Q&A: Rural Washington HIE builds on physicians efforts
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“That kind of grew into a vision of data sharing, for the primary care community at least, and maybe, eventually, for the specialty community,” said Solberg in an interview with CMIO. Since then, the HIE has received national recognition for integration with Washington State’s public health department, both with the immunization record and with the reportable disease condition record. Not bad for an HIE that, Solberg said, is not fully implemented yet.
CMIO: What entities are connected?
We are a rural community so we’re a fairly primary-care-based community. [The] local critical access, community hospital has developed into the hub of the medical community, especially over the last several years. What began as “let’s explore record-keeping systems for in the office” has emerged into at least the foundation of an HIE. It’s not yet fully implemented, but we are working to move that way, and gradually expand and pull in some of the other providers in the system.
We have already made some interesting connections; for example, our public health system uses a NextGen Healthcare client to deal with reportable disease conditions and to help them in their investigations of those patients. We’re in process of rolling out the system to the geriatric nurse practitioners who service nursing homes and home-care facilities, assisted living facilities in the community and so on, to integrate their records with the rest of the system.
We’re trying to pull together most of the primary care base within that system. We have integrated with state immunization database again through efforts of health department and we have automatic data sharing with the state in terms of their statewide immunization database.
CMIO: How many providers are participating?
We have close to 30 physicians in the community, nurse practitioners and other midlevel providers and that does not include various specialists. We have a couple of specialists that use the financial module but don’t use the medical record module at this point.
We’re working toward a common database of patients for the community, and that poses its own set of challenges. Across the U.S., the HIE serves a population in the mid-30,000 range, and our practitioners service about 85 percent of that population.
CMIO: What information is currently exchanged?
We send primarily immunization information, for both children and adults (hopefully, that will soon be flowing in bidirectional direction). As part of our implementation, we have a reasonably full-scale lab ordering system (not bidirectional) and we are installing a PACS in the hospital—we should have reasonably bidirectional flow for various imaging modalities that will be fairly well integrated into the system. That’s scheduled for later this year.
CMIO: How is the Kittitas Valley HIE funded?
We had a number of startup grants of very modest size at the very beginning of the project several years ago. At the current time, we’re funded by ongoing operations of the hospital.
CMIO: As the HIE community expands, what interoperability challenges do you face?
That remains the essence of the conundrum for EHRs … that’s the piece everybody founders on right now. Our hope is that the full implementation of HIE will solve some of that interoperability problem by just being able to share the important pieces of the health record through a standard, everybody-has-it kind of format.
That does not, however, solve all of the complex issues of just getting data to talk between various machines and entities and subsystems that make up the modern healthcare delivery system. I’ve got three people [who spent almost a week] just trying to get a new lab machine to talk to the system correctly. We’re still working to interface some of the older hospital-based systems into that outpatient record because the hospital’s inpatient system is not fully interoperable with the outpatient system.
We are having pretty good luck working with this planned PACS installation and a high level of commitment to this from [McKesson].
The largest challenge we face is that we’re not a huge, multi-billion-dollar hospital system; we’re trying to do this for a fairly limited, fairly contained population and a relatively rural community across geographic, economic and political barriers in a time of significant cost constraint. It is not impossible, but requires commitment and insistence that complex proprietary systems must be ”bent to our will.”