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Health Information Exchange Roadmap of a

successful local HIE C

The Massachusetts eHealth Collaborative provides an instructive success story. By Dave Delano

ommunities across the country have encountered structural and technical challenges in their efforts to adopt health information exchanges (HIEs). Many organizations either fi nd implementation unattainable or determine it a project with little benefi t. The Massachusetts eHealth Collaborative (MAeHC), a pioneer from the earliest era of HIE implementation efforts, pro- vides an instructive success story through its North Adams eHX (electronic health exchange) program. By following a community-based collaborative model, a small, rural com- munity can develop centralized processes to successfully implement and synchronize HIE among all stakeholders to achieve measurable success.

The history A non-profi t company launched in 2004, MAeHC re- ceived a $50 million fi nancial commitment from Blue Cross Blue Shield of Massachusetts to build a coalition of 34 nonprofi t organizations and launch three pilot projects to demonstrate the costs and benefi ts of wide-scale EHR deploy- ment, understand the barriers to adoption of EHRs and HIEs and test an organizational model for managing and executing community-wide use of EHRs and HIE.

These three pilot projects ended in 2009, at which point the most successful HIE of the three communities was the North Adams project. This included North Adams Regional Hospital and 14 local affi liated physician practices, totaling roughly 46,000 patients in a primarily rural and underserved part of Massachusetts.

The challenge

Creating sustainability and improving the quality of care in a cost-effective manner was the primary challenge of the North Adams HIE project. A centrally hosted architecture was developed to obtain a high level of interoperability uti- lizing both physical and virtual server technologies attached to local, clustered and SAN storage technologies. Microsoft clustering and VMWare virtual machines provided the nec- essary failover redundancy in the central data center, which was supported by the community hospital (North Adams Regional).

20 September 2011 The journey

The project initially determined that the successful HIE would require highly reliable, high-bandwidth wireless connec- tivity between and among the central “clearinghouse” system and the off-site practices.

The centralized infrastructure allowed hospital IT depart- ments to assume a support- services role with local com- munity practices. This provided local community practices with access to advanced support and sophisticated technological ca- pabilities at a fraction of market costs. A common network and security infrastructure allowed the hospital to serve as the cen-

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tral hub for the community HIE, which greatly facilitated the interoperability and exchange capabilities between the hospital and the community practices.

The results

The project achieved a very high level of success and has been widely recognized as one of the earliest, yet most effec- tive, HIE projects to date. Success of the project can be largely attributed to extremely high levels of patient adoption and the quality of interoperability and information sharing among the North Adams community.

Adoption

One-hundred percent of providers identifi ed in this project adopted use of the HIE initially and sustained usage of it go- ing forward. Ninety-three percent of patients opted in for the program and, though a lower percentage of patients re-opted after the fi rst 24 months, patient participation remains high.

Interoperability

This local HIE experienced additional points of success during implementation, including: • Integration of laboratory results between hospital MED- ITECH system and eClinicalWorks systems; • Inbound CPOE for labs;

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Dave Delano is project director with the Massachusetts eHealth Collaborative. For more on

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