HIE Chronicles: One State, One HIE, One Flood

In March 2010, a severe storm dropped an unprecedented 15.44 inches of rain on the state of Rhode Island, leaving much of the state, including areas of its capital, Providence, under water. Lost in the deluge was the hardware for Rhode Island's HIE, housed on the basement floor of Hewlett Packard in nearby Warwick, at that time under the leadership of the Rhode Island Department of Health.

The floodwaters reached up to the second floor, reported Laura Adams, CEO and president of Rhode Island Quality Institute (RIQI), a Providence-based collaboration of healthcare stakeholders working together to transform the healthcare system in the state.

"As we realized Warwick had devastation, we started to feel almost as if we couldn't breathe," Adams recounted. The HIE system was so close to being ready, "[i]t was like your blood was running cold for days as the water receded and we began to figure out exactly what happened [to the infrastructure]."

Luckily, although the hardware in Warwick was ruined and some code had to be reconstructed, no currentcare (the statewide HIE, now under the auspices of RIQI) data were lost. However, because there was no redundant hardware installation, "when the infrastructure was wiped out, it was gone. The state couldn't operate it from [another system] because it hadn't been embedded in [any other system]," said Adams.

"It was almost as if we didn't have an HIE at all at that point," she said.

RIQI took on technical responsibilities at the end of July 2010. The Institute already had responsibility for governance, the policy framework, certain aspects of operations such as enrollment and financial sustainability, which began in 2003. As a "State-designated Entity" for statewide HIE in RI, the Institute was given $5.2 million from the federal government in 2010 for direct spending on an HIE infrastructure.

During the summer, RIQI built a new HIE technology platform and will soon start work on a data warehouse. The silver lining around the flood was that RIQI was able to avoid numerous and expensive upgrades to the old HIE platform, and instead could purchase the latest version of the technology (from InterSystems) that held greater functionality than the earlier version. For example, the InterSystems system automatically integrates with Surescripts to provide patient's medication histories, Adams said.

After overcoming natural disasters, the task of gaining the community's trust and funding challenges, Adams said she's confident of RIQI and stakeholders' perseverance to make the HIE a success for the state.

"We feel we have convinced the community and ourselves that we will persist and move past formidable barriers, whatever they might be," concluded Adams. "We're becoming known for just forging ahead."