Western Nebraska looks to health IT to improve patient safety and quality of care

History of collaboration, shared vision laid foundation for the Western Nebraska Health Information Exchange

By Anne Byers, Nebraska Information Technology Commission

Health care providers in Nebraska ’s Panhandle have a long history of working together to create a regional community of care. For over 10 years, the Rural Nebraska Healthcare Network, consisting of the CEO ’s of 9 hospitals in western Nebraska , has engaged in collaborative projects to improve health care delivery and to keep patients in the Panhandle.

“The need for health information sharing was identified by the CEOs who participate in the Rural Nebraska Healthcare Network four years ago,” said Joan Frances, director of the Rural Nebraska Healthcare Network. “They saw that health IT was the wave of the future. They also realized that in a frontier area with limited resources, not all hospitals could equitably implement health IT. They needed to plan together in order to make sure all hospitals in the region could participate in health information exchange. It is a unique commitment and an honorable viewpoint.”

The network’s history of collaboration and shared vision of using health information exchange (HIE) as a way to improve patient safety and quality of care laid the foundation for the formation of the Western Nebraska Health Information Exchange.

“It is all about developing trust,” said Kim Woods, project director for the Western Nebraska Health Information Exchange. “There has to be executive buy-in and a shared vision of where they want to go.”

A planning grant from the U.S. Department of Health and Human Services Agency for Healthcare Research and Quality (AHRQ) in 2004 enabled partners to begin the planning process for a regional health information exchange (often called a Regional Health Information Organization or RHIO).

“The year-long planning process was valuable and allowed the participants to have a common understanding of terms and phrases and to develop a shared vision,” said Joan Frances. “The planning process really jelled the region.”

In 2005, a three-year implementation grant from AHRQ was awarded.

Partners in the original Western Nebraska Health Information Exchange include:

• The Rural Nebraska Healthcare Network
• Box Butte General Hospital , Alliance
• Chadron Community Hospital , Chadron
• Garden County Health Services, Oshkosh
• Gordon Memorial Hospital , Gordon
• Kimball Health Services, Kimball
• Memorial Health Center , Sidney
• Morrill County Community Hospital , Bridgeport
• Perkins County Health Services, Grant
• Regional West Medical Center , Scottsbluff
• Panhandle Public Health District
• Region I Mental Health and Substance Abuse

A HRSA Rural Network Development Grant has provided the opportunity to expand this regional work to Panhandle Community Services Health Center , private physician’s clinics, long term care, and others.

University of Nebraska Public Policy Center is the Principle Investigator for the AHRQ grant, providing research and consultation on the project design.

Partners implemented a tier-like organizational structure to facilitate information sharing at the local, regional, and executive level. The planning structure includes:

• A project steering committee comprised of the CEOs of the nine participating hospitals, the Panhandle Public Health District, Region I Mental Health and Substance Abuse, and the University of Nebraska Public Policy Center ;
• Five regional teams focusing on information technology, organizational, financial, clinical, and training & education issues; and
• Local teams including an IT professional, clinical representatives, administration, finance, providers, as well as personnel responsible for quality assurance and HIPPA compliance.

“Having a broad base of people who understand the project has been one of the keys to the project’s success,” said Kim Woods.

In September 2005, the partners completed a plan for implementing a health information exchange “that will enable providers, patients, and others to share information, communicate orders and results, support evidence-based decision-making, streamline public health disease surveillance and reporting, and enable data management for non-clinical purposes (e.g., billing, quality management).“
(See the plan at http://www.ppc.nebraska.edu/program_areas/documents/PanhandleRegHealth%20InfoExchPlan-10-2005.pdf.)

The plan includes short-term goals to establish

• A health information exchange system that will provide current information, from all hospitals and rural health clinics, at the point of care; and
• An operational entity that will provide the sustainable infrastructure necessary to support regional health information exchange and common developments in the electronic health records, and
• To enhance capacity to develop electronic medical records in the region’s critical access hospitals and rural health clinics

The partners are continuing to make progress toward their goals.

“One of the things that sets this project apart from others around the country is the amount of time and energy that we are dedicating to high-caliber training in health IT and project management,” said Joan Frances.

Training sessions with nationally recognized trainers for becoming a Certified Professional in Health Information Technology (CPHIT) and Certified Professional in Electronic Health Records (CPEHR) have been held in the Panhandle. As a result, the Panhandle has the highest number of certified professionals in health information technology (HIT) and electronic health records (EHR) per capita in the United States . Approximately 10% of all certified professionals in HIT and EHR in the United States are in the Panhandle.

Training has also been offered in project management, vendor selection, process mapping, and skill training. A training academy developed in partnership with Western Nebraska Community College now offers training for college credit at participating hospitals. Over 45 user skill training sessions have been offered in the past six months.

“These skills translate to other projects,” said Joan Frances. “We have received good feedback on how the training impacts health IT and other projects. It has been very valuable.”

Partners are using their own resources to fund electronic health record systems. Some partners already had systems in place. Others are in the process of selecting or implementing systems. Regional West Medical Center operates a Web portal for physicians on staff to have full access to patient information and has recently allowed other physicians to view lab results and x-rays of patients. The Western Nebraska Health Information Exchange is completing an intensive survey of partner systems and is developing an RFP for a regional sharing solution.

“We don’t want to rip and replace existing systems,” said Kim Woods. “We want to integrate with existing systems.” said Kim Woods.

Work has also been done with a legal firm to develop users’ agreements and protocols for compliance with privacy and security standards under the Health Information Privacy and Accountability Act (HIPAA).

One of the biggest barriers to the development of health information exchanges or RHIOs is the misalignment of financial incentives. While providers bear the brunt of the cost of health information technology, consumers and payers (including insurance companies and employers) receive most of the benefits, including improved patient safety, improved quality of care, and reduced medical costs. The Western Nebraska Health Information Exchange is working on a business plan to sustain the project.

The Western Nebraska Health Information Exchange is addressing public health in a unique way. The entity has developed a reporting matrix which includes the non-mandatory and mandatory reporting that hospitals and clinics do. Partners have met with state agencies to discuss how the regional health information exchange being developed can interface with state systems.

“We see the inclusion of public health information as an integral part of this work,” said Kim Woods.

Although much progress has been made, significant work lies ahead. “It is a process, not an outcome,” explained Joan Frances.

When pressed to give advice to other entities developing a regional health information exchange, Nancy Shank , associate director of the University of Nebraska Public Policy Center said: “Collaboration is the key. Although the technology is complex and detailed, it is not the key factor. You need partners willing to collaborate and slog through a difficult, time-consuming process with the goal of improving patient safety and quality of care.”

For more information, see the following Web sites:

Western Nebraska Health Information Exchange
www.communityhealth.org

Panhandle Information Exchange Quick Reference Guide
http://www.comhealth.org/project%20reference/Project%20Reference%20(03-28-06).htm

TANgents, a quarterly publication of Technologies Across Nebraska, is edited and produced by Linda Tempel, University of Nebraska—Lincoln Extension, ltempel@unlnotes.unl.edu, and Anne Byers, Nebraska Information Technology Commission, abyers@notes.state.ne.us. Please contact us if you would like to contribute an article or an idea for an article. Comments and suggestions are also welcome.