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RHIO or Not—It Works

September 1, 2007
by Daphne Lawrence
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A pilot program on medication histories in EDs is first for Vermont Health Information Exchange

Vermont chose medication history as its first RHIO project—but those involved aren't calling it a RHIO. "We feel there's no way to define that term accurately," says Andrea Lott, CIO of Northeastern Vermont Regional Medical Center and a member of Vermont Informational Technology Leaders (VITL), Montpelier, Vt., a not-for-profit public-private partnership. "We are calling this a health information exchange, and it's the one designated for the state."

VITL's first pilot project is already running in the emergency departments of two local hospitals. It delivers patient medication lists within seconds of the patient's arrival—even if the patient has never visited that hospital before.

Medication data is available on 75 percent of the patients visiting the emergency department due to the cooperation of major payers like Blue Cross Blue Shield of Vermont, MVP Healthcare, and the Vermont Medicaid program. This allows the hospital to access real-time claims data for prescriptions filled anywhere in the state for a more complete patient medication history, enabling increased patient safety, reduced drug interactions, and faster treatment for the patient, according to those involved with the project.

Patients arriving at the emergency department are asked by triage nurses for permission to access their electronic medication history. Almost all choose to opt in. Easy and rapid access to the Web-based medication history is key in the fast-paced emergency room, and the request for the medication history is made in a few keystrokes. "If it was more than three keystrokes, we don't think it would have been successful," says Lott. "We chose this as an early win."

VITL had a standards and architecture committee that evaluated many projects. But the Vermont doctors and nurses cited medication history as their pain point. "This was clinically driven," says Lott. "They were the ones that said medication history would be the biggest bang for the buck and, technically, it was one of the easiest for us to do."

GE Healthcare, South Burlington, Vt., developed the service for VITL and provides maintenance and support for the hospitals. "We already had an HL7 ADT interface from Meditech (Westwood, Mass.) that we were using for our PACS," says Lott. "All that GE required for the query was the five ID data elements and, of course, whether the patient opts in."

Data from prescriptions filled at pharmacies is provided by pharmacy benefit managers including RESTAT, West Bend, Wis., and MedMetrics, Worcester, Mass. RxHub, LLC, based in St. Paul, Minn., electronically routes the up-to-date patient-specific medication history and pharmacy benefit information to the caregivers. The cooperation between various stakeholders—payers, practitioners, hospitals, vendors and state agencies—made the process effective, according to those involved.

Rutland Regional Medical Center and Northeastern Vermont Regional Hospital in St. Johnsbury are the first two hospitals in Vermont to implement the new electronic medication history service in their emergency departments. The service will be rolled out to other hospitals in the state over the next year—whether or not they have an EMR (the medication reconciliation can be printed.) VITL does expect to hook up with other RHIOs in the country.

"We thought it would be an early win and prove to the legislature that this model can work—and we'd be benefiting our customers at the same time," says Lott. "It's absolutely made a difference to many of our patients already. It seemed like an easy win for everybody and it has turned out to be."