The Indiana Network for Patient Care (INPC) started in the mid-'90s as a proof-of-concept initiative to share data between two separate emergency departments (ED) in Indianapolis. Although geographically only about three miles apart, they had very distinct patient profiles.
“The question was whether sharing information between two emergency departments made a difference in patient care,” says John Finnell, M.D., associate professor of emergency medicine and director of medical informatics for the emergency department at Indiana University, and affiliated scientist at the Regenstreif Institute. “The answer is ‘yes.’ ”
Based at the Regenstrief Institute on the Indiana University Medical Center campus in Indianapolis, the INPC links together the medical records of physician offices, hospitals, and other healthcare facilities statewide. Currently, there are more than 30 different hospital systems, as well as public health and other entities, sharing data across the state.
“As communication between the emergency departments became more accepted, and as those patients were admitted to the hospital, the internal medicine folks began asking for access to data to help with inpatient management,” says Dr. Finnell. “Then the private practice offices began asking for the ability to follow patients in the hospital to better understand what happened when they were discharged back to their care.”
The INPC structure allows chief information officers one-stop shopping. Attaching to the regional health information exchange (RHIE) provides CIOs with access to more data. Since every interface connection costs money, attaching to a network that already includes many other facilities is easier and cheaper for the CIO.
“The advantage of connecting to a RHIE is that it is less expensive because you don't have to establish a bunch of connective networks,” says Finnell. “The users are able to talk to one place and we are able to push out that data from multiple sites. This saves money, time, and effort from having to query all the possible data sets.”
When a new group joins the network, the experts at Regenstrief first match the existing dictionary of terms to the network's dictionary. This helps to work around concerns such as a Chem-7 at one hospital being called a Basic Metabolic Profile at another.
“What we are asking participants to do is send us the same data they are already sending around their own hospital,” says Finnell. “When Hospital X generates a lab report, those data are usually sent from that hospital's lab computer system to its other information systems. All we ask them to do is to send a copy of the result to us and then we'll do the rest.”
The system works best when data standards such as Health Level 7 are used. However, the INPC realizes that different hospitals have different levels of sophistication and the system can also work with batch or FTP uploads if needed.
“There is a management committee that meets quarterly to discuss how the data are to be used and shared, and other concerns such as research projects that look at the data,” says Finnell. “This committee is charged with overseeing the overall health information exchange.” For example, when the network was recently expanded to include pre-hospital providers, the management committee decided what set of data would be made available. They worked with the providers to ascertain what kind of information was useful.
“We took the basic set of ED data and whittled it down to things like the medications list, recent history, and allergies,” Finnell says. “The medics only needed to talk to us to get information from all participants, instead of checking in with hospital A, then B, then C. That is the win for the CIO and helps us deliver information almost instantaneously to the medic or whoever needs it.”
Kurt Ullman is a Carmel, Ind.-based freelance journalist. Healthcare Informatics 2010 August;27(8):32
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