Utah Medical Practices Connect With Health Information Exchange

An AHRQ contract funded in 2004 to the Utah Health Information Network (UHIN) has been greatly influential in helping medical practices throughout this rural State become electronically connected in order to improve patient care. By the end of 2012, more than 300 clinical offices—many of them small practices—were securely exchanging patient laboratory, radiology, and other clinical information, even though many of the practices have not adopted electronic health record (EHR) technology.

AHRQ’s contract helped UHIN, a nonprofit coalition of Utah health care insurers, providers, and other interested parties, expand from exchanging administrative data exclusively to also exchanging clinical data. In conjunction with other federal funding and UHIN’s revenue, AHRQ’s contract helped cover the cost of information technology (IT) infrastructure and helped Utah providers with the cost of connecting to Utah’s clinical health information exchange (cHIE). One of the ways it did so is by offering providers without an EHR system access to a “virtual health record.” The virtual health record can be accessed simply by a computer and Internet connection using a secure online portal.

John Berneike, MD, a family physician at St. Mark’s Family Medicine Practice in Salt Lake City and Vice Chair of the UHIN Board of Directors, says cHIE in Utah “used the seed money from AHRQ to get the ball rolling.” He adds, “UHIN is a unique organization. We have providers, hospitals, and payers sitting around the table collaborating with one another, but also competing with one another. I think there is a fair bit of hesitancy to venture into new territory, especially when the return on investment isn’t guaranteed.” This is especially true for smaller medical practices, where the costs of medical record technology can be particularly high.

Leverett Woodruff, UHIN’s Communications Coordinator, agrees. “AHRQ’s contract was extremely beneficial in helping UHIN overcome the hurdle of significant upfront costs for the IT infrastructure necessary to operate a health information exchange. Without the assistance of federal funding, including the valuable contribution from AHRQ, Utah’s cHIE would be much less further along in its development.”

By December 2012, the system, which requires patients’ consent before their data can be made accessible through Utah’s cHIE, has seen nearly 400,000 residents opt to have their records stored in the cHIE. A total of 305 clinical offices and 39 hospitals were entering data into the system in late 2012. The system went live in May 2010.

“Our clinic was one of the first health care organizations in Utah to begin actively consenting patients,” notes Berneike, who was an IBM software engineer before pursuing a career in medicine. Unlike many smaller practices, St. Mark’s Family Medicine adopted an EHR system in 2007. He adds, “At that time, the cHIE, e-prescribing, interoperability, and electronic exchange were the kinds of functions being added to EHRs that got us over the hump and made us seriously consider purchasing an EHR.”

But many smaller practices have only recently looked into adopting EHRs because of the advent of federal payment incentives for adopting the technology. Wanting to include Utah’s many smaller clinical practices in cHIE from the start, UHIN offered providers the virtual health record. UHIN also offers a baseline EHR to offices that do not have one. Both approaches allow clinicians to upload patient data into the cHIE and search for consenting patient records.

For providers with an EHR system, UHIN’s cHIE became a separate, almost parallel system that does not automatically feed patient data into their organization’s EHR. Berneike says, “Data production or data exporting to the cHIE is a very necessary first step. But data consumption, or importing data from the cHIE, is what makes the cHIE valuable to providers. Interoperability, with automatic import and export between EHRs and the cHIE, is the ultimate goal.” UHIN’s cHIE developed out of the reality that from 2004 to 2009, most medical practices did not have EHRs. As a result, Berneike says the current approach “is a workable solution but not ideal.”

In 2013, UHIN is focusing on integrating cHIE and participating organizations’ EHR systems. UHIN is working with EHR vendors to develop interfaces to import and export data to and from the cHIE. A big help is the Federal Government’s Meaningful Use Stage 2 rules, which are motivating the industry toward more seamless interoperability. Also, UHIN expects two of Utah’s largest health systems, Intermountain Healthcare and IASIS Healthcare, to begin contributing data to the cHIE.

For more information on UHIN, visit http://www.uhin.org.