Accessing the Cutting Edge: Implementing Technology to Transform Quality in SE Kern

In Kern County, in southeastern California, 74 percent of all deaths are related to chronic disease even though 91 percent of the population is under 65 years of age. Based on the findings of an Agency for Healthcare Research and Quality (AHRQ)-funded planning grant, infrastructure, access, and education were identified as critical issues that must be addressed in order to improve quality and chronic disease management in this region. The findings and issues of the planning grant led to the identification of three key aims for a followup project, funded by an AHRQ Implementation grant, to develop a regional health information exchange (HIE) with relevant electronic data to exchange in a rural community. Specifically, this project sought to:

1. Build infrastructure by creating a culture, an organization, and mechanisms that promote safe and high quality of care;
2. Enhance the health professions' workforce through education and organization; and
3. Enhance quality of care using health information technology (IT).

The following four comprehensive health IT strategies within these key aims were implemented and evaluated:

1. Establish an administrative and governance infrastructure, the East Kern County Information Technology Association (EKCITA), to guide and sustain development of the HIE, personal health record (PHR), and teleconsultation services over time.
2. Design and implement a rural HIE for the Tehachapi area linking the local hospital, rural health centers, private primary care practices, pharmacies, radiologists, and laboratories.
3. Implement a tele-ophthalmology service for Tehachapi residents.
4. Implement a PHR for patients living with diabetes.

The investigators found that the realities of implementing health IT strategies are more difficult than that of a design or plan put on paper. There were many valuable lessons learned through the process of adoption and utilization of health IT that will be helpful for project expansion or for organizations newly engaging in such a process. Some lessons include building the option to push selected data collected from the HIE into the existing electronic health record (EHR) for workflow integration and ease of the provider; discussing in-house server or Application Server Provider model for EHR selection; understanding differences in support services; and the understanding that isolated rural locations may not receive adequate response times to operate certain health IT software. In addition, the tele-ophthalmology service was implemented and evaluated but was not sustained due to inability to bill for retinal scans and issues that arose with the location of the equipment.