State and Regional Demonstration in Health Information Technology: Rhode Island

The Rhode Island Statewide Health Information Exchange (HIE), known as Currentcare, is one of six Agency for Healthcare Research and Quality (AHRQ) - sponsored State and Regional Demonstration (SRD) projects begun in late 2004 and early 2005 to create State or regional HIEs. Currentcare was created via the collaboration of the Rhode Island (RI) Department of Health (HEALTH) and the Rhode Island Quality Institute (RIQI), as well as with other stakeholders across the State. This project facilitated the development of the capability to deploy health information infrastructure at a statewide scale.

RIQI’s role in the project was to determine the governance for the project, while HEALTH’s role was focused on the project management aspects of building and deploying the HIE. It was planned from the onset that once the HIE was operational it would be managed and maintained outside State government. The project team engaged the broader community throughout the project, including in their formulation of policies and the design of the technical infrastructure.

The main objectives of the project were to:

• Improve the quality, safety, and value of health care in the State of Rhode Island through a sustainable statewide HIE system.
• Incorporate a master patient index into the HIE to locate longitudinal patient health information from numerous data-submitting partners statewide.
• Design the HIE so that consumers will be allowed to control access to their data.
• Implement the capability to present data from various sources in an integrated, patient-centric manner using a common user interface.
• Transition all operating, management, and governance responsibility of the HIE to a community-based regional HIO.

The project had a unique challenge not experienced by other SRD projects in that the RI HIE Act of 2008 contained stricter privacy and confidentiality protections than other State and Federal health information privacy laws. This required a great deal of work on the part of RIQI, HEALTH, and the larger community to ensure compliance with those laws. The decision to engage the larger community, while positive overall, also created challenges. The project team experienced delays in system development related to the complexities of their administrative, technical, and policy processes and the challenges of consensus building. As a result there was a delay in generating value from the HIE and a postponement as to when the project will enter a phase of sustainability. The team considered policy development, HIE legal protection passage, and consumer engagement— all of which exceeded community expectations— as the project’s main successes.

At the end of the project the team stood firmly behind their approach taken, the resultant policy decisions, the implementation of those policies, and the implications for the process and results. At the conclusion of the funding period, this project had successfully developed the capacity to deploy health information via an HIE infrastructure across the State. The physical infrastructure along with the policy, legal, and operational framework derived from the project is beginning to be used to augment the practice of medicine in the State. Future research will generate answers to essential strategic questions pertaining to the value proposition for electronic HIE.