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Maine HIE Charts its Course After a Healthy Start

September 9, 2010
by Jennifer Prestigiacomo
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Part I: Dev Culver, Executive Director, HealthInfoNet

HealthInfoNet, Maine’s statewide HIE, started as a feasibility study in 2004, sponsored by the public/private partnership of the Maine Center for Disease Control and Prevention (Augusta), an organization that at that time was called the Maine Health Information Center (now the Manchester-based Onpoint Health Data), and the philanthropic Maine Access Foundation (Augusta). After engaging providers, consumers, and others, the actual planning process started in 2005 with coming up with core principles on what the exchange should address and a clinical and technical group that put together the first technical specifications for the exchange. Fast forward to this June as HealthInfoNet just finished its two-year demonstration phase with the state’s six major healthcare organizations, which represents about 50 percent of Maine’s population, sharing patient information. The organization is now plowing forward to get the rest of the state on board. HealthInfoNet’s Executive Director Dev Culver, previously the CIO of Eastern Maine Healthcare (Brewer), spoke with HCI Associate Editor Jennifer Prestigiacomo in a two-part interview.

In Part I Culver shares some lessons learned for HealthInfoNet’s demonstration phase. In Part II of the interview Culver talks about sustainability and possible new revenue streams for his HIE.

Healthcare Informatics: Can you give me a little background on HealthInfoNet?

Dev Culver: In 2006 [HealthInfoNet] was incorporated as a not-for-profit and built as a public/private stakeholder organization. And what that means is, the board is a community board representing five stakeholder communities: consumers, providers, payers, business, and state government. There were also two standing committees created: a consumer advisory committee, which is populated by advocates like Maine Civil Liberties Union, Planned Parenthood, and other organizations that engage to support us in development, policy, operations, and communications; and a technical and professional practice advisory committee, which advises the board on where the exchange is heading.

We spent two years banging around and raising money. [He became executive director in June 2006.] In the very beginning of 2008, we executed a technical contract with 3M as our primary contractor to build a two-year demonstration phase, and that work began in February 2008. It involved six provider organizations, which represent facilities all over the state of Maine. Four of them are the four large delivery systems in the state, so pure go for volume early. One was a small, independent, rural hospital—we wanted to find out how hard this was going to be. And one was an ambulatory group practice with multiple locations around the state, so we wanted to understand the process around group practice workflow.

Those six healthcare organizations, which is 15 out of the 39 hospitals in the state, represent about 50 percent of all clinical care activity [Maine’s population is 1.3 million], so it’s a fairly healthy starting point for a demonstration phase. Part of the demonstration phase was connection to the public health system through Maine CDC to see if we could demonstrate the viability of automating lab reporting for mandated disease control.

It took about a year to build out the information exchange technically. We have a fairly robust clinical data set. It’s based on the continuity of care record, so it involves person identification, allergies, prescription medication, lab and radiology results—we’re not doing images at this point, just printed results—diagnosis, visit history, problem lists from the ambulatory space, and other transcribed notes. So every single registration event at any of those hospitals flows through us. We get our prescription data from the commercial side from [St. Paul, Minn.-based] Surescripts, and we are just now providing access to the Medicaid prescription data.

So, the first clinical use of the exchange started in July of 2009, and our demonstration phase officially concluded in June of this year. Now we’re taking those lessons learned and four months to retool. We’re changing out some of our vendors.

HCI: What vendors are you’re changing?