Q&A: Big health IT plans in a small state
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Earlier this month, the National Coordinator for Health IT, David Blumenthal, MD, cited Rhode Island as an innovator, and RIQI received $5.28 million more in funds to enable additional health information exchange (HIE) initiatives. Laura Adams, RIQI president and CEO, has been named chair of the National eHealth Collaborative’s board of directors. Adams recently spoke with CMIO about RIQI’s wide-ranging initiatives.
How far along is the RIQI health information exchange project?
Rhode Island, as recipient of an AHRQ grant in 2004 [to plan and implement the governance, policy and technology foundation for a HIE to facilitate interoperability and sharing consented patient data statewide], selected Hewlett-Packard/InterSystems as the technology vendor.
In June or July, responsibility for that technology system will come over lock, stock and barrel to the RIQI, per plan, with state regulatory oversight. That was part of our initial proposal for the AHRQ grant—that at the end of this project, it would become in essence owned by the community, [and would not be] a state-run, or for-profit run, but a not-for-profit owned, in essence, by the community.
We are also working on aggregating EHRs for connection to the InterSystems platform. We’re running what we call the “LEAP” project—limited EHR aggregation pilot—that is with eClinicalWorks, to learn about EHR aggregators and what they can and cannot do, and how they would potentially fit with our model. That limited pilot project has a beginning and an end, and we’ll evaluate the effect and take next steps based on what we learned.
How does the NHIN [National Health Information Network] Direct project fit into the discussion of HIEs?
The recent announcement [of] the NHIN Direct initiative has sparked discussion because some of those who are implementing HIEs are asking the question: ‘If physicians can be enabled to meet meaningful through the use of NHIN Direct, will they not need us?'
As we explore the implications of NHIN Direct, there could be a lot to be optimistic about, recognizing that we’re all learning about exactly what the NHIN Direct is and isn’t, and how we can work with the federal government to ensure that it augments existing efforts to build widespread HIE capability. The NHIN Direct isn’t meant to replace a local HIE, rather, it’s a set of standards, policies and services that enable simple, secure transport of health information between authorized care providers. NHIN Direct is being developed within a policy framework recommended by the HIT Policy Committee, based on work of its NHIN Workgroup. The NHIN Direct won’t be capable of producing the comprehensive, integrated view of the patient’s data from multiple sources, that’s just not what the NHIN Direct provides.
We’re exploring the possibilities for us to use NHIN Direct to help create some of these connections that seem particularly difficult, such as, how are we going to connect up all of these EHRs? It’s more like the use of the internet. If users’ products can transmit the data using the required standards and adhere to the trust fabric, then they can send a message through the NHIN Direct. We can then pull in that standardized message through the NHIN Direct, rather than a “custom interface.” We’re not entirely sure, but we may be able to solve some of the challenges that present themselves when the data flows bi-directionally.
We still want our HIE to be able to give us our Rhode Island population’s data so our providers can obtain an comprehensive, integrated view of data from multiple sources and we can understand how we’re doing from a population health standpoint for all of Rhode Island, and that’s not what NHIN Direct provides.
But there are many questions to be answered and issues to be worked through regarding the NHIN Direct. For some HIEs, their long-term sustainability strategy includes charging for a secure messaging in the early phases. They have expressed concern that, if secure messaging was just rendered essentially “free,” what does that mean for that aspect of their model?
The challenges of building the business case for exchange are formidable at this nascent stage of development. As for the NHIN Direct—we’re going to learn a lot faster if we can create a rapid learning cycle and immediacy of the feedback. Rhode Island may be one of the most effective test sites for the NHIN Direct standards, specifications and trust fabric. We want to participate in rapid cycles of learning and help inform those leading the NHIN Direct work, other HIEs, and the nation. It comes down to rapid testing, telling the truth about our experiences and using the learning to advance HIE nationwide. My many years in quality improvement have convinced me that that’s the fastest road to progress.