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R.I.'s Direct Approach To Health Information Exchange

CIO Gary Christensen saw that if doctors could exchange records directly, the state's centralized HIE would also benefit.

So far, there has been no formal study to translate that correlation into proof of cause and effect, Christensen acknowledges. "It might be that the early adopters for this kind of technology are the ones who are really good at avoiding readmits in the first place," he said. "Still, it's holding up."

As more doctors find themselves getting paid based on results, rather than hours, it will be the availability of these alerts and similar services that will drive them to enroll with CurrentCare.

The Direct architecture has made it much easier to work with EHR vendors, since sending a Direct message is not much more complicated than sending an email, Christensen said. To layer on functionality such as sending alerts, or sending regular updates to the CurrentCare repository, all that's required is some sort of trigger mechanism -- such as detecting the release of a lock on a database record -- to cause the system to generate and transmit an XML-formatted patient record every time new information is recorded. Getting the systems to generate correctly structured continuity-of-care documents that CurrentCare can actually import and make use of is usually where the real challenges lie, he said.

The payoff is that CurrentCare is positioned as the only statewide database with records for all patients, regardless of where they have received care, providing of course that patients and the providers involved participate in the system. This is where HIEs that operate on a federated model -- coordinating the exchange of data, rather than acting as a central repository -- are missing out, Christensen said. Federation is an easier model conceptually, compared with creating a data warehouse and dealing with all the attendant HIPAA patient data privacy issues, he said. However, achieving the data-exchange scenarios for which HIEs were originally envisioned is only the beginning of the potential, Christensen said. He talks about second- and third-order benefits, such as playing a bigger role in population health studies and providing other analytic and even consumer services. "I think it will be hard for the federated HIEs to achieve those second order and third order benefits," he said.

For example, one current initiative known internally as "my HIE" would use the CurrentCare repository to support apps that would be provided directly to consumers. The downfall of most personal health record programs has been the assumption that consumers would take the time to key in their own data, or obtain their electronic records from a provider to be imported. But an app that plugged in to CurrentCare could take advantage of the fact that it already has the data. The first such app on his list, which he's dubbed "MyMeds," would be one for the elderly and their caretakers to keep track of all the medications they're taking.

A first customer he has in mind is his sister, who is the one in the family who takes their mom to her doctors' appointments and keeps track of a growing medications list with a piece of paper tacked to the refrigerator.

"There are potential markets all over the place -- we're just early on in this," Christensen said.

Follow David F. Carr on Twitter @davidfcarr or Google+. He is the author of Social Collaboration For Dummies (October 2013).

Though the online exchange of medical records is central to the government's Meaningful Use program, the effort to make such transactions routine has just begun. Also in the Barriers to Health Information Exchange issue of InformationWeek Healthcare: why cloud startups favor Direct Protocol as a simpler alternative to centralized HIEs. (Free registration required.)

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Alex Kane Rudansky
Alex Kane Rudansky,
User Rank: Author
11/20/2013 | 12:48:07 PM
I'd love to hear how Christensen addresses two major HIE challenges I've come across: competition and privacy. I've seen practices that are hesitant to participate in an HIE because of the possibillity of losing patients (HIEs make it easier for patients to switch doctors). There's also the issue of privacy. What should be included in an HIE? How much is too much? The sharing of HIV status and psych data, among others, is a hot button issue.
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