State and Regional Demonstration in Health Information Technology: Colorado

This project built a prototype data exchange among four health care organizations. The project functioned as a learning laboratory which identified architecture and policy issues needing to be addressed to establish a sustainable business model for health information exchanges (HIE). The four partners of the Colorado Connecting Communities project, formerly known as the Colorado Regional Health Information Organization (CORHIO) project, were Denver Health and Hospital Authority, Kaiser Permanente Colorado, the Children's Hospital Colorado, and the University of Colorado Hospital. This project was one of six AHRQ sponsored State and Regional demonstration projects begun in late 2004 and early 2005 to create a State or regional HIE. The main objectives of the project were to:

• Facilitate the live exchange of clinical information across four sites.
• Evaluate clinical impact.
• Analyze role of the Medicaid program.
• Develop a sustainability model.

The project team was able to successfully develop a non-profit, independent entity to promote exchange of health information in Colorado. Policies, procedures, and the technical and legal infrastructure were developed and deployed to allow secure, federated exchange of information between the four organizations over the Internet utilizing Federal standards and protocols.

The project uses a robust electronic master patient index that allows records to be matched and shared at the point of care. This system offers authorized emergency room practitioners at the four sites access to radiology reports, laboratory results, prescribed and dispensed medication information, EKG reports, registration information, and problem lists aggregated from all sites. All existing standards from the Healthcare Information Technology Standards Panel were incorporated into the architecture. CORHIO and its partners went live with a demonstration on December 1, 2008.

The initial CORHIO effort brought data to emergency department (ED) providers, but deployment in this setting showed that busy ED physicians were less likely to seek additional information on their patients unless it was extremely accessible and of high priority. While the process of aggregating data into usable information was shown to be feasible, the deployment within a busy ED environment might have shown less impact than in other care environments.

Feedback from several users described instances in which use of the Point of Care (POC) system improved the quality or efficiency of care. Users felt that the interface was intuitive, but that the patient search function could be improved. The relatively short password lifespan of 3 weeks was a definite impediment to use. An area where CORHIO began to explore remedies to barriers to use was in trying to leverage another system's authorization and authentication procedure to identify a user within CORHIO. Ongoing promotion and support of the POC system would also have reminded potential users that such a service was available for their use.