CEO SUMMARY: One trend getting little publicity is that of health information exchanges (HIEs). Since its founding in 2009, the Colorado Regional Health Information Organization (CORHIO) has grown steadily. Today, most of the state’s independent lab companies and hospital laboratories are connected to CORHIO. Real-time access to laboratory test data is one feature that has high value to participating providers. This is particularly true for emergency room physicians.
ONE TREND IN HEALTHCARE operating quietly in the background is that of health information exchanges (HIEs). Across the nation, clinical labs and pathology group practices are “hooking up” to their regional HIEs and providing lab test data in real time.
HIEs represent a transformational force in healthcare because they give participating providers immediate access to patient data when a patient shows up for care. In turn, this access to patient information often leads to improved patient care within the region served by the HIE.
Launched Operations in 2011
Founded in 2009, the Colorado Regional Health Information Organization (CORHIO) demonstrates how a sustainable health information exchange can work to benefit both providers and their patients. CORHIO is a nonprofit, public-private partnership that was funded with more than $9 million in grants from the Office of the National Coordinator for Health IT. It launched operations in 2011.
All of Colorado’s largest hospitals and laboratories are now connected or in the process of connecting to CORHIO. Currently there are 1,800 office-based physicians, 100 long-term and post-acute care facilities, and 13 behavioral health centers participating in the network, along with skilled nursing facilities, home health services, health clinics, health plans and public health departments.
“The overall goal of CORHIO is to help providers provide better patient care,” noted Kelly Joines, CORHIO interim CEO and Vice President of Operations. “Our HIE changes workflow in a positive way. For example, it helps to avoid unnecessary tests and facilitates sharing of patient histories among attending physicians.”
Laboratory test data has an important role within the HIE. “Our exchange delivers quick lab results for more appropriate intervention,” explained Joines. “Physicians can also trend data, and this enables them to observe a specific population over time.”
Physicians participating in CORHIO agree that the HIE is beneficial. Jesse Flaxenburg, M.D., is a Nephrologist at Pikes Peak Nephrology in Colorado Springs and has used CORHIO for nearly a year. He said the HIE “hasn’t changed the way I practice medicine, but it has markedly improved the efficiency with which I do.”
In particular, Flaxenburg noted that quick access to lab test results dramatically improves his ability to monitor his patients’ status. “I receive test results on a more timely basis and in a more usable format than I had previously,” he said. “As a result, I more quickly catch things that require my attention.”
Flaxenburg noted that this is especially important in monitoring kidney transplant patients, as it enables him to identify organ rejection earlier and intervene quicker. He also pointed out the benefits of CORHIO’s data trending feature.
“The ability to collect and trend large quantities of data allows medical practitioners to much more easily and dramatically improve the lives of our patients,” said Flaxenburg. “This is key to the identification of best practices and helps us, as practitioners, see how we are applying these best practices. Without it, this would be a much more difficult task.
“CORHIO also allows the sharing of information with other physicians in the community,” Flaxenburg continued. “Five years ago, physicians practiced more or less independently of one another. Information was scattered across multiple platforms—some paper-based and some electronic.
“That’s far less common today,” he stressed. “With EHRs and information hubs like CORHIO, information sharing is seamless. In most physicians’ offices, there exists instantaneous access to patient medical information.
“There are many benefits to this,” continued Flaxenburg. “It can prevent medical errors, like drug interactions between medications prescribed by separate providers. Those kinds of errors are far less common than they used to be.
“Additionally, it’s important for physicians of various specialties to communicate, so they don’t repeat tests or prescribe inappropriate medications,” Flaxenburg added. “This not only prevents potentially harmful errors, it reduces costs.”
Pathologists and clinical lab managers will be interested to learn that physicians, more so than in years past, are considering cost before ordering tests and other health-care services. “Patients today bear a larger portion of healthcare-related costs— whether it be through higher insurance premiums, deductibles or co-pays,” noted Flaxenburg. “Therefore, the challenge becomes how to provide a higher quality of care at a lower cost than in the past.”
Flaxenburg’s experience in working with a health information exchange and an electronic health record shows pathologists and clinical laboratory managers how the integration of healthcare informatics can contribute to improved patient care in several important ways. It is also provides examples of how laboratories can deliver more value to clinicians using lab test data and integrated informatics.
Flaxenburg believes that the fully-digital electronic health record is essential if healthcare is to succeed with implementation of the Affordable Care Act and the evolution toward integrated clinical care. “I think there will be a steep learning curve between now and then, but we can’t continue to practice medicine like in the 1950s,” he said. “To improve the quality of care and better control costs, we must coordinate care, and we can’t do that with a paper-based system. That is why the data exchange facilitated by CORHIO is essential as healthcare transforms itself.”
Changes In Practice Patterns
Clinical laboratories feeding data into CORHIO are noticing similar changes in clinical practice patterns—all to the benefit of patients. “Real-time access to lab test data through the HIE delivers real benefits,” stated Amery Ray, Laboratory Outreach Coordinator, Memorial Hospital at the University of Colorado Health (UCHealth) in Colorado Springs. “In our hospital, we see it every day as physicians in the emergency room are able to use CORHIO to view the patient’s lab test data and see his or her cumulative lab test results.”
Because Colorado Springs is a military and college town, Ray sees the practical value of CORHIO daily. “If a person working at a different military base or a student gets into a car accident here and he or she has been seen in the UCHealth system previously, the attending physician can obtain immediate health data from the patient’s record from earlier visits to any of our facilities along the Front Range,” she explained. “The physician no longer has to make calls to multiple providers to gather needed information because the information—including lab data—comes directly from CORHIO into the hospital or physician’s electronic health record system.”
Another factor that is important to hospitals is patient satisfaction, which is measured in surveys and is part of the hospital’s accreditation. “Studies show that the ability of providers to access medical information quicker results in greater patient satisfaction,” observed Ray.
“There are big benefits when a physician has quick access to lab results,” she continued. “It allows the physician to treat patients for a condition while they’re still at the physician’s office, so they don’t have to return another day to be treated.”
There are other practical benefits for the clinical laboratory participation in an HIE. “Partnering with CORHIO is very forward thinking,” emphasized Ray. “It improves even simple things. For example, we save money because paper has been eliminated. We save time because we no longer need to scan documents and fax them to doctors. These savings are small on a per-test basis, but compound over thousands of tests and become significant over time.”
Stage 2 Meaningful Use
Another factor that should not be overlooked is that compatibility with HIEs is a key component of Stage 2 Meaningful Use. Therefore, Colorado providers participating in the federal EHR Incentive Programs will find it easier to meet this requirement and qualify for their incentives.
CORHIO Supports Full Menu of Functions and Services
IN ITS THIRD YEAR OF OPERATION, the Colorado Regional Health Information Organization (CORHIO) now has the medical histories of 2.8 million people in its database. This is just over half of Colorado’s population.
The health information exchange (HIE) gives participating providers access to:
- lab and pathology test results;
- radiology reports;
- transcript notes, including discharge summaries, H&Ps, and operative and ED reports;
- admits, discharges and transfers.
CORHIO also provides automated referral and consult requests. It facilitates the sharing of patient medical histories and HIPAA-compliant data with other providers. This includes secure messaging, and community-and state-wide connectivity.
The HIE assists providers in meeting and qualifying for Medicare and Medicaid EHR incentives and reduces administrative and overhead costs.
Future plans at CORHIO call for providing electronic ordering of laboratory, pathology and radiology tests. The HIE intends to support public health alerts and notifications. It also wants to support continuity of care documents.