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Regional Work
Since January 2010, over $50 million in federal stimulus funds have been awarded in DC, Maryland, and Virginia to expand the use of Health Information Technology. In the District, $5 million was allocated to the DC Primary Care Association to establish a health information exchange (HIE) and another $5 million was granted to create DC's regional extension center (REC), eHealth DC. In Maryland, over $9 million of stimulus money was granted to the Maryland Health Care Commission to establish an HIE, and another $5 million was awarded to build a REC. In Virginia, the Virginia Dept. of Health received $11 million to build its HIE, the Commonwealth Information Management & Exchange (CHIMES), and the Virginia Health Quality Center received $12 million to implement Virginia's REC. For an overview of federal programs and grants for regional extension centers and health information exchange, Click HERE.
As of 2010, many of the community-based primary care health centers and free clinics affiliated with the primary care associations/coalitions in the District of Columbia, Maryland, and Virginia are using some form of electronic health records (EHRs) and participating in health information exchanges (HIEs). The region’s current efforts focus on expanding adoption of EHRs and HIEs by providers, labs, and specialty care facilities, and improving the utility of EHRs to meet patient and clinic needs.
District of Columbia
The DC Primary Care Association (DCPCA) has been at the forefront of HIT adoption, working with DC community health centers to adopt electronic medical record systems, and enabling health information exchange through the DC Regional Health Information Organization (RHIO).
DCPCA has aided health centers in improving operational efficiency and enhancing quality of care through EMR adoption. As of October 2010, eight safety net clinics in DC have implemented an electronic medical record system called eClinical Works (eCW), and one more will adopt eCW in 2011. As EMRs collect data at these clinics over time, DCPCA will explore their potential to drive evidence-based practices through aggregation and analysis of population-level data. Through its regional extension center (REC), eHealthDC, DCPCA is committed to assisting 1,000 primary care providers in implementing and achieving meaningful use of EMR. Funded by a $5.4 million grant from the Office of the National Coordinator for Health Information Technology, eHealthDC helps providers conduct “meaningful use” readiness assessments and gap analyses for EMR adoption, gives them access to educational tools and expert resources around HIT, and provides technical assistance and other services.
The DC RHIO aims to connect patient EMRs across healthcare facilities within the District through a seamless, integrated, interoperable health information exchange. The RHIO first enabled six community health centers and two hospitals to exchange live patient data. That existing network is expanding with the addition of two more health centers (totaling an additional 30 clinic sites) and two hospitals. The RHIO is slated to become the Health Information Exchange for the District, under a $5.1 million federal stimulus grant. The RHIO plans to add personal health records to increase patients’ self-management; connect to the Patient Data Hub, a health information repository for Medicaid claims data run by the DC Department of Health Care Finance; and continue to add clinics, hospitals, and labs in order to create a District-wide system of health information exchange that improves care quality and coordination.
Maryland
The Maryland state health information exchange (HIE) and regional extension center (REC) will be implemented by the Chesapeake Regional Information System for Our Patients (CRISP). The HIE goal is “to deliver the right health information to the right place at the right time – anywhere in Maryland – providing safer, more timely, efficient, effective, equitable, patient-centered care”. With $10 million in state funds and $9.3 million in federal stimulus funds for implementation, the Maryland HIE began operation in October 2010 at three hospitals, three radiology centers, and two laboratory facilities in Montgomery County. All 48 Maryland hospitals have agreed to join the HIE. Additionally, with a $5.5 million federal grant, CRISP will implement a REC to assist 1,000 primary care providers in rural and underserved areas in adoption and meaningful use of EHRs.
In Montgomery County, The Primary Care Coalition (PCC) of Montgomery County, Center for Community-Based Health Informatics (CCBHI) is working with its Community HealthLink Clinics to put practice management and electronic medical/health records in place and use those systems to exchange relevant health information with other providers in the region. With the support of a Community Access Program grant from HRSA, CCBHI developed CHLCare, an open-source technology product that includes robust demographic information, an appointment-scheduling module, a visit planner, and clinical information including ICD-9 and CPT codes all in a single, shared system used by many clinics in the region. PCC is also using CHLCare to aggregate population data, tracking quality measures for diabetes and hypertension across community health link clinics. It also developed and implemented The Clinical Desktop through an Access to Digital Libraries grant from the National Library of Medicine. This functionality allows clinic staff and patients to easily access quality health information on the Internet. The grant also included training for clinic staff on how to assess the quality of this health information.
PCC is using the Metro DC Health Information Exchange (MeDHIX), funded through a Transforming Healthcare Quality through Information Technology grant from the Agency for Healthcare Research and Quality (AHRQ), to provide the infrastructure necessary to facilitate exchange of electronic health information among CHLCare, other electronic health records, and mainstream health care. The information to be exchanged includes patient demographics, medications, conditions, allergies, and results of laboratory tests. Additional capabilities include electronic receipt of laboratory test results from Quest Laboratories and PDFconversion of faxed specialty consultation reports for inclusion in the CHLCare EHR. MeDHIX includes PCC’s Montgomery Cares clinics as well as hospitals, where PCC also provides staff training for MeDHIX. As part of this project, picture ID cards were added to CHLCare and MeDHIX for safety net clinic patients to facilitate care and identify patients to hospital ER staff and consulting specialists. Both the picture ID cards and the MeDHIX “eChart” clinical summary available to ER staff are integral components of the “ED-PC Connect” project that focuses on identifying medical home clinics for ER patients to improve outcomes and reduce costs.
A formal report on the MeDHIX project highlights the complexity of confidentiality and privacy laws that govern patients’ health information across neighboring jurisdictions. This is a significant issue in the DC area where patient populations migrate across jurisdiction borders quite frequently, further complicating the challenge of timely access to medical data for care continuity, quality, and cost effectiveness. In the report, the MeDHIX Principle Investigators lay out next steps for the sustainability of the regional HIE project, including the expansion of the DC RHIO and continued funding of safety net EHRs and HIEs across the jurisdictions. The full report can be accessed HERE. Please contact Tom Lewis, Chief Information Officer of the Primary Care Coalition of Montgomery County, for more information at Tom_Lewis@primarycarecoalition.org.
The eleven Community HealthLink Clinics use a mix of EHRs, including seven using CHLCare, two in the process of implementing NextGen, one using Centricity, and one using eClinicalWorks. In addition, all use some safety net oriented features of CHLCare, including a distributed, network based specialty referral request and management system.
The PCC, the Montgomery Cares safety net clinics, and the Montgomery County Dept. of Health and Human Services are conducting a current state assessment and readiness assessment of opportunities and issues related to recent health reform legislation. Funded by Kaiser Permanente, the goal is to identify strategic directions related to EHR use and evolution, Medicaid/Medicare participation, meaningful use, and financial sustainability considerations.
The Montgomery County Health Information Exchange (MCHIE) group was co-chaired by Dr. Roger Leonard, VP for Medical Affairs at Montgomery General Hospital, and Dr. Tom Lewis of the Primary Care Coalition, with active participation by all the county hospitals, several of the safety net clinics, the Montgomery County Dept. of Health and Human Services, the Prince George's County Health Department, and many community organizations. Although completed in February 2009, the MCHIE final report continues to serve as a valuable reference for the planning and implementation of HIEs. Of particular interest are the focus groups conducted among patients and providers utilizing safety net clinics, which found that patients look forward to having access to their own health data, though some cited privacy concerns. The report reflects the perspectives of community hospitals, safety net clinics, and community members on issues of importance for a successful statewide health information exchange. Although the MCHIE group dissolved at the end of the project, many of the members serve as advisors to the CRISP HIE implementation contractor, as members of the Maryland state HIE Policy Board, or as active members of EHR and HIE projects in Montgomery County hospitals. The full report is available HERE.
Virginia
In December 2009, Virginia received $11.6 million to create a statewide health information exchange, the Commonwealth Information Management & Exchange (CHIMES). CHIMES will build on the work of MedVirginia and CareSpark, two existing health information exchanges in central and southwest Virginia, to build an HIE that incorporates all Virginia residents. For the full CHIMES proposal to the ONC, Click HERE.
With a $12.4 million federal grant, the Virginia Health Quality Center (VHQC), in conjunction with Center for Innovative Technology, is establishing a Virginia HIT Regional Extension Center, which will give providers access to affordable EHRs as well as consulting services, including needs assessment, vendor selection, system and workflow change implementation, and education and training. The VHQC will partner with EHR vendor athenahealth, as well as the Community Care Network of Virginia, the Medical Society, and the Virginia Academy of Family Physicians, to bring robust EMR systems to 2,300 providers in Virginia.
In Northern Virginia, at least six safety net clinics that are part of the Northern Virginia Health Services Coalition have transitioned to electronic medical records, with four more adopting EMRs soon. The Northern Virginia Regional Health Information Organization (NoVA RHIO) was established in 2007 to improve the health status of Northern Virginia workers and residents by facilitating the adoption of interoperable EMRs and supporting development of a regional health information exchange. Funded by federal and state grants, as well as donations from business and individuals, the NoVA RHIO has a diverse board with representation from physician practices, allied health providers, hospitals, academia, insurance companies, government, corporations, legal and banking entities, clinics and laboratories, pharmacies, and patient groups, with the empowerment of the patient at the heart of its mission. In 2011, NoVa RHIO is launching a MEDS-ED Link pilot project that will enable Inova Alexandria Hospital emergency department (ED) to access patient records contained in SureScripts, an existing prescription data repository for insured and Medicaid patients in Virginia. The two-year pilot project, in conjunction with Inova Health System and GE Healthcare, is supported by a $150,000 grant from the Commonwealth of Virginia and matching contributions. To build regional health information exchange, additional hospitals, hospital systems, laboratory data, and radiology reports could be added to the system in the future.