The University of Colorado Health Sciences Center will analyze data submitted by Quality Health Network to see if health information exchange positively impacts the use of healthcare services.

The year-long study, funded by  a federal grant from the Agency for Healthcare Research and Quality, will determine whether the number of diagnostic and clinical exams declined in the Grand Junction, Colo., region because physician had better access to data at the point of care and therefore did not order duplicative tests, said Dick Thompson, executive director and CEO of QHN.

The veteran HIE, which was widely adopted by the community in late 2006, has tracked the use of exams since its go-live date in mid-October 2005. It will submit data collected from 2005 to the end of 2008, he said.

Quality Health Network found evidence of what appears to be a difference in the rate of increase in utilization, according to Thompson, and not the overall utilization, as originally reported. "The reason for the study is to determine if the evidence is supporting reality and what the causes of the disparity in the rates of utilization increase might be," he said.

The research being conducted is centered within the context of the rate of increase in test utilization between users of HIE and non-users. "The difference is important," Thompson stressed.

To illustrate, Thompson offered a hypothetical situation in which both HIE-connected physicians and non-HIE connected physicians each have a base of 100 utilization tests per period of study for the same number of patients. In the example, the non-HIE connected physicians show a 2 percent increase in the overall rate of utilization for a total of 102. HIE-connected physicians have a flat or slight increase of 1 percent - thus the ratio of 1 over 2 or 50 percent - for a total of 101 for the same period of study. "While the rate of increase is half in this example, the overall impact is about one percent - certainly lending credence to a bending of the cost curve - but not one of 50 percent (as originally reported), which is not credible in the most optimistic of circumstances," Thompson said.

"We expect the study's results to show the HIE is responsible, and the impact on cost will reflect real dollars saved on a per member per month basis," he said.

Network expands

QHN is also involved in other initiatives. It has expanded its footprint in Western Colorado and Eastern Utah. Aspen and Montrose joined QHN in 2009 as the two most recent community participants. The initial results show that adoption of QHN's HIE tools by these two communities is growing at a faster rate than in Mesa County in Colorado where it debuted.

QHN recently deployed tools to make it easier for physicians to get data from one source. The HIE is following through on one of its early goals to develop population management tools, Thompson said. The tools include a chronic care disease state registry to be used by physicians to better manage patients that have diabetes, asthma or cardiovascular disease. QHN is adding a new registry tool to track depression, as well as preventative measures such as mammograms and colonoscopies.

"We want to supply and build tools for doctors to help them identify the at-risk population and gaps in evidence-based medicine guidelines for appropriate care of those patients," Thompson said.

Thompson sits on the board of the Colorado Regional Health Information Organization (CORHIO), which is the state-designated HIE. QHN has signed a memorandum of understanding to connect QHN's infrastructure to CORHIO's infrastructure as quickly as possible, he said.

QHN is also one of four supporting organizations comprising the Colorado Beacon Consortium, one of 17 communities that has received funding under the Beacon Community Program to serve as models for the broad use of healthcare IT. QHN was a participant in the 2007 federal pilot to improve connectivity with the Veterans Affairs Department. Ten percent of QHN's patient population is served by the VA, Thompson said.

The HIE is working with its HIE vendor Axolotl to get a gateway operational to connect the VA and treating physicians. The goal is to deliver relevant clinical information during transitions of care, where gaps in care often occur, he said.