Strengthening Patient Care as a Rural Health Information Exchange

It’s hard for providers in remote locations to deliver high-quality and coordinated patient care without a rural health information exchange (HIE).

HIEs are crucial for connecting communities and ensuring patient medical records are available at all times. While interoperability remains a significant issue for HIE implementation, HIE connectivity is becoming more prevalent across the country.

According to the 2019 American Hospital Association IT Supplement published by the Office of the National Coordinator (ONC) for Health IT, there was nearly a 40 percent increase in the proportion of hospitals that used a national network to find patient data between 2018 and 2019.

On the other hand, state, regional, or local HIEs were the most common method utilized by hospitals to find patient data from outside providers, jumping from 46 percent of providers using a smaller HIE in 2018 up to 53 percent that did in 2019.

And while 80 percent of medium to large hospitals participated in either a state, regional, or local HIE network, adoption lags behind in rural areas. Only 68 percent of small, rural hospitals participated in HIE networks. Less than 50 percent of small, rural, and critical access hospitals (CAHs) participated in national and state, regional, or local HIE networks.

Montana’s statewide HIE, Big Sky Care Connect, officially launched at the end of 2020, making it the 49th state in the country to launch a statewide HIE.

Although the HIE is currently active, providers across ‘Big Sky Country’ are still experiencing patient data exchange difficulties because it is still in its infant stage.

“In Billings, the largest city in Montana, we have three healthcare institutions, and we can't share data across the street,” Randy Thompson, chief health analytics officer at Billings Clinic, told EHRIntelligence. “There are certain patients that the three healthcare facilities share and it's challenging for us to get a complete picture of the patient, their health, and all their conditions. That's the state of where we are right now.”

So far, Big Sky has over 35 providers inked and roughly 100 more providers ready to join.

“There hasn’t been a big impact yet,” Thompson continued. “We've been waiting for it, and it hasn't taken the HIE long to ramp up its client list. We've been waiting for this functionality to be a reality, and now that it’s here, we're all excited that we're a lot closer than before.”

Implementing an HIE extends interoperability and improves health data access. Interoperability is essential in a rural state like Montana, where individuals often travel far and visit multiple healthcare facilities for care.

One way to build and run a successful state-designated HIE is to partner with vendors to give clients a broader range of tools to improve patient data exchange and patient care.

For example, a successful statewide HIE could integrate a separate enterprise master patient index (EMPI) vendor, a notification alert vendor, a clinical data repository (CDR) vendor, and a social determinants of health (SDOH) vendor. If the HIE wants to replace a tool in the system or find another solution, it can integrate a new tool without blowing up the entire infrastructure.

Leaders at BCSS used that partnership strategy to integrate a medication history information system to help clinicians with drug orders.

“The integration brings a different level of knowledge about the patients to the participants of the HIE,” Thompson said. “Not only do we get to see what prescriptions that patients are prescribed, but we get to see if they filled their prescription, and we get their complete medication history.”

BSCC leveraged DrFirst’s MedHx solution to give providers a more significant picture of what patients are doing outside their health system.

“Our system is pretty big, but we get a much more complete picture, and that will be important for those smaller institutions, such as the critical access hospitals, that their patients might go to several big cities to try to fill their medications,” Thompson explained.

Montana providers can leverage the HIE for patients they treat to view a complete and comprehensive patient medical record, including the entire medication history. Furthermore, it promotes medication adherence.

“It also closes the loop because we know that about 60 percent of patients will fill their prescriptions, the rest of them won’t fill their prescriptions, and we don't have any idea of which ones do and don't fill their prescription,” Thompson said.

“We now have visibility that allows us to ask different questions about why a patient isn’t filling her prescription. Is she having financial issues? Can we get her subsidized medication? Do we need to switch her to a different generic brand? Overall, it gives us more information about the patient so we can improve their care as well.”

Following the footsteps of successful state-designated HIEs, Thompson, who also serves on the Big Sky committee, said the HIE wants to boost statewide adoption and expand capabilities into medical imaging exchange.

“The next goal would be adopting a robust data and analytics tool for us to understand both our patients and our systems a little bit better and gain insight from the data that we're collecting about our patients,” Thompson said.

Thompson said Big Sky is in the final stages of selecting a data and analytics vendor and in the process of adding an image exchange vendor.

With any technology that harbors or exchanges an individual’s data, its leaders must ensure total privacy and security for its customers, or in this case, its patients.

“If patients are concerned about the safety and security and privacy of their data, it's always a difficult task to assure them of that,” concluded Thompson. “I always like to bring that point up, that Big Sky Care Connect takes that extremely seriously, and the privacy and security and safety of that data is their number one priority.”