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To Be the State HIE, Or Not To

August 9, 2010
by Jennifer Prestigiacomo
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Web-Exclusive Interview: James S. McIlwain, M.D., CEO and President, IQH

After Hurricane Katrina left death and destruction in its wake, Mississippi learned the value of the electronic health record, as physician practices that weren’t entirely flooded, dried their paper records on the sidewalk. Out of this tragedy sprung the hope of the Mississippi Coastal Health Information Exchange. James S. McIlwain, M.D., CEO and President, IQH & Co-Chairman of the Mississippi Health Information Infrastructure and Task Force Grant Administrator for the Mississippi Coastal Health Information Exchange, spoke with HCI associate editor about what challenges he and his team have been facing trying to put together the pieces of this coastal health information exchange.

Healthcare Informatics: What were the overarching goals for setting up MSCHIE and how it was formed?

McIlwain, M.D.: Mississippi was very fortunate to finally recognize the value of having electronic healthcare data. Following Katrina we’ve had offices that had troubles with their medical records. We had doctors drying their medical records out on the pavement. There were very few doctors that had electronic medical records. Some of those offices who did [have EMRs] were damaged and flooded. They were trying to get their hard drives revived. It would have benefited us to have had electronic health records.

We see electronic health records and the exchange of information as vital to transforming health care delivery both to improve quality and reduce costs. Our governor supported this and created an executive order [in March 2007] to form a taskforce to suggest ways to increase adoption of EHRs by providers and create an exchange of information. Just having electronic data is good, but it’s not the ultimate high point where we needed to be. So the taskforce looked at the problem and created a pilot project in which we were able to get funding to use in the coastal area to create an information exchange Mississippi Coastal Health Information Exchange. We even thought about putting an ‘f’ on there for ‘foundation’ and calling it MISCHIEF, but we didn’t think that would go over well. [chuckles]

We sat around with a lot of technology people—I’m not a technology person—we formed some smaller workgroups to plan the system we wanted to have. We did have a $4.8 million grant through our state to apply to the coastal area to reinforce electronic health information. It had a timeline of one year, but we got an extension and were able to extend it for a couple of years. So that grant is up now up in August 30. IQH [the federally designated Quality Improvement Organization (QIO) for Mississippi under contract with Centers for Medicare & Medicaid Services (CMS)] has a nonprofit corporation that volunteered to administer the grant. We actually contracted with the Department of Information Technology Services, which is the state agency that does the information systems for the state of Mississippi. We contracted with them to do a procurement process, write an RFP, do an evaluation, and review the contract and go through that process for us. They did a good job. We had eight national vendors that submitted a proposal and went through an evaluation process. Medicity [based in Salt Lake City, Utah], the company that was selected had the best cost and technical processes.

In phase one [which began on Oct. 29, 2008], we started creating this exchange. We originally had three stakeholders Singing River Health System, which had two large hospitals on the coast and Memorial Hospital of Gulfport, which was three of the 11 hospitals on the coast. Along with Coastal Family Health Center, which was a federally-qualified health center that had nine clinics on the coast that did outpatient medical treatment. So those were our original stakeholders for our phase one, which was the first year. They became live in January [2010], and we’re working on phase two now. The difficulty is how do we sustain this to phase three and keep it going after that?

HCI: Can you tell me what’s going on in phase two, as well as a little about the outreach training campaign you’re working on?