State and Regional Demonstration in Health Information Technology: Utah

The Utah Health Information Network (UHIN) 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 a State or regional health information exchange (HIE). UHIN is a coalition of health care insurers, physicians, hospitals, laboratories, local health departments, health centers, State agencies, and other interested parties that have come together to reduce health care costs and improve the quality of care through the use of electronic data interchange.

UHIN’s goal was to implement statewide information and communication technologies to facilitate the exchange of clinical data among its members. The first 4 years of the UHIN project were dedicated to building coalitions, developing infrastructure, identifying and engaging in dialog amongst disparate UHIN partners, developing self-governance policies and procedures, and determining technological and administrative requirements needed to support the HIE. The enhanced infrastructure, which allows initial exchange of clinical information through UHIN, is a utility for direct entry of claims, eligibility inquiries, and other health care transactions. In 2009, the project contracted with the Axolotl Corporation to develop a comprehensive solution for clinical information exchange that will form the technical infrastructure for the clinical health information exchange (cHIE). Axolotl, now OptumInsight, is a consulting and outsourcing company which provides technology solutions to organizations. This change in direction caused delays in the overall implementation of the HIE.

The main objectives of the project were to 

• Develop a novel exchange of laboratory and prescription drug data among unrelated entities.
• Conduct analyses of the role of the Medicaid program. • Provide an evaluation of the project.
• Implement a sustainability model.
• Community implementation of clinical data exchange utilizing the expanded cHIE infrastructure that includes an “Electronic Medical Record Lite,” a master patient index, and virtual health records-query functionality.

At the completion of the project’s funding period, 13 facilities, including 11 hospitals, one large clinic group, and one independent laboratory had sent more than eight million clinical messages to the HIE. While the impact of the use of cHIE by clinicians on patient safety and quality of care could not be measured due to its early stages, interviews completed with both clinics and hospitals indicated that, despite initial delays in implementation, enthusiasm and expectations for the cHIE remain high.

An important lesson learned over the course of the project was that evaluation of immature HIEs must be formative in nature to access the process and progress of the HIE. It can be difficult to measure outcomes until an HIE is functioning, mature, and widely used.