Slow going for R.I. health-information exchange

The deployment of mobile technology in the delivery of health care is under way, with an estimated 30 percent of health care providers in the United States already working with tablets, and another 50 percent of providers making tablet decisions in the next year, according to AT&T research. At the Warren Alpert Medical School at Brown University, incoming students are now provided with an iPad.
What’s still missing from the equation is the completed information highway – the health IT infrastructure of networked, cloud-based data marts of secure, patient clinical information – that is currently under construction.
The adoption of electronic health records and the development of information exchanges that undergird the new health IT infrastructure is being financed in large part under the federal health care reform law. When the federal money runs out in 2013, it’s unclear how the exchanges will develop new revenue streams to make the operations sustainable.
In Rhode Island, the health-information-exchange effort, branded as currentcare, has been slow going, with only 200,000 patients – 20 percent – enrolled to date and, at the ongoing rate of about 8,000 a month, the numbers won’t reach 300,000 until 2013, according to Laura Adams, president and CEO of the Rhode Island Quality Institute.
Adams attributes a large part of the slow response to date to the opt-in enrollment system chosen by Rhode Island to ensure a patient’s privacy. “I think our rate is steadily increasing,” she said, indicating that a new sign-up form, embedded in a provider’s computer, was going “like gangbusters.”
The Quality Institute, a nonprofit organization with more than 50 full-time employees and numerous consultants, is responsible for administering federal funds to construct the state’s health-information exchange and promote adoption of electronic health records by physicians and providers. The institute’s board of directors reads like a who’s who of Rhode Island health care, with numerous hospital and health insurer CEOs, as well as the president of the Greater Providence Chamber of Commerce and the Rhode Island health insurance commissioner. The tipping point for currentcare to reach a critical mass, Adams admitted, is still months if not at least a year away. But she voiced excitement about some of currentcare’s services that are now up and running and operational, including a provider-notification system linked to hospitals. Coastal Medical, South County Hospital and Thundermist Health Center are employing currentcare access for provider notification, so that when a patient enters or leaves the hospital or its emergency room, the primary care provider is notified, along with a summary of the care received. Lifespan and Care New England are soon to follow, Adams said.
There continues to be a slow adoption rate for Rhode Island doctors to employ electronic medical records, in large part because of cost barriers. The average cost for installing a new EMR system runs about $30,000. Only about 40 percent of physicians in Rhode Island are using EMRs, according to a recent survey conducted by the R.I. Department of Health.
“In Rhode Island, we have lots and lots of solo and small practices,” Adams said. “For many of those [physicians], there is no upfront money available from incentives offered through Medicare and Medicaid” for achieving the benchmark of meaningful use.
By comparison, Massachusetts has achieved a 70 percent rate of adoption EMR use by physicians, according to the Massachusetts e-Health Institute.
One solution to reach the 60 percent of providers in Rhode Island who are not currently using EMRs may be to consider an open-source solution that is fully congruent with federal requirements, according to Fine.
“We may have relied more on the marketplace than we should have, in developing a public-health enterprise,” Fine said. “I believe that there’s a need to find a balance between the public interest [and] what might be called the general good, or the market.” Instead, Fine suggests what is needed “is an informational system that supports public health, building such a system in an organized way, around public health as a single enterprise.”
In terms of sustainability, there is yet no solution about what to do in 2013 when the federal grant money runs out, Adams said. But she anticipates a legislative solution will be developed. In the past, there was a proposal to support the state’s health-information exchange through a surcharge on health-insurance claims.
Sustainability may be tied to developing a different business model, according to Colin Barry, the CEO of MEDfx of Warwick, a national company with a large footprint of clients throughout the U.S. Barry is working in partnership with Virginia to develop its health-information exchange, providing both software and services.
Barry cited a 2011 report by Chilmark Research, saying that health-information exchanges have struggled to define a sustainable business model. The report said that private health-information exchanges, often formed by large, integrated delivery networks, have seen a slightly better success rate because of the ability to develop a sustainable business model.
Currently, Verizon licenses MEDfx components as part of its global health-information-exchange suite.
The wildcard in the development of the health IT information highway is the role of the patient. Many of the current systems have been developed from the perspective and needs of the provider and hospital, a top-down approach. Online health applications promise to change the market from caveat emptor to a very aware consumer.
“We need to keep our eyes on the prize – a health care information system that includes the entire population, one that delivers in providing the best patient experience,” said Fine. “[We need] a health-information system that improves public-health outcomes and helps to provide care at a price that’s affordable.” •

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