1.  The Indiana Network for Patient Care: An Integrated Clinical Information System Informed by Over Thirty Years of Experience

Author(s): Biondich PG, Grannis SJ

Source: Journal of Public Health Management and Practice: JPHMP. 2004 Nov;(Suppl):S81-S86. 2004 Nov;(NULL)(Suppl):S81-S86.

Summary: Presented in this article is the Indiana Network for Patient Care, an integrated citywide medical record system that promotes health quality by enabling efficient access to clinical information throughout the broader population of Indianapolis and the rest of the caregivers within the state of Indiana. It begins with a description of the system's infrastructure, which includes an explanation of how the system accomplishes data integration. This is followed by a series of descriptions and rationales behind the many clinical applications that interface with these data.  The keys to success for this project include leveraging the value of the integrated data and identifying workflow inefficiencies, having a commitment to standards such as LOINC and SNOMED so all participants use the same standard language, and managing sociopolitical challenges specific to our community.  In doing so, some of the factors that we feel contribute to the success of the system are illustrated.

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2.  The United Hospital Fund Meeting on Evaluating Health Information Exchange

Author(s): Hripcsak G, Kaushal R, Johnson KB, Ash JS, Bates DW, Block R, Frisse ME, Kern LM, Marchibroda J, Overhage JM, Wilcox AB

Source: Journal of Biomedical Informatics. 2007 Dec;40(6 Suppl):S3-S10 Epub 2007 Aug 30.

Summary: Health information exchange (HIE) projects are sweeping the nation, with hopes that they will lead to high quality, efficient care, but the literature on their measured benefits remains sparse. To the degree that the field adopts a common set of evaluation strategies, duplicate work can be reduced and meta-analysis will be easier. The United Hospital Fund sponsored a meeting to address HIE evaluation. HIE projects are diverse with many kinds of effects. Assessment of the operation of the HIE infrastructure and of usage should be done for all projects. The immediate business case must be demonstrated for the stakeholders. Rigorous evaluation of the effect on quality may only need to be done for a handful of projects, with simpler process studies elsewhere. Unintended consequences should be monitored. A comprehensive study of return on investment requires an assessment of all effects. Program evaluation across several projects may help set future policy.

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3.  A Randomized, Controlled Trial of Clinical Information Shared from Another Institution

Author(s): Overhage JM, Dexter PR, Perkins SM, Cordell WH, McGoff J, McGrath R, McDonald CJ

Source: Annals of Emergency Medicine. 2002 Jan;39(1):14-23.

Summary: Emergency physicians often must deliver medical care with minimal access to historical clinical information. A pilot randomized, controlled trial of providing information from a large, longitudinal, computer-based patient record system of clinical data from an urban hospital to emergency physicians at either of two urban EDs was conducted. The emergency physician received information both as a printed abstract and by means of online access to the computer-based patient record. We assessed charges, hospital admissions, repeat visits to EDs, and the emergency physicians' satisfaction with the information. This pilot study is the first to demonstrate the feasibility of sharing clinical information between different health care systems. We observed a trend toward cost savings at one of two hospitals and no differences in the quality measures we studied. Our experience underscores the difficulties inherent in studying the effects of community-wide health care interventions on cost and quality of ED care.

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4.  State and Community-based Efforts to Foster Interoperability

Author(s): Frisse ME

Source: Health Affairs (Millwood--Spring Hope). 2005 Sep-Oct;24(5):1190-1196.

Summary: The MidSouth eHealth Alliance is developing a comprehensive health information infrastructure supporting providers in three Tennessee counties.  The greatest contribution of a formal RHIO might be to articulate and support a single, common legal and technical framework for realizing an interoperable regional health information infrastructure.  The state will have to assume a greater role in setting and adopting guidelines for RHIOs; regions should continue their oversight of the technical infrastructure and enforcing regional policies.  Success in the alliance's first year is the result of sustained leadership (and capital), a systematic assessment of regional needs and capabilities, a flexible technical architecture, and a critical review of best practices from four different data exchange models already operating in other states.  Long-term evolution to a truly interoperable health information infrastructure will depend on the extent to which the alliance demonstrates value to consumers and practitioners.

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5.  Building an Interoperable Regional Health Information Network Today with IHE Integration Profiles

Author(s): Donnelly J, Mussi J, Parisot C, Russler D

Source: Journal of Healthcare Information Management: JHIM. 2006 Summer;20(3):29-38.

Summary: One of the key challenges of architecting electronic record sharing solutions that are scalable and can provide acceptable performance is how to create a longitudinal record for a patient when the desired data will be stored in several distributed point-of-service systems. This paper will review the design and standards selection process made by Integrating the Healthcare Enterprise, a multi-national collaborative of care providers and developers that analyzed a variety of approaches. Guidance will be offered to architects of regional health information organizations to take advantage of this experience and leverage the IHE Technical Framework, its testing processes, and tools to accelerate their projects and facilitate the interfacing of EHR systems serving different care settings from different vendors or developers. The implementation experience in 2005-2006 of the IHE Integration Profile specifications supporting an interoperable RHIO solution among various EHR systems from more than 30 vendors will be analyzed, with key lessons summarized.

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6.  The Santa Barbara County Care Data Exchange: What Happened?

Author(s): Miller RH, Miller BS

Source: Health Affairs (Millwood--Spring Hope). 2007 Sep-Oct;26(5):w568-580 Epub 2007 Aug 1.

Summary: The Santa Barbara County Care Data Exchange was once one of the most ambitious and publicized U.S. health information exchange (HIE) efforts. Eight years after its inception, and several months after providing some data, the Santa Barbara Project shut down operations. Despite its developed HIE infrastructure, participants found no compelling value proposition in initial HIE services. Although there are several proximate causes for the project's slow progress - California HealthCare Foundation (CHCF) grant money, lack of community leadership, vendor limitations, and the duration of the process - the main underlying cause was lack of a compelling value proposition for Santa Barbara organizations.  Even with fewer technology delays and more community leadership, other regional health information organizations (RHIOs) may also stumble over HIE service-value propositions without some combination of grants, incentives, and mandates that develop initial RHIO infrastructure and services and ensure provision of unprofitable yet socially valuable services.

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7.  The Indiana Network for Patient Care: a Working Local Health Information Infrastructure. An Example of a Working Infrastructure Collaboration that Links Data from Five Health Systems and Hundreds of Millions of Entries

Author(s): McDonald CJ, Overhage JM, Barnes M, Schadow G, Blevins L, Dexter PR, Mamlin B; INPC Management Committee

Source: Health Affairs (Millwood--Spring Hope). 2005 Sep-Oct;24(5):1214-1220.

Summary: The Indiana Network for Patient Care (INPC) is a local health information infrastructure (LHII) that includes information from the five major hospital systems (15 hospitals), the county and state public health departments, and Indiana Medicaid and RxHub. This network carries 660 million separate results. It provides cross-institutional access to physicians in emergency rooms and hospitals based on patient-physician proximity or on hospital credentialing. The network includes and delivers laboratory, radiology, dictation, and other documents to a majority of Indianapolis office practices. LHIIs must focus their limited resources on the high-volume data producers, which often are large hospital systems.  LHIIs can be expected to improve efficiency and reduce cost growth.  However, if their primary purpose becomes cost control, they will likely fail, as did the community health information networks (CHINs) of the 1990s.  The INPC began operation seven years ago and is one of the first and best examples of an LHII.