Holomua Project Improving Transitional Care in Hawaii

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Project Details -
Completed

The Holomua Project piloted an endeavor to improve the flow of information between patients and families, community health centers (CHCs), and tertiary centers (TCs) by developing and implementing the Holomua Master Visit Registry (HMVR). The HMVR sought to improve coordination of care that patients receive when transitioning between CHCs and TCs. The specific aims of the project were to:

  1. Increase accuracy and timeliness of shared patient information during transitional care between primary and tertiary care facilities;
  2. Reduce incidence of medical errors that may occur due to linguistic and/or cultural barriers between patients and medical providers;
  3. Reduce occurrences of duplicated diagnostic procedures performed;
  4. Increase participation and involvement of patients and families in decisionmaking on health related matters; and
  5. Determine mechanisms by which information resources, information systems, and other information technology initiatives and/or networks in Hawaii can best support the Holomua Project.

The project consisted of both technological and non-technological solutions to the problem of transitional care. The technological solution involved developing and implementing the HMVR as a means of sharing health information between systems. It was chosen since it represents a scalable, interoperable solution that takes into account the disparate resources of all partner organizations. The non-technological solutions related to transitional care involved charting workflows, developing corresponding polices and procedures, and using dialogue and communication to facilitate the process. The non-technological methods were based on abundant research that illustrates the necessity of attending to the human side of information technology to ensure success of implementation efforts.

The collaborators successfully developed and implemented a live health information exchange involving approximately 250,000 patients, 150 clinician users, and 500,000 visits. In addition, the team trained over 100 HMVR end-users across three health care facilities, created policies and procedures for transitioning patients, and increased partners’ awareness of managing patients who visited multiple facilities.

More information on the project is available at http://www.hawaiipca.net.

Christine Sakuda, MBA
The phrase 'Pupukahi i Holomua' is Hawaiian for "unite in order to progress." With this spirit in mind, the Holomua Project to Improve Transitional Care in Hawaii launched a four-year project to help community health centers and hospitals improve care for their shared patients transitioning between the participating CHCs and hospitals. Project leaders hope to expand the network to multiple facilities across the state's six major islands.

With help from an Agency for Healthcare Research and Quality grant, the Hawaii Primary Care Association in 2005 began developing a Master Visit Registry (MVR) that helps doctors locate a patient's history of visits, shows what type of care they received and who provided the care.

The project includes the Hawaii Primary Care Association, Kalihi-Palama Health Center, Kokua Kalihi Valley Health Center, Hawaii Pacific Health and The Queen's Medical Center. Participants hope that the project will improve the quality of transitional care between community health centers and hospitals through the exchange of patient information.

Project leader Christine Sakuda, MBA said a key issue is when patients are seen in one health care facility and then go to a different facility --without records of their critical medical information following them. A compounding issue is that many of these patients do not speak English as their first language.

The Holomua Project aims to reduce errors and improve quality using the MVR. Through the MVR, physicians can access information such as the patient's name, date of their last visit and the physician they saw at the two participating CHCs and two participating hospitals, which facility they visited, the type of visit and related diagnosis codes. The MVR allows facilities to share timely, accurate patient information, even if the patient isn't able to provide a medical history. In addition, the registry will help participating facilities develop policies and procedures that improve the coordination and continuity of health care as patients transfer between different locations.

"Part of the challenge of implementing this project, which connects to existing recordkeeping systems, was standardizing the data elements, such as patient name, facility visited or type of visit that would feed into the registry from the different source systems," Sakuda said. "There is significant risk if the available information doesn't accurately reflect the history of the patient."

All participants had to agree on the specific elements that would go into the registry, and how those elements would appear. Other challenges included refining the master patient index, which reflects the unique patient demographics in Hawaii that includes a homeless population with no fixed address among a diverse Pacific Island population that may have common names and complex spellings. Sakuda acknowledges that it took awhile to get agreement on the data elements. But ongoing collaboration helped the various parties hammer out standards that worked for all.

Successful queries in the master patient index are only as accurate as the data provided by the partner facilities. Part of the hope is that the registry will show participating facilities any potential inconsistencies in information on the same patient being pulled from multiple institutions. This will help them improve upon the accuracy of their existing systems.

Another common concern among participating facilities was ensuring that patient privacy policies and security procedures were in place for this health information exchange. As part of its privacy solution, only authorized providers can access the registry. Once a provider selects the right patient in the MVR, a history of the patient's visits will appear. The provider then selects the visit he or she wants more information on. The participating health centers and hospitals developed data-sharing agreements for the test and go-live phases. Once the system is live, users can access the MVR from their workstation within the clinic or hospital.

As of the summer of 2008, the system contained data on 450,000 patient visits from the previous year with roughly 220,000 patients. The registry is expected to go live by September 2008. In the future, project leaders hope that the registry developed in this pilot will be incorporated into a statewide initiative to create a broad health information exchange among hospitals, physician offices and health insurance companies.

Sakuda says she'd also like to give patients the ability to access their own records.

"Our ultimate goal is to increase patient safety, quality and continuity of care for Hawaii's most vulnerable patients by using health information technology to improve the link between patients, families, community health centers and hospitals," Sakuda says.