State and Regional Demonstration in Health Information Technology: Tennessee

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Project Details -
Completed

In this project, the MidSouth eHealth Alliance (MSeHA) implemented and evaluated a regional data-sharing and interoperability service for health care entities in the Greater Memphis area. The MSeHA is a nonprofit organization that works in conjunction with the Vanderbilt University Regional Informatics Team. The Alliance enables providers to review medical information from several organizations quickly while restricting access to a patient’s medical information to current and direct care providers. This project is one of six AHRQ-sponsored State and Regional Demonstration projects begun in late 2004 and early 2005 to create a State or regional health information exchange (HIE). The main objectives of the project were to:

  • Facilitate the exchange of clinical data elements among providers in a three-county region with a population of about 1 million.
  • Leverage the Vanderbilt technical architecture to initiate the exchange and eventual transition to an independent platform.
  • Expand the number of participating organizations to remaining safety net providers and primary care ambulatory providers.
  • Develop a business model for sustainability.

Since 2005, the nonprofit MSeHA has governed and managed HIE services among 14 major health care provider organizations in the Memphis, Tennessee metropolitan area. Information available from participating organizations varies slightly among organizations. All major hospitals provide hospital discharge summary notes, laboratory data, pathology reports, radiographic reports, select transcribed notes, and a range of other clinical and administrative documents. Other participating organizations provide demographic information, registration information, and a limited number of clinical data types. Clinicians began accessing HIE data in emergency departments in May 2006 and later obtained access on hospital wards and in ambulatory clinics. As of October 2010, clinicians had access to over 7.5 million encounter records on 1.7 million patients, 4.9 million chief complaints, 45 million laboratory tests, 5 million radiology reports, and 2.1 million other reports and documents. Patients are offered the chance to “opt out” from HIE participation at the time of each encounter at participating hospitals and clinics.

The overarching findings from the current study suggest that both the process and technical models can make substantial contributions to a National HIE. The Vanderbilt-based architecture was shown to be a robust, scalable, and very inexpensive model for HIE. As a wider array of ambulatory-based electronic health records, laboratory devices, and other technologies are integrated there will be a convergence of issues regarding data centralization, privacy considerations, and data sharing provisions. Therefore, future HIE efforts will realize even greater cost benefits. This broader integration will foster more effective care coordination and allow for demonstration of care impact across entire populations and not just those who seek hospital or emergency department care.

Mark Frisse, MD
A patient walks into an emergency department for a seemingly simple procedure: a cut that requires stitches. But with the help of a network that allows Memphis-area hospitals to share patient data electronically, physicians can see that the patient had visited another emergency department with tuberculosis that was untreated. Armed with this information, doctors are able to recommend the appropriate treatments, and put the patient into isolation to avoid spreading potentially deadly infection any further.

Unfortunately for many hospitals in the United States, this scenario is many years from becoming a reality. But for hospitals and clinics participating in the MidSouth eHealth Alliance (MSeHA), it's in place today, thanks to a $4.8 million contract from the Agency for Healthcare Research and Quality and a $7.2 million grant from the state of Tennessee. The project aims to improve patient care and reduce costs through eliminating duplicate or unneeded tests, reducing hospital stays and decreasing ED utilization.

Since May 2006, the Regional Health Information Organization (RHIO) has helped emergency departments and clinics within the Memphis region exchange a variety of patient data, such radiology reports, lab data, physician notes, discharge summaries and demographic information. The MSeHA currently exchanges data among 9 hospitals, 15 ambulatory clinics and the University of Tennessee Medical Group (UTMG) in the region. Physicians in the EDs of these hospitals can view patient data through a secure, Web-based browser that provides a real-time data feed to the hospitals and clinics.

Today, the exchange has generated more than 2.1 million patient records. Each day, the MSeHA handles about 33,000 patient records and 800,000 lab results. Project leaders are still busy figuring out how to measure the project's return on investment, but Mark Frisse, MD, Director of Regional Informatics Programs through the Vanderbilt Center for Better Health in Nashville, Tenn., projects that the data exchange is saving local emergency departments about $500,000 per year.

Part of the challenge for making such data exchanges successful -- and much of the reason they've failed in the past -- is getting various players to agree on issues such as privacy and security of the network. But the MSeHA created a taskforce to deal with privacy and security issues with senior management teams of the various hospitals before the network launched. They also used the Markle Foundation's Connecting For Health project model privacy and security policies for health information exchange to guide their discussions. Project officials say it took about five months to hammer out these agreements.

"We took the time and energy invest in it. We never brushed aside anybody's concern or idea," says Vicki Estrin, program manager for the Regional Informatics at the Vanderbilt Center for Better Health and chairperson of the MidSouth eHealth Alliance's Operations Committee. "People are looking for easy answers to hard questions. In some cases, you have to create the answer."

Another reason for the project's success? It didn't require participants to have expensive electronic medical records systems already in place. Instead, participating organizations use build-on technologies in use at Vanderbilt Medical center for more than a decade.

"We didn't let the initial effort get bogged down by the politics vendor selection," Frisse says. "Rather, we were fortunate to build a technology base off of Vanderbilt systems. At some future point, the lessons learned from this effort may lead the MidSouth eHealth Alliance to adopt different vendors and technologies, but they will be in a far stronger position to understand what it is they need, what the benefits should be, and what costs to expect."

The project also succeeded by capitalizing on what Frisse calls "immediate, short-term wins" through providing data to emergency department physicians and avoiding some of the traditional roadblocks of health IT projects: physician resistance. "The emergency room doctors are starving for data. We choose settings where it's easy to get providers to use it," he says.

A sense of urgency also helped drive the project,since several hospitals were facing cuts to TennCare, the state's Tennessee's Medicaid managed care program that provides health coverage for 1.2 million low-income children, pregnant woman and disabled state residents.

Next Steps

As the Alliance examines ways to measure its return on investment from the project, the network will expand to additional hospitals and ambulatory settings. Frisse says hospitals and large employers are trying to figure out how to pay for such systems, but that the answer might lie in financing between the state government, health plans and other groups that benefit from the network.

Project officials say the key to success now and in the future is to be willing to change with the users' needs. "It's impossible to do right the first time. You've got to evolve," Estrin says.