Taconic Health Information Network and Community (THINC)

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Project Details -
Completed

The Taconic IPA, a 3,000 physician independent practice association located in Fishkill, NY involved in an information technology project to improve the quality, safety, and efficiency of healthcare in our region. In the past, the organization worked with area hospitals and laboratories to create a community wide electronic data exchange. At the beginning of the project, Taconic IPA physicians electronically managed the data through a clinical messaging system as part of their daily workflow, which is the first step in adoption of an electronic health record (EHR). The Taconic IPA added a health care portal to the existing community wide electronic data exchange which allowed for use of the current electronic messaging system along with migration to a full EHR. We believed that a full EHR with clinical decision support and patient registries was required to signficantly improve the quality, safety, and efficiency of health care. Most uniform EHR systems have been developed and deployed in Integrated Delivery Systems or large university hospitals under a staff model setting. Independently practicing physicians and competing community hospitals do not engage in efforts to deploy interoperable systems with standards and common vocabularies necessary to address quality improvement on a population-based and individual physician basis. The IPA was one of the first to attempt deployment of a standard EHR with a community wide electronic data exchange among a large group of independently practicing physicians as has been done in staff model settings. Although studies have demonstrated cost savings and, to a limited extent, quality improvement in staff model implementations, large controlled trials do not exist in the private practice setting. Our project evaluated: physician office efficiency improvement and cost reduction, payer return on investment, safety improvement, and quality improvement. The groups evaluated included a control group, the group using the electronic messaging system, and a group using a full EHR.

A. John Blair, III, M.D.
Creating an electronic medical record (EMR) system for a 3,000-physician IPA comprising mostly small, widely dispersed practices is no easy task, as A. John Blair, III, M.D., well knows.

"It's like a 3-D chess game. There's a lot of elbow-to-elbow work to doing this, which is why there are not too many success stories out there," says Blair, a laparoscopic surgeon and president and CEO of Taconic IPA, Inc., Fishkill, NY.

Taconic is the exception.

In late 2001, the IPA established a plan to implement a health information exchange (HIE) model among insurers, hospitals, laboratories, and physicians. Today, about 600 of the 16-year-old IPA's physicians in two of the eight counties covered by Taconic participate in the data exchange, called Taconic Health Information Network and Community (THINC). THINC allows physicians to electronically manage health care data via a clinical messaging system - the first step to adopting an electronic medical record (EMR). Using a secure password, physicians log in to a main portal from either laptop computers or personal digital assistants to retrieve lab reports, x-rays, and other clinical data.

"Within five seconds, you can pull up the results from a lab test. If it's a critical result, a beeper sounds so you can act on the information immediately. It's efficient, and the lab report won't get lost on a fax machine, or get misplaced," Blair says. As the HIE model phases in, more physicians will be added, as will the ability to write e-prescriptions and access EMRs.

A three-year, $1.5 million AHRQ grant will allow Taconic to push the project to the next level. The grant focuses on two priorities. The first is to hire an independent clinical investigator to study the impact of HIE on health care quality. The second is to expand the program by helping more of the IPA's primary care physicians offset the costs of participating in the electronic network.

"This grant will allow us to do seminal work, and to answer key questions: Does this type of technology really work? What's the value of the whole electronic data exchange, and does it actually improve the quality of health care and reduce medical errors? No one has ever had the data to study community-based physicians, where 80 percent of Americans get their health care," says Blair.

The impact study will assess outcomes among three groups, each comprising approximately 100 physicians: a control "paper" group, an electronic prescribing group, and a group using fully integrated EMRs. "We will look carefully at medical errors, adverse drug events, quality issues, and cost in all three groups," Blair explains.

The infusion from the grant will also help Taconic IPA's physicians overcome the cost hurdle of joining the network by providing technical assistance during start-up and implementation. "The No. 1 problem for small physician practices is the start-up costs of EMRs. The other problems are having the expertise, trouble-shooting capabilities, and training such programs require in order to use them," says Blair.

Start-up costs for EMRs can run $30,000 per physician; Taconic IPA physicians pay approximately $500 per month to use the system. "Large groups can afford to pay $1 million or so to implement an electronic system. We are offering a solution to the vast hoard of small practitioners who just can't afford to do this on their own," Blair says.

The program also opens the door to allow primary care physicians to qualify for some of the pay-for-performance incentive programs offered by insurers and employers to providers who use electronic information technology. A physician could receive up to $400 per month from such incentives, according to Blair.

"The ultimate goal is to help fill the void for the small practitioners who can't do this on their own, to improve the quality of health care, and to reduce medical errors," says Blair.