In light of the recent shuttering of Tennessee’s statewide health information exchange (HIE), what has never been more apparent is that HIEs must solve concrete business problems, while also fitting into clinician workflow. Nine healthcare providers in western Pennsylvania are seeking to do just that by launching ClinicalConnect, the region’s first HIE, to improve the quality and coordination of care for patients as they move among the region’s hospital systems.
ClinicalConnect, which operates on technology from the Pittsburgh, Penn.-based dbMotion, will provide clinicians with patient information like allergies, medications, lab results, past hospitalizations, immunizations, and other data from hospitals connected to the HIE. Expected to be one of the largest HIEs in the state—with more than 7 million unique patient records—ClinicalConnect seeks to reduce unnecessary testing, delays and costs; increase the use of preventive care and chronic illness management programs; and assist in efforts to track and improve public health. Longer-term, the exchange is expected to be connected to federal and state data-sharing systems.
Heritage Valley Health System, a community-based healthcare system located in southwestern Pennsylvania, is currently piloting ClinicalConnect among 13 pediatricians, who access the HIE through iPads. The goal is to have all Heritage Valley physicians using the ClinicalConnect within eight weeks. Butler Health System, a community health system based in Butler, Pa., is also in pilot mode.
In addition to Heritage Valley Health System and Butler Health System, the HIE's founding members include Altoona Regional Health System, ACMH Hospital, Excela Health, Jefferson Regional Medical Center, St. Clair Hospital, The Washington Hospital, and the University of Pittsburgh Medical Center (UPMC) health system, which is by far the largest participant, with more than 6 million patient records. All participants are under three-year contracts to provide for sustainability.
Armstrong Hospital, Altoona Regional Health System will be able to access ClinicalConnect later in July, while the rest will come onboard in the next four months. “The data is going to get richer and richer as we’re exposing clinicians to the view across our various members,” says Chris Carmody, vice president, information services division, outreach services, at UPMC. “The more participation we get from providers in our area in western Pennsylvania, the better it’s going to be for the patient.”
ClinicalConnect was founded to provide clinicians with a more complete view of the patient, as many of the regional health system partners have patients that receive services from UPMC. David Carleton, CIO, Heritage Valley Health System, and ClinicalConnect board member, says that 62 percent of his patients have encounters at UPMC at one point in their care. “There’s a significant crossover of activity, so it’s very valuable from the standpoint of [the physicians’] ability to see what happened to that child when they were children, labs, medications, everything that is tracked,” he adds.
The participating health systems compete in certain areas, admits Norm Mitry, president and CEO, Heritage Valley Health System, and chairman of ClinicalConnect, but ClinicalConnect was the right approach to take to give physicians the right information at the right time. He adds that he and his colleagues at other partnering facilities have built deep relationships and regularly dialogued before ClinicalConnect was even conceived. The organizations continue to develop this trust by employing strict security practices for ClinicalConnect. “We’re logging all use of the data, and audits are being put into place even now, so there’s audit processes, as well as the technology to track all usage of the data,” says Carleton.
There will be three main phases of ClinicalConnect (see table), says Mitry. In 2012, acute care providers and physician offices will be brought onboard, while 2013 will be spent bringing in long-term care providers and independent physicians. Carleton adds the challenge will be “figuring out how to bring in all those smaller organizations and individual physician offices that may not have the resources or expertise, or may not even have an EMR at this point.” In 2014, Phase 3 will involve engaging payers.
HIE Architecture
The HIE operates on a push/pull model with participating organizations pushing continuity of care documents (CCDs), which then get aggregated in ClinicalConnect. Physicians view the information from ClinicalConnect directly via their electronic health record (EHR) system. A button within each of the health system’s EHRs launches a query to the HIE to provide a summary view of the patient’s record. “We wanted to make it as seamless as possible for the clinicians’ workflow and not make them do five extra clicks to find data on their patient,” says UPMC’s Carmody.
The next step will be to have the EHRs ingest the CCD, but many policies need to be in place to monitor the use of the data beforehand, says Carleton. In the future, physicians will receive alerts within the EHR if there is extra information in the HIE.
A possible future use for ClinicalConnect that Thomas McGill, M.D., vice president of quality and safety at Butler Health System, and chair of the ClinicalConnect quality subcommittee, finds exciting involves assessing diagnostic imaging radiation exposure that patients receive across multiple care settings. “If someone had gotten care at a number of places, it’s actually only something like a health information exchange that could sum up those radiation exposures across the region, and maybe across the nation eventually,” he says. McGill recently saw a patient who had 80 cat scans in five years, and says that an HIE like ClinicalConnect can provide exposure information that could lead clinicians to take different approaches.