The Taconic Health Information Network and Community of the Hudson Valley
"It's like a 3-D chess game. There's a lot of elbow-to-elbow work to doing this, which is why there are not too many success stories out there," says Blair, a laparoscopic surgeon and president and CEO of Taconic IPA, Inc., Fishkill, NY.
Taconic is the exception.
In late 2001, the IPA established a plan to implement a health information exchange (HIE) model among insurers, hospitals, laboratories, and physicians. Today, about 600 of the 16-year-old IPA's physicians in two of the eight counties covered by Taconic participate in the data exchange, called Taconic Health Information Network and Community (THINC). THINC allows physicians to electronically manage health care data via a clinical messaging system - the first step to adopting an electronic medical record (EMR). Using a secure password, physicians log in to a main portal from either laptop computers or personal digital assistants to retrieve lab reports, x-rays, and other clinical data.
"Within five seconds, you can pull up the results from a lab test. If it's a critical result, a beeper sounds so you can act on the information immediately. It's efficient, and the lab report won't get lost on a fax machine, or get misplaced," Blair says. As the HIE model phases in, more physicians will be added, as will the ability to write e-prescriptions and access EMRs.
A three-year, $1.5 million AHRQ grant will allow Taconic to push the project to the next level. The grant focuses on two priorities. The first is to hire an independent clinical investigator to study the impact of HIE on health care quality. The second is to expand the program by helping more of the IPA's primary care physicians offset the costs of participating in the electronic network.
"This grant will allow us to do seminal work, and to answer key questions: Does this type of technology really work? What's the value of the whole electronic data exchange, and does it actually improve the quality of health care and reduce medical errors? No one has ever had the data to study community-based physicians, where 80 percent of Americans get their health care," says Blair.
The impact study will assess outcomes among three groups, each comprising approximately 100 physicians: a control "paper" group, an electronic prescribing group, and a group using fully integrated EMRs. "We will look carefully at medical errors, adverse drug events, quality issues, and cost in all three groups," Blair explains.
The infusion from the grant will also help Taconic IPA's physicians overcome the cost hurdle of joining the network by providing technical assistance during start-up and implementation. "The No. 1 problem for small physician practices is the start-up costs of EMRs. The other problems are having the expertise, trouble-shooting capabilities, and training such programs require in order to use them," says Blair.
Start-up costs for EMRs can run $30,000 per physician; Taconic IPA physicians pay approximately $500 per month to use the system. "Large groups can afford to pay $1 million or so to implement an electronic system. We are offering a solution to the vast hoard of small practitioners who just can't afford to do this on their own," Blair says.
The program also opens the door to allow primary care physicians to qualify for some of the pay-for-performance incentive programs offered by insurers and employers to providers who use electronic information technology. A physician could receive up to $400 per month from such incentives, according to Blair.
"The ultimate goal is to help fill the void for the small practitioners who can't do this on their own, to improve the quality of health care, and to reduce medical errors," says Blair.