The New Mexico Health Information Collaborative (NMHIC) is the statewide health information exchange (HIE) network and the name of the collaborative that supports the network. Supported and operated by the non-profit organization LCF Research, the NMHIC HIE network currently has access to patient information at 14 hospitals, two major medical groups, and three independent laboratories. NMHIC has been in production providing electronic lab results and patient encounter information from hospital emergency departments to the New Mexico Department of Health (NMDOH) since June 2010.
At NMHIC, patient information from each healthcare provider is stored on edge servers at each provider’s facility. Providers have been adding information to their NMHIC edge servers for some time. Every time new patient information is stored on an edge server, a message is sent to the NMHIC master person index (MPI) to determine whether that information is from an existing patient or a new patient. If the new information is for an existing patient, the MPI will link the new information to an existing patient identity; but if it is a new patient, the MPI will create a new patient identity.
NMHIC now has more than 1.3 million unique patient identities in the MPI, out of a total state population of 2 million. This design, where patient information is stored at each provider’s facility, while the master person index and record locator service are centrally operated at the LCF Research data center, is called a hybrid HIE architecture, says Craig Hewitt, chief information officer (CIO) of NMHIC. Hewitt recently spoke to HCI Assistant Editor Rajiv Leventhal about challenges, HIE trends, and how the government can better enable health information exchange. Below are excerpts from that interview.
What is the NMHIC currently working on?
In the last year, we have expanded into a much broader range of services. We are now ultimately targeting patient populations, with tools around case management, chronic disease management, using business intelligence tools to understand and model information with the ability for intra-exchange as well as inter-exchange. We are now expanding even beyond that so we have the capbility for consumers to be engaged in that decision process with the use of our patient portal and a number of other satellite services that are focused on more of a community health exchange. The patient information displayed on the web portal is gathered from all of the healthcare facilities that have previously treated the patient, and that are part of the NMHIC network. All of the information from the patient’s previous visits is integrated into a Summary Patient Record for easier clinician review. This capability makes care coordination easier, faster and less expensive.
Recently, we chose an HIE platform [hosted by the New Zealand-based] Orion Health (with U.S. headquarters in Santa Monica, Calif.) to power the statewide exchange and expand the capabilities it offers to healthcare providers across New Mexico. We are in the midst of migrating from our current platform and will transfer about one million MPI records to the Orion HIE. With the enhanced features that Orion Health HIE offers, users will not only have access to the latest patient information, they’ll have the tools needed to drive improvements in care throughout the state. You can track what you want to know about your patients, whether they’ve been to other clinics, hospitals, the emergency room, if they have been discharged. You can automatically set yourself inside that circle of information so you know what’s going on. In the prior world, that was really difficult to do. That’s the big push that we hear from providers—it’s a big demand. The ability to take a look at what’s happening across multiple cases of like diseases, be able to analyze that, and put in best practices based on what you’re seeing—or even go target areas or groups that may not be at the level of providing care that they need to be—this wasn’t even on our radar screen years ago.
What are some of your most pressing challenges as CIO?
Well, contrary to popular belief, technology is actually the least of our concerns. Instead, the biggest barriers to our success are funding and patient consent. We currently receive funds through the Office of the National Coordinator (ONC) for Health Information Technology, the Agency for Healthcare Research and Quality (AHRQ), the New Mexico State Legislature, and community stakeholders. But federal funding is expected to diminish. In my opinion, there needs to be incentives for organizations to use the technology, which actually seems like an oxymoron, because by using it, it will make you more effective in providing quality care as well as providing value in saving costs in things you don’t need to do. But we need to give them some incentive to pay for it.
There is also a constant concern regarding who has access to my information. How should it be used? Some of that thinking will change, as we have capabilities in the digital world to give us even more [knowledge] about what is going on with that information. But we don’t have a universal standard that allows us to share information from an intra-perspective to an inter-perspective without having so many barriers in place, and that gives us problems. Also, providers worry about the insurers, wondering what they’re going to do with that information and if they’re going to tell them how to practice healthcare. Although a lot of that has changed with the accountable care organization (ACO) model now, there is still concern.