Rhode Island Quality Institute is using its statewide health information exchange to send real-time notifications for care transitions to and from emergency departments and hospitals. The alerts include direct messaging, EHR notifications and real-time dashboards.

Elaine Fontaine, director of data quality and analytics at RIQI, says sharing that real-time information with providers across Lil' Rhody is leading to some worthy gains in efficiency and care quality.

CurrentCare, Rhode Island's statewide HIE, was launched in 2006, and RIQI took over the maintenance of its data in 2010.

"We have more than 400 data sharing partners in Rhode Island," said Fontaine. "All of the acute care hospitals are delivering to us admission, discharge and transfer data as well as continuity of care documents. We're getting the vast majority of ambulatory radiology and lab results. We are also connected to more than 200 ambulatory practices, as well as to Surescripts."

That's a pretty robust data set. And Fontaine – who'd worked at a health plan and at a large integrated delivery system before joining RIQI in 2014 – said the idea of diving in to find new and innovative uses for it all was "wildly appealing."

After all, she said, "having data across multiple platforms, not bounded by geography or payer or provider, was very powerful with regard to being able to aggregate and deliver data to various stakeholders in a way that would really impact health.

"That vision was always part of RIQI's thinking as they built out the HIE," she added. "Many other states really have this federated point-to-point model without the data being maintained in a centralized source. But RIQI understood that to be able to leverage the value of that data, maintaining it over time was critical."

From the get-go, data integrity was a primary focus for CurrrentCare. "Rhode Island focused on governance before they focused on the technology of the HIE," said Fontaine. "Ensuring data governance across the community, and having everybody onboard with the model and the security and the understanding of how the data was going to be delivered and used really eased the opportunity to make this work."

Competitive concerns among various stakeholders took a back seat too. The key, she said, "is that the patient is the North Star. And whenever there were challenges or concerns about data sharing, the ability to say, 'If the patient shows up at your doorstep and there's information in someone else's EHR that can save that patient's life, is there a reason to not allow that data to flow?' That kept the conversation honest at all time."

Near real-time data helps nurse care managers prioritize interventions
A couple years ago, RIQI started some talks with a forward-thinking CEO at one of Rhode Island's federally qualified health centers, which had received some funding from the Jessie B. Cox Foundation that could enable a pilot to better leverage HIE data for efficiency gains.

"He said, 'I have many processes in place, and when a patient is admitted or discharged from the ER or the hospital, I have a large number of staff doing document management, and they're getting faxes and electronic notification and phone calls,'" Fontaine explained. "'It's administratively inefficient. Sometimes we get many notifications and sometimes we get none. Our ability to efficiently manage care coordination is a challenge for us. Is there a way that the HIE can help?'"

The result was a dashboard – "simple and elegant and powerful" – that shows the provider three charts.

"One is just is just a bar graph showing the number of patients in the emergency room or in the inpatient hospital," she said. "The next is a bar chart looking at the last four days of discharges (ER and inpatient). And then the bottom is a run chart, over the last 12 months, of the number of admissions to the emergency room and inpatient settings. So if somebody was actually running an improvement project doing a PDF/A, they could actually see the impact of their intervention without having to go look for that data somewhere else."

The benefits became apparent pretty quickly, said Fontaine: "When the care manager dove into, let's say, the people who were discharged from the emergency room yesterday, to do discharge follow-up, they get a listing of those patients: what facility they were in, what the reason for admission was, and a variety of demographic related information."

And iterative adjustments have only improved it, she said. "We have added to that a simple calculation that folks had been trying to pull together manually from all of the faxes and pieces of paper, which is the number of times the patient has been to the ED or the inpatient setting in the past six months. And this data is updated every 45 minutes."

The ability to sort by patient has been a boon to overburdened providers, said Fontaine. "If you're the nurse care manager and you have to prioritize who you're calling first today because you have a limited amount of time, to do followup for people who were discharged yesterday, you sort on those who have been to the ED most.

"Every single time we do it, we see people who have been to the ED 80 times, 90 times, 100 times in the past six months," she added. "You're looking at the admission reason and the number of times they've been admitted. So if you're looking at someone whose admission reason is chronic pain, and they've been there 100 times, your response as a nurse care manager is going to be very different than if you get to the bottom of your list and you see lacerations and this is the first time they've been in. So who do you call first?"

Having data in near real-time is an obvious win for nurse care managers who are often "spending upwards of 15 hours a week chasing data," said Fontaine.

Moreover, "they're waiting sometimes as long as 48 hours after discharge to know it," she said. "Now we're telling you in an hour. And in a way that's organized in one place so you can actually prioritize and act on it."

Fontaine, with her RIQI colleague Alok Gupta, will present "Expanding Real-Time Notifications for Care Transitions," on Tuesday, Feb. 21, 2017 from 10-11 a.m. in Room 304A.

HIMSS17 runs from Feb. 19-23, 2017 at the Orange County Convention Center.

This article is part of our ongoing coverage of HIMSS17. Visit Destination HIMSS17 for previews, reporting live from the show floor and after the conference.

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