Primary Care Leader Benefits From AHRQ-Seeded Health Information Exchange

Coastal Medical, Rhode Island's largest primary care practice, receives an immediate electronic alert whenever its patients are seen in the emergency department or hospitalized, helping the practice to better coordinate the care of its patients. "CurrentCare Hospital Alerts" are possible thanks to an AHRQ contract to the Rhode Island Department of Health to develop a statewide health information exchange (HIE).

AHRQ's funding in 2004 helped the Rhode Island Department of Health develop a statewide HIE through a public-private collaboration with the Rhode Island Quality Institute (RIQI), allowing clinicians to share and view patient records. Today, RIQI operates the HIE, called CurrentCare, a query-based clinical viewer model that offers authorized providers access to a patient's vital health information, including laboratory results, medication history, and admission, discharge, and transfer information on hospital and emergency department encounters.

G. Alan Kurose, MD, President and Chief Executive Officer of Coastal Medical, says, "AHRQ's money in 2004 was well spent. CurrentCare is becoming the network we use to share patient information among all who provide patient care." As an electronic information platform, CurrentCare "will make a quantum improvement in primary care, quality improvement, and reduced cost."

For primary care provider organizations like Coastal Medical that enter into shared-savings and other value-based contracts, exchanging medical information about patient encounters outside the doctor's office is vital for coordinating and managing patient care. Coastal Medical provides a patient-centered medical home to 110,000 residents of Rhode Island and is designated as an Accountable Care Organization (ACO) by the Center for Medicare & Medicaid Innovation.

As of November 2012, CurrentCare holds vital health information for nearly 30 percent of Rhode Island's population. It is an opt-in model, meaning that patients must consent to having their medical information in the system. Moreover, health information may only be released to providers who sign an agreement to participate in CurrentCare as data users. While that can make for slower enrollment growth, CurrentCare officials say that such an approach allows the HIE to integrate behavioral health information, which many other States are unable to do.

As highlighted in the Rhode Island Health Information Exchange Act of 2008, the State views CurrentCare as a way to promote patient-centered care, encourage widespread use of electronic health records by providers, improve the quality, safety, and value of health care, and better meet public health goals.

Coastal Medical has demonstrated that electronic health records and the ability to send and receive real-time patient data among hospital providers, specialists, and other clinicians is essential for improving care and the care experience for patients and for operating a patient-centered medical home. Accessing records of patients who seek care from other providers is also crucial for primary care practices to operate efficiently under reformed payment models, whether pay-for-performance contracts, shared risk, or capitated arrangements.

CurrentCare's Hospital Alerts, for example, send secure, real-time email notices to primary care providers when a patient is hospitalized or seen in the emergency department. The Hospital Alerts can help reduce errors, avoid costly duplication of services, and give patients a better care experience when their primary care provider immediately knows of a change in health status.

Kurose, who is also a RIQI board member, says, "We suffer from a fragmented care system in Rhode Island. Communication between doctors and hospitals is not very good." As a result, it is common for a primary care practice not to learn that a patient was hospitalized or even died in the hospital until several days later. "That's the kind of scenario Hospital Alerts can solve."

Kurose highlights an example of the benefits of CurrentCare. After one of Coastal Medical's patients a man with diabetes who was taking the blood thinner medication Coumadin went to an emergency department after hitting his head, a Hospital Alert was immediately sent to the practice. This prompted a Coastal Medical nurse care manager to call the patient the next day to check on him, confirm that his clinical status was stable, check to see if the emergency doctors changed his medicine, and review red-flag symptoms for both head injury and issues with Coumadin. Moreover, the nurse was able to make sure the patient correctly understood his Coumadin dosing.

Kurose adds, "In retrospect, the nurse care manager feels that the call, prompted by the electronic Hospital Alert, was much appreciated by the patient, served to ensure his safety, and solidified the relationship between the patient and his patient-centered medical home in general and the nurse care manager in particular."

By early 2013, clinicians at Coastal's 18 sites were using the system and talking to their patients about opting into CurrentCare. Kurose expects as more patients consent to CurrentCare, use of the system will increase. He adds, "That will be imperative as more health care providers operate under patient-centered medical homes, ACOs, or value-based contract arrangements."

For more information on CurrentCare or RIQI, visit http://www.currentcareri.com/matriarch/default.asp or http://www.riqi.org/matriarch/MultiPiecePage.asp_Q_PageID_E_94_A_PageName_E_HIELearn.