The system is called “currentcare,” and in the coming months, doctors, health centers, nursing homes, hospitals and other health care providers will be encouraging their patients to enroll.
The payoff won’t be immediate: Even if thousands of Rhode Islanders sign up today, it will take a few months for their medical information to accumulate; providers won’t be able to log in and access patient records until sometime next spring.
And even then, the data will be limited – only test results from Lifespan, East Side Clinical Laboratory and R.I. Department of Health labs and medication histories from pharmacies that participate in the SureScripts system (most in the state do).
But eventually, architects of Rhode Island’s
new health-information exchange say, imaging results, hospital discharge reports, electronic medical records at doctors’ offices and even patients’ advance directives will be accessible through currentcare.
Emergency room doctors treating an apparent heart attack will be able to pull up, within seconds, the patient’s last EKG and blood test results and see which drugs he’s taking, so they can save time, avoid duplicate tests, and provide more appropriate treatment.
An 80-year-old who sees six different doctors won’t have to tell each one what the others have done; it’ll all be accessible through currentcare. If she’s hospitalized and then goes into a nursing home, all her caregivers will have accurate, up-to-date information at their fingertips.
“We get this built,” Gov. Donald L. Carcieri said at a ceremony last week, and “we have the most efficient, the most effective health care system in the country.”
Information technology is considered one of the most promising tools to improve the quality, safety and efficiency of health care in America. It’s already making a big impact for individual doctors and especially hospitals and large health systems, but to reach its full potential, most in this field believe, all those individual systems have to be connected to one another.
To work toward that goal, the federal government has been promoting the development of regional health-information exchanges. Locally, meanwhile, since 2002, the Rhode Island Quality Institute, a collaboration of hospitals, doctors, insurers, consumers, government, business and academia, has been working to build a statewide exchange since 2002.
In 2004, Rhode Island was awarded a $5 million, five-year contract from the federal Agency for Healthcare Research and Quality (AHRQ) – one of six given nationwide – to help finance the exchange project and, in turn, serve as a potential model for others across the country.
Each of the six states involved is taking a different approach, but all aim to produce measurable improvements in health care quality, safety and efficiency. Rhode Island hired the Quality Institute to run the state’s initiative, and also to oversee the resulting exchange.
Knowing that patient privacy concerns were a major issue, and convinced that broad-based public support would be crucial to the project’s success, the Rhode Island team invited providers, consumers, insurers, state officials and advocacy groups to give their input at numerous meetings, through a survey, and at a half-day workshop.
The result was a bill introduced this year in the General Assembly that defined the structure of the health-information exchange, how patients and providers would participate, how the data would be protected, and criminal and civil penalties for violating patient’s privacy.
The measure had high-profile, bipartisan support, but it still faced controversy, with the Rhode Island affiliate of the American Civil Liberties Union leading critics who said privacy protections weren’t strong enough. Amendments were made, and though the ACLU wasn’t satisfied, the bill passed. It’s the first such law in the nation.
The law, which goes into effect in March, explicitly says participation is voluntary for both consumers and providers. Consumers can allow access to their data in emergencies only; in emergencies and for specific providers; or for any provider caring for them, and they can change access anytime.
Patients cannot, however, pick which kinds of data can be accessed – to block, say, psychiatric information. Laura Adams, president and CEO of the Quality Institute and leader of the project, said doctors wouldn’t want to use data “full of holes,” since it could be misleading.
In addition, consumers can get a copy of the information available about them on the exchange, and they can ask for a log of who has accessed their data. They can also request that inaccurate information be corrected through a provider.
Adams said the system is set up in such a way that currentcare won’t hold any medical data, just records with basic patient-identifying information, and then it will pull in data as requested through a cache system – so it doesn’t directly access providers’ databases – or, for pharmacy data, through SureScripts, a separate, secure system.
In the future, the Quality Institute hopes to also have some kind of system for providers to make EMRs available for their patients, Adams said.
But funding will determine how fast all of this happens. Along with the AHRQ money, the state has a Medicaid grant to cover the first phase. Yet building out the exchange is going to cost $3 million to $4 million per year for several years, Adams said, far more than is on hand.
Carcieri has committed to cover up to a quarter of the cost with state funds, but the rest has to come from the private sector, Adams said. Major providers and the state’s two major health insurers are all involved – Blue Cross & Blue Shield of Rhode Island is especially supportive – but a wide range of constituencies could benefit from investing in this, she said.
“It’s really the interstate highway system for the medical economy,” she said.
Then there’s the biggest challenge of all: getting Rhode Islanders to join currentcare.
The Quality Institute has already sent faxes and e-mails to providers urging them to enroll their patients, and the state sent out letters to 25,000 Medicaid beneficiaries. There will also be tables at public events, and Adams said she hopes employers will host tables at workplaces.
At this point, sign-ups have to be in person, but Adams said the institute plans to accept registrations on the project Web site, currentcareri.com, and by phone at (888) 858-4815.
Much as project leaders “strongly believe” in the opt-in system, Adams said, “this thing will live or die on the enrollment,” and early sign-ups are especially valuable.
“We feel a sense of urgency,” Adams said. “I literally feel that lives are at stake here.” •
