The Rhode Island Quality Institute (RIQI), a unique statewide organization facilitating both quality improvement work and health information exchange (HIE)across the Rhode Island healthcare community, has been recognized as a semi-finalist in the Healthcare Informatics Innovator Awards program, and will be recognized for its accomplishments at the Healthcare Informatics Innovator Awards Reception, to be held in Orlando on Feb. 24, during the HIMSS Conference.
The Providence-based RIQI is the state-designated regional HIE manager in Rhode Island, and it implemented and operates the statewide HIE there, called CurrentCare. CurrentCare has over 60 data sharing partner organizations that provide lab data, medication histories, encounter/condition data, admit/discharge/transfer (ADT) data, telehealth data, and diagnostic imaging reports from institutions and physician practices. All but two Rhode Island hospitals are connected, and those last two are currently in process. Indeed, over 85 percent of all lab results, and more than 90 percent of all prescriptions, are collected. And more than 277,000 clinical summaries (continuity of care documents, or CCDs), had been captured from practice-based electronic health records (EHRs), as of late 2013.
As part of RIQI’s ongoing collaboration with Rhode Island’s largest all-player (including Medicare) patient-centered medical home (PCMH) programs, RIQI recognized the need for primary care providers to receive consistent, real-time notification whenever their patients were admitted to or discharged from a hospital or visited an emergency department (ED). Accordingly, RIQI developed and implemented its Hospital Alerts program, in which CurrentCare continuously monitors the information coming in from hospitals and EDs, looking for admissions and discharges for patients who have enrolled in CurrentCare. When those events are detected, CurrentCare automatically sends a Direct message to the primary care physician, informing that physician of the patient’s health event, if that doctor has signed up to participate in the Hospital Alert service.
For its work in concepting, developing, and implementing this set of innovations, the editors at Healthcare Informatics are delighted to recognize RIQI as a semi-finalist organization in its Innovator Awards program. Below are excerpts from HCI Editor-in-Chief Mark Hagland’s interview with Gary Christensen, chief operating officer and chief information officer of RIQI.
Tell us a bit about the overall context of the Rhode Island Quality Institute’s work, and how the Hospital Alert program came to be?
The Institute is aimed at improving the quality, efficiency, and value of healthcare in the state of Rhode Island. And we do run the HIE; that’s one of our collaboratives; we’re also the state’s REC [regional extension center]. We’re the only organization in the country that won all three major types of grants—the REC grant, one of the 17 Beacon grants, and the HIE grant—all three emerging out of the HITECH [Health Information Technology for Economic and Clinical Health] Act. So we do lots of outreach, and are trying to help change the healthcare system in the state, with a particular emphasis on HIT.
Let’s talk a bit about how you and your colleagues developed Hospital Alerts.
We were involved in the Direct project team; and a large group of volunteers came together and worked together to create Direct, and I was on that team, and served on several of the workgroups. And I’m on the board of directors for DirectTrust. And I saw that it solved such a big problem for us as an HIE—how you communicate with physician practices with a low amount of networking hassle. We were the first state to have provider-to-provider communications via Direct. That went live two years ago. And we run the Rhode Island Trust Community, which was a precursor to DirectTrust; and we’ll transition our Rhode Island Trust Community, that communication channel, to Direct. And we’re about to hit 1 million Direct transactions in the state.
If we roll out direct to everybody so they can do point-to-point health information exchange, then we in our health information exchange organization can take advantage of the fact that everybody’s wired with healthcare e-mail. And we do: we use Direct as a vehicle by which we collect information from EHRs into the HIE; and we use Direct to communicate from our HIE into primary care practices. And we’re using Direct to send alerts to PCPs. For example, we watch all the admit and discharge transfers, and whenever we see an admit or discharge to a hospital or an ED visit, if the patient is participating in CurrentCare—we have the opt-in to participate in the HIE—and the PCP for that patient is participating in hospital alerts, then we send a Direct message to that PCP saying, your patient, Mary Smith, was just seen in an ER or just got discharged. And based on that alert, practices have their protocols as to what to do as a follow-up.
How many alerts of that type have occurred so far, as part of Hospital Alerts?
Nearly 70,000 alerts have been triggered since January 2012, to 138 sites, at the end of 2013; we’re probably at 145 sites now.
You must be satisfied that you’ve initiated that process?
Oh yes, this was one of our major accomplishments in the Beacon program.
What has the response been from practicing physicians across the state?
Physicians in our patient-centered medical home program in the state and who are part of new, at-risk payment models, well, hospital readmits is one of the metrics that matter to them. So those practices have been really enthusiastic about using this. They now have another tool in their toolbox.
Can you guess what percentage of physicians are at risk now in any type of at-risk contracts?
I don’t know that, but there are 48 practices in the state’s patient-centered medical home program. We’re partners to that program, and provide quality metrics to the participants in that program, CSI—the Chronic Care Sustainability Initiative.
Your participation in Beacon and REC—what have been the most satisfying elements and the biggest learnings so far?
On the Beacon side, it was really satisfying that it allowed states to build infrastructure that now continue to support innovation. Our analytics environment, which allows us to understand the data that’s coming into the HIE, that was great, we funded that through the Beacon program, and that analytics infrastructure allows us to do public health analyses, where are the instances of Lyme disease, for example, and where are the trends going? And you could do all sorts of interesting, insightful and important learnings going forward, some of which will trigger alerts, trigger learnings.
So our status and participation as a Beacon Community helped us create that platform. And in terms of the REC, we’ve established relationships with other 1,000 providers across the state, and we’ll continue those relationships. And through those relationships, we’re able to disseminate a great deal of information and communications going forward. We think of our regional extension center as an Apple Store, as it were, to doctors. It is our retail distribution channel for any of our HIT products and services, any of our communications.
What should healthcare leaders nationwide take from your experiences?
It’s no surprise, but change is really hard; and it’s incredibly easy to get caught up in complexity. And the secret is, just start. You know, people told us that we wouldn’t be able to do any of the things we’d be able to do, for a thousand and one reasons. But we just started. Hospital alerts were a very simple concept. And we were able to put in this incremental thing that’s having a real impact on patients in the states. I mean, we can talk about some comprehensive program, and immediately fall into the morass of complexity around HIT. But if you just try to set some small, incremental goals, you can evolve forward: it’s the thin edge of the wedge thing. I’m quite sure that the infrastructure we’ve created will be used for things we’ve never even thought of yet. If you start with the end point of what you want created, you end up in a morass of complexity.
So you should start building a vehicle and see where it takes you?
I think that’s correct. I don’t think that any initiative like this starts with no vision. But realize that you’re creating an innovation platform, and so many things can come out of that.