Metro DC Health Information Exchange (MeDHIX)

The primary goal of the Metro DC Health Information Exchange (MeDHIX) project was to create and deploy a multi-jurisdictional regional safety net clinic oriented health information exchange (HIE) to link safety net clinics to one another and to mainstream providers, with initial emphasis on hospital emergency departments and specialist referrals. This research was performed at free clinics, Federally Qualified Health Center safety net organizations, hospitals, local governments, and community organizations in the Washington, DC, metropolitan area.

The MeDHIX was deployed at 14 safety net clinics at 40 care sites across three jurisdictions that can be accessed by five community hospitals, the Montgomery County Department of Health and Human Services, and medical specialists treating safety net patients. Only minimal deployment was achieved by the end of the grant funding period due to factors such as legal concerns, shifting hospital priorities, and dwindling support for a regional approach.

The evaluation of the project focused on the practical challenges of building a sustainable, useful safety net-oriented HIE and utilized interviews and group discussions to document perceived benefits, barriers, willingness to participate, current electronic health record use, and desired HIE content and features. Focus groups of underserved individuals elicited opinions on risks and benefits of HIE. Provider feedback on actual HIE utility was planned post implementation. A model to measure any reductions in emergency department (ED) visits was designed, although no data were obtained by the end of the grant period because of delayed implementation of the HIE.

There was a general consensus among hospitals that the benefits of an HIE would outweigh the costs for safety net patients in terms of improving health and controlling costs. However, there was a prevalent belief that the confidentiality risks outweighed the benefits for insured patients, who typically have existing relationships with providers and already have access to all or most of the necessary medical data. Emergency room physicians, who see both uninsured and insured patients, did not share this belief, observing that additional data would be useful for both insured and uninsured patients. Patients emphasized the value of increased access to their own health information, although many also expressed concerns related to the confidentiality of their data and the security of the system.

Barriers to effective HIE among safety net clinics and mainstream health care providers include the following: more pressing safety net clinic medical priorities, limited paid staff, a heavy volunteer component, lack of technology skills in the clinics, technical complexity and cost of data interchange systems, privacy concerns, and organizational priorities by both clinics and mainstream health care providers that are considered to be much more important for access to quality care than HIE.