Rocky Mountain RHIO

A low-key management style and an emphasis on improving care have boosted physician support for a RHIO in Colorado

The Quality Health Network (QHN) in Grand Junction, Colo., was launched less than two years ago, but the regional health information organization has already reached a milestone: three-quarters of the digital health care data available to its subscribers is circulating electronically. That means physicians are actually using its services.

“We are now at the point where 75 percent of the data in our community that can be transmitted electronically is actually being transmitted electronically,” said Dick Thompson, QHN’s executive director. “The doctors really like the system, and so we feel like a transformation is truly occurring.”

QHN executives say the network’s success reflects the region’s culture of collaboration. Tucked between the Rocky Mountains and the Great Salt Lake Desert, about midway between Denver and Salt Lake City, Mesa County is defined by its geographic isolation, which leads residents to depend on one another to get things done.

In 2004, that mentality led some of the region’s major health care organizations — including two acute-care hospitals, a health care plan, a community-based specialty health care provider and an independent physicians’ association — to found and fund QHN. The network went live in October 2005.

“The idea was to create QHN as an apolitical, trusted third party,” Thompson said. Adhering to that ideal has been critical to the RHIO’s effectiveness, he added. “In other words, we are seen by everyone as a level playing field where all the participants play evenly and fairly rather than fulfilling one organization’s agenda,” he said.

The business model
QHN aggregates data from diverse sources and then delivers results and information to authenticated users.

The network collects data from two hospitals, various commercial laboratories, two surgery centers, more than 120 pharmacies, the local public health organization, physician practices and the Rocky Mountain Health Plans.

It sends aggregated data to physician practice databases, a patient population database and a repository of patient histories available only to physicians in emergencies. The data is used to reconcile medication orders, manage shared risk populations, develop disease-prevention strategies and aid in managing disease.

QHN offers 22 services, including clinical messaging, electronic medical record interfaces, electronic prescribing and ordering of medications, a common patient index, data privacy and security standards, workflow training and support, and help-desk and network management. Axolotl supplied the network infrastructure and software for QHN.

“We’ve tried to create a compelling volume of data so physicians can connect in one place and get all of this data from different sources,” Thompson said.

A benefit of participating in QHN is that physicians can now easily fill information gaps in a patient’s record, said Dr. John Beeson, vice president of medical affairs at St. Mary’s Hospital and Regional Medical Center, and one of the system’s participants.

Patients “may show up in the emergency department after visiting the office of a specialist the day before, and the results of that consultation would not have been available prior to the implementation of QHN,” he said. “Now, if the provider and the facility are both using QHN, the information is available in real time.”

Follow the data
However, the best testament to the system’s popularity comes from physicians’ increasing use of QHN, with the following results.
  • The network collected more than 107,952 clinical results in March, and 75 percent of them were delivered electronically.
  • User requests increased from 169,406 in November 2005 to 914,841 in January, meaning that “not only are physicians getting the data, but they’re acting on it multiple times,” Thompson said.
  • The average daily number of physician requests was 26,384 in March, a 32 percent increase since December 2006.
The Mesa County Physicians Independent Practice Association recently gave a clear indication of physician support for the network when its members voted overwhelmingly to pay a subscription fee to QHN. “That’s how strongly they feel about how valuable it is to them,” Thompson said.

So how has QHN managed to gain this momentum in such a short period of time? Thompson said a key factor is the emphasis on quality improvement rather than technology. “Health information exchange is not the reason for our existence,” he said. “We’re using that as a methodology to improve care.”

QHN’s governance
Two committees direct all of the RHIO’s activities. The first is the Quality Oversight Committee, which encompasses public and community health initiatives. It oversees tools for managing chronic care and disease registries that allow the health care community to identify at-risk populations and collaborate on their care.

Meanwhile, the Quality Health Information Network Committee provides standards for the privacy and security of clinical data. Committee members spent months determining how to maintain the privacy and security of QHN’s medical records. The data model it chose has been another critical factor in QHN’s success, Thompson said.

“The source of the data is in control with this model, so participants who order data only get to look at what I send you because I know that’s all you’re supposed to get,” he said. “To us, it’s a simpler and more secure method.”

QHN also instituted requirements for physician enrollment, with each doctor going through an approval process. Practice leaders also must affirm their staff members so QHN can set up role-based access. And everyone is bound by a formal agreement to protect the privacy and security of the network’s health information.

“Rightly or wrongly, we’ve made it so you can’t just sign up for this online and log on,” Thompson said.

Despite their early success, QHN officials are not going out of their way to seek media attention. Thompson said he believes everyone is better served if QHN remains relatively anonymous and operates as a behind-the-scenes, shared health care service.

“We want to be kind of like the phone company,” he said. “Our participants get on the system and it just works. They don’t need to know what’s happening or who’s on the back end, just that they get the function they desire.”

Even so, the network is receiving its share of national exposure. In January, QHN participated in a prototype demonstration of the National Health Information Network at the third NHIN forum.

As a member of Northrop Grumman’s team, the RHIO successfully demonstrated the ability to move the health records of a fictitious patient among several organizations, including the Centers for Disease Control and Prevention in Atlanta.

5 success factorsThe following principles help guide managers at the Quality Health Network.
  1. Keep the focus on improving health care, not just exchanging information.
  2. Operate as a neutral third party.
  3. Ensure that all participants understand that the network uses health care information to improve outcomes and not to gain a competitive advantage.
  4. Protect patient privacy and simplify the process for physicians by limiting access to data based on the users’ role.
  5. Find a mentor. Officials at HealthBridge, a health information exchange in Cincinnati, provided invaluable advice and support that helped speed the network’s progress and success.
— Heather B. Hayes

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