HIE Chronicles Part VI: An exchange pioneer
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The Rhode Island Primary Care Physicians (RIPCPC), a Cranston-based practice of 160 primary care physicians, was the first in the nation to exchange a complete, secure, encrypted message using the Direct Project framework. Albert Puerini, MD, president of RIPCPC, spoke with CMIO about RIPCPC’s involvement in the Direct Project and the practice’s plans regarding currentcare, the statewide health information exchange (HIE).
How did you get involved in the Direct Project?
Direct is a simple concept. Today there are hundreds and hundreds of different EHRs across the country. This allows everyone to have a nice data collection tool in their office but, unfortunately, for the most part, no one can really share that data with anyone. Many can exchange within their own vendor’s client base, but that’s the extent of it. It helps immensely in the office setting, but the real value is being able to share that data with hospitals, ERs and other providers.
What the government wanted to do was create a simple means of exchange. Direct is like an email system on steroids. It’s much more secure, encrypted and can only be opened up by the clinicians to whom you’re sending the information. Patients have to give permission to upload their clinical data and that only needs to be done once.
Laura Adams [president and CEO of Rhode Island Quality Institute] approached me and [asked] if we wanted to be involved in the Direct Project, and I was thrilled. We began working on the Direct Project in October 2010 and we teamed up with Arcadia Solutions [an implementation and assessment service provider], RIQI and [EHR software vendor] Polaris … and were able to complete the project by the end of January. We were the first office in the country to do a complete, secure, encrypted doctor-to-doctor transmission abiding by all the federal specifications.
What was that transmission?
The first transmission was a referral request from a primary care physician to a gastroenterologist to see a patient to do a certain test. With that transmission, I was able to give a patient summary sheet—a document outlining patient’s demographics, medical problems, medication list, allergies, recent tests, etc.—and a separate sheet with my request for the patient’s symptoms and what I thought the patient needed. We extracted the patient’s data from the EHR, put [them] into the exchange document and essentially emailed the document to the referring physician, which sat in his inbox until he opened it with his own password.
You have to have an EHR to send that type of exchange through the Direct Project, but not necessarily to receive the clinical information.
I’m on the advisory committee to currentcare and what we plan on doing now is to use Direct to continue setting up for physicians to do doctor-to-doctor exchange but also to use it as a conduit to access currentcare.
What are RIPCPC’s plans for participating in currentcare?
It’s a work in progress. We haven’t done a transmission through currentcare yet but that is the next step in the business plan. Our hope is to use that same scenario and be able to connect with currentcare and send data into currentcare and/or extract data from currentcare so Direct will act as a conduit to securely exchange information with the HIE.
When might that happen?
There are so many variables. Right now, 12 percent of the Rhode Island patient population is signed up into currentcare. We need to get a lot more people in. We also need to figure out how to do the transmission into the HIE and back out. Our hope is to accomplish this by the end of this year.
Do you think pushing data into the system will help your organization?
Absolutely. I think first and foremost that it’s unquestionably going to improve the care we’re able to provide to patients. For example, say a 50-year-old guy with a lengthy patient history goes into an ER with a heart attack. The doctor has never seen him before and the man can’t talk. When you think about it, it’s very scary where this poor ER clinician has to go into this very sick patient knowing nothing about him to keep him alive.
Ultimately, our goal with this system is that [the clinician will] be able to go into currentcare and pull [the patient’s] clinical history out. That’s what this is about: Improving the way we take care of our patients.
What do you think will be the biggest challenge?
We’ve got to get Rhode Islanders in general and Rhode Island physicians specifically to get tuned into this because unless that happens, it’s going to be hard to make this successful across the board. We don’t want it to be successful with just the 15 percent of doctors and 12 percent of patients that have signed up; we want everybody. Hopefully, as we unfold it in smaller niches, we’ll be able to show other doctors our results and get them excited to join. That’s probably going to be the best marketing tool.
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