sites.
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For More Information
For additional information on AHRQ
projects on health information
technology, please visit
http://www.healthit.ahrq.gov or contact
staff at the AHRQ National Resource Center (NRC) for Health IT at
NRC-HealthIT@ahrq.hhs.gov.
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AHRQ Publication No. 10-P011
Replaces AHRQ Pub. No. 07-P005
Current as of August 2010
Internet Citation:
Health Information Technology: State and Regional Demonstration Projects. Fact Sheet. AHRQ Publication No. 10-P011, August 2010. Rockville, MD: Agency for Healthcare Research and Quality. http://www.ahrq.gov/research/hitdemoproj.htm
540 Gaither Road Rockville, MD 20850 