State and Regional Demonstration in Health Information Technology: Rhode Island (Rhode Island)

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Summary:

The Rhode Island Statewide Health Information Exchange (HIE), known as Currentcare, is one of six Agency for Healthcare Research and Quality (AHRQ) - sponsored State and Regional Demonstration (SRD) projects begun in late 2004 and early 2005 to create State or regional HIEs. Currentcare was created via the collaboration of the Rhode Island (RI) Department of Health (HEALTH) and the Rhode Island Quality Institute (RIQI), as well as with other stakeholders across the State. This project facilitated the development of the capability to deploy health information infrastructure at a statewide scale.

RIQI’s role in the project was to determine the governance for the project, while HEALTH’s role was focused on the project management aspects of building and deploying the HIE. It was planned from the onset that once the HIE was operational it would be managed and maintained outside State government. The project team engaged the broader community throughout the project, including in their formulation of policies and the design of the technical infrastructure.

The main objectives of the project were to:

  • Improve the quality, safety, and value of health care in the State of Rhode Island through a sustainable statewide HIE system.
  • Incorporate a master patient index into the HIE to locate longitudinal patient health information from numerous data-submitting partners statewide.
  • Design the HIE so that consumers will be allowed to control access to their data.
  • Implement the capability to present data from various sources in an integrated, patient-centric manner using a common user interface.
  • Transition all operating, management, and governance responsibility of the HIE to a community-based regional HIO.

The project had a unique challenge not experienced by other SRD projects in that the RI HIE Act of 2008 contained stricter privacy and confidentiality protections than other State and Federal health information privacy laws. This required a great deal of work on the part of RIQI, HEALTH, and the larger community to ensure compliance with those laws. The decision to engage the larger community, while positive overall, also created challenges. The project team experienced delays in system development related to the complexities of their administrative, technical, and policy processes and the challenges of consensus building. As a result there was a delay in generating value from the HIE and a postponement as to when the project will enter a phase of sustainability. The team considered policy development, HIE legal protection passage, and consumer engagement— all of which exceeded community expectations— as the project’s main successes.

At the end of the project the team stood firmly behind their approach taken, the resultant policy decisions, the implementation of those policies, and the implications for the process and results. At the conclusion of the funding period, this project had successfully developed the capacity to deploy health information via an HIE infrastructure across the State. The physical infrastructure along with the policy, legal, and operational framework derived from the project is beginning to be used to augment the practice of medicine in the State. Future research will generate answers to essential strategic questions pertaining to the value proposition for electronic HIE.

Rhode Island Statewide Health Information Exchange (HIE) State and Regional Demonstration Project (currently known as currentcare) - 2011

Summary Highlights

  • Principal Investigator: 
  • Funding Mechanism: 
    State & Regional Demonstration Contracts (SRD)
  • Contract Number: 
    290-04-0007
  • Project Period: 
    September 2004 - June 2011
  • AHRQ Funding Amount: 
    $5,000,000
  • PDF Version: 
    (PDF, 230.24 KB)

Summary: The Rhode Island Statewide Health Information Exchange (HIE), known as currentcare, is one of six Agency for Healthcare Research and Quality (AHRQ)-sponsored State and Regional Demonstration projects initiated in 2004 and 2005 to create HIEs. Currentcare was created via the collaboration of the Rhode Island (RI) Department of Health (HEALTH), the Rhode Island Quality Institute (RIQI), and stakeholders across the State. This project developed the capability in RI to deploy health information infrastructure on a statewide scale.

RIQI's role in the project was to determine the governance for the project, while HEALTH's role was focused on the project management aspects of building and deploying the HIE. It was planned from the onset that once the HIE was operational, it would be managed and maintained outside State government. The project team directly engaged the broader community throughout the project to be involved with the formulation of policies and the design of the technical infrastructure.

The project had a unique challenge because the RI HIE Act of 2008 contained stricter privacy and confidentiality protections than other State and Federal health information privacy laws. This led to a great deal of work on the part of RIQI, HEALTH, and the larger community to ensure compliance with those laws. The decision to engage the larger community, while positive, created its own challenges. The project team experienced delays in system development from complexities in administrative, technical, policy processes, and the challenges of consensus building. As a result, there was a delay in generating value from the HIE and a postponement of when the project will become self-sustainable.

Enrollment efforts initially targeted Medicaid beneficiaries and were expanded to include patients at the site of care and in long-term care facilities. By the end of the project, more than 150,000 patients had been enrolled in currentcare. Major project successes included the development of policy, the passage of HIE legal protections, and consumer engagement, all of which exceeded community expectations. It is hoped that the project's contribution to the HIE body of knowledge will be used to emphasize the need to understand and actively manage the complex relationship between the propensity for change in social and health systems and the conditions required for acceptance of technology as a tool for progress in a given community.

Project Objectives:

  • Improve the quality, safety, and value of health care in the State of Rhode Island through a sustainable statewide HIE system. (Ongoing)
  • Incorporate a master patient index (MPI) into the HIE to locate longitudinal patient health information from numerous data-submitting partners statewide. Design the HIE so that consumers will be allowed to control access to their data. (Achieved)
  • Implement the capability to present data from various sources in an integrated, patient-centric manner using a common user interface. (Achieved)
  • Transition all operating, management, and governance responsibility of the HIE to a community-based regional health information organization. (Achieved)

2011 Activities: The focus of activity during 2011 was on completing the acceptance testing phase and security audit and launching the pilot implementation. In early 2011, the data submitting partner agreements were executed by a large regional laboratory, an independent hospital, and one of the State's largest integrated delivery networks. Live laboratory data began flowing into currentcare on April 5, 2011. As of the end of AHRQ contract in June 2011, currentcare enrollment exceeded 150,000 consumers, approximately 15 percent of the State's population.

The overall timeline of the project was extended because unprecedented floods in Rhode Island in 2010 completely destroyed the data center that housed currentcare. The contract was extended for 1 year to allow time to replace hardware and recover software. Once the replacement data center was operational, the acceptance testing continued and overall progress resumed. The project was completed in June 2011.

Impact and Findings: This project was subjected to several unanticipated and significant schedule delays and, as such, did not deliver a fully functioning HIE solution in time to measure and report the impact on health outcomes. However, the project successfully developed the capability to deploy health information via an HIE infrastructure across the State. Notable results included: 1) the development of a comprehensive HIE policy framework; 2) the passage of State law; 3) promulgation of regulations to ensure patient privacy safeguards; 4) demonstration of a consumer-driven consent model with implementation of a participation service to broker consented data sharing; and 5) a "leveraged infrastructure" model that dovetails with current HIE trends.

The physical infrastructure and the policy, legal, and operational framework derived from the project are being used to augment the practice of medicine in the State. Future research will help generate answers to essential strategic questions pertaining to the value proposition for electronic HIE.

Target Population: General

Strategic Goal: Develop and disseminate health IT evidence and evidence-based tools to support patient-centered care, the coordination of care across transitions in care settings, and the use of electronic exchange of health information to improve quality of care.

Business Goal: Implementation and Use

Rhode Island Statewide Health Information Exchange (HIE) State and Regional Demonstration Project (currently known as currentcare) - 2010

Summary Highlights



Target Population: General

Summary: The Rhode Island Department of Health is collaborating with the Rhode Island Quality Institute (RIQI) and stakeholders across the State to develop, implement, and evaluate an interconnected statewide health information system with a master patient index (MPI). The aim of the system is to provide information to clinicians and patients when and where it is needed. The Rhode Island health information exchange (HIE) system, known as currentcare, is intended to evolve into an interconnected statewide health information network that will improve the quality, safety, and value of health care services and support critical public health needs for the broader Rhode Island population. This project is one of six Agency for Healthcare Research and Quality (AHRQ)-sponsored State and Regional demonstration (SRD) projects begun in late 2004 and early 2005 to create a State or regional HIE.

The project is intended to design, develop, test, deploy, and evaluate the initial phase of a secure and reliable HIE system governed by RIQI, the State-designated health information organization (HIO). Initial types of data to be shared as part of the HIE during the project period include laboratory results and medication history. Initial end users will be long-term care facilities, community health centers, private providers, and hospital emergency departments. Other data-sharing partners, end users, and data types (including interfaces with electronic health record systems) will be added as quickly as possible.

Currentcare is being implemented in accordance with the Rhode Island HIE Act of 2008, which stipulates stricter privacy and confidentiality protections than other State and Federal health information privacy laws. The rationale, impact, and results of this law on HIE system implementation have been a major focus of the project evaluation. Currentcare is expected to go live in mid-2011.

Project Objectives:
  • Improve the quality, safety, and value of health care in the State of Rhode Island through a sustainable statewide HIE system. (Upcoming)
  • Incorporate a MPI into the HIE to locate longitudinal patient health information from numerous data-submitting partners statewide. Design the HIE so that consumers will be allowed to control access to their data. (Achieved)
  • Implement the capability to present data from various sources in an integrated, patient-centric manner using a common user interface. (Upcoming)
  • Transition all operating, management, and governance responsibility of the HIE to a community-based regional HIO. (Achieved)

2010 Activities: Project stakeholders worked with the technical vendor team to finalize the first version of currentcare for testing and a security audit. Technical development included addressing issues discovered during testing. In addition, a major effort was made to complete the transition of responsibility for implementing and operating the HIE system from the Department of Health to RIQI, as the State’s designated entity, including system software, hardware, and the hosting environment. This work was done amidst recovery from unprecedented floods in Rhode Island which completely destroyed the data center that housed currentcare. Software recovery took longer than anticipated and contributed to major delays in user acceptance testing. Further, all hardware required replacement and a new data center and hosting contractor were identified. RIQI continued efforts to obtain consumer registration (enrollment) in currentcare using various strategies including community outreach and education, training and development among providers, and paper-based and electronic marketing strategies. Enrollment efforts initially targeted Medicaid beneficiaries and were expanded to include patients at the site of care and in long-term care facilities. By the end of the year, more than 100,000 patients had been enrolled in currentcare.

In early 2010, RIQI was awarded three grants from the Office of the National Coordinator for Health Information Technology that are expected to facilitate continued near term growth of the statewide HIE system. In May 2010, the project team participated in the final “Capstone” meeting with fellow AHRQ-sponsored SRD projects to share lessons learned and reflect on the future direction of the initiatives. While currentcare remained in the user acceptance testing phase in late 2010, it is anticipated to be completed, along with a security audit, and ready for go live in a pilot implementation in mid 2011. Efforts continued to finalize the data-sharing agreement, which will be signed once the system is ready to go live.

Preliminary Impact and Findings: The project’s Final Evaluation Report was submitted to AHRQ which included an evaluation of the benefits and challenges of the Rhode Island community governance and patient consent approaches. In the report, Rhode Island’s decisions relating to community involvement and privacy protections are studied and their impact on Rhode Island’s progress is analyzed. The outcome of focus group evaluation of policymaking processes and decisions confirmed an overall broad-based sense of community pride in the work carried out to date to build a statewide HIE system. The focus group evaluation also reflects stakeholders’ general agreement with the community collaboration approach and the consent policy direction that was undertaken.

In addition, a study of the currentcare enrollment strategies and results in long-term care facilities was included. For nursing homes, the value of and need for the HIE system is perceived to be high, however, the nursing home environment has both significant advantages and challenges for enrolling residents. The nursing home study describes how efforts to enroll nursing home residents in currentcare met with varying success and identifies key attributes for success in engaging long-term care facilities.

It is hoped that the project’s contribution to the HIE body of knowledge can be used to emphasize the need to understand and actively manage the complex relationship between the propensity for change in social and health systems and the conditions required for acceptance of technology as a tool for progress in a given community.

Strategic Goal: To develop and disseminate health IT evidence and evidence-based tools to support patient-centered care, the coordination of care across transitions in care settings, and the use of electronic exchange of health information to improve quality of care.

Business Goal: Implementation and Use

State and regional demonstration in health information technology: Rhode Island - final report

Citation:
Rhode Island Department of Health. State and regional demonstration in health information technology: Rhode Island - final report. (Prepared under Contract No. HHSA 290-04-0007). AHRQ Publication No.15-0074-EF. Rockville, MD: Agency for Healthcare Research and Quality. December 2015. (PDF, 2.33 MB)

(Persons using assistive technology may not be able to fully access information in this report. For assistance, please contact Corey Mackison)

Principal Investigator: 
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