Mastering Data Management

Connecting healthcare across rural Louisiana has improved patient care

Health information exchange has significantly impacted the way healthcare is delivered in Louisiana. When the Louisiana Rural Health Information Exchange (LARHIX) was formed by the Louisiana Rural Hospital Coalition in 2007, the state ranked 48^th in overall health quality by America’s Health Ratings.

Today 24% of the population lives below the poverty level, more than 25% are uninsured and the patient to physician ratio in rural areas is 1925:1, compared to 870:1 for the urban areas of the state.  LSU Hospital System is the only Level I trauma center that treats the uninsured and consistently operates at 100-110% occupancy.

Before LARHIX was in operation, a typical patient encounter that required a visit to a specialist was time and cost prohibitive due to the requirement to physically visit LSU Hospital in Shreveport, LA.  After being referred to a specialist, the patient very often had to take time off work and make multiple trips to LSU Hospital for the consult, testing, diagnosis and treatment.

Recognizing that this was a significant obstacle for our citizens to obtain quality healthcare, LAHRIX was formed and tasked with taking measures  to use technology to effectively enable electronic information sharing between rural providers and LSU Hospital System (LSUHSC) .  In other words, bring specialist care to the rural hospitals. The results speak for themselves:

• 98% decrease in redundant testing
• 100% patient satisfaction
• Save patients ~90 days in waiting for an appointment
• Improvement in breast cancer detection & treatment
• Rural practitioners complete CME courses remotely

As a central component of our technology strategy, we deployed a state-of-the-art telemedicine system that connects each participating hospital with the LSU Hospital This allows us to provide more immediate care to rural citizens by conducting initial visits and discussing test results from the local hospital, and only requiring the patient to drive to Shreveport  for tests or scans that could not be performed remotely.

To successfully implement this technology, we quickly realized the need to modernize the information systems at many of the rural hospitals and create a network that would facilitate the exchange of patient records between the facilities and the LSU Hospital.

This introduced two key requirements for success: 1) The ability to exchange information between the many disparate legacy HIT systems in use, and 2) A governance strategy that all participants could live with.

We met the first requirement by implementing an integrated, open systems platform that provides the secure, real-time electronic data exchange necessary to keep patients in their home community for healthcare.

We then implemented the Enterprise Master Patient Index (EMPI) in a federated style hub, which eliminated the “who owns the data” argument that can hinder governance efforts.

Data governance is a difficult issue to address in any exchange due to the sensitivity of patient data and the HIPAA requirements that impact access and security. To avoid months of negotiations and debates about common definitions and ownership, we refused to go down any path that would allow patient data from hospital A to be manipulated by hospital B.

The federated style patient data hub alleviates many governance concerns by allowing each entity to retain ownership of the data and only share certain content with trusted entities.

When a physician needs to view a patient record from elsewhere in the exchange (e.g., a specialist at LSU needs to view a patient’s medical history from one of our rural hospitals), the secure web-based infrastructure displays a real-time view of patient information maintained by that hospital.

After the physician closes the browser the information goes away.  The data never moves from its original location, and is not manipulated by another facility.

Under this model, physicians can view, in real time, the information they need to make critical care decisions about patients without requiring the patient to leave his local community.

We anticipate that the infrastructure in place at LAHRIX will serve as the foundation we build from to develop the state-wide HIE.

Join me at HIMSS2010 in Atlanta to learn more. I’ll be speaking at two different sessions, on Sunday, 2/28 at 1 PM (in room B308) and Wednesday, March 3 at 9:45 AM (in room C304).

For more on Jamie's presentation and other opportunities to talk to Initiate customers, read our HIMSS Preview.