Reliant Medical Group/HealthAlliance Hospital Advance Health IT Through Information Exchange

An AHRQ grant that facilitated the development of SAFEHealth (Secure Architecture for Exchanging Health Information), a health information exchange (HIE) system in central Massachusetts, is now being used by a hospital and a group medical practice in the State to share clinical information about consenting patients.

SAFEHealth connects Reliant Medical Group (formerly known as Fallon Clinic) with HealthAlliance Hospital, a nonprofit acute care hospital in Leominster, Massachusetts and a member of UMass Memorial Health Care. Reliant Medical Group is a 250-physician multispecialty medical group practice with more than 20 sites in central Massachusetts.

Under SAFEHealth, clinical information follows patients with their consent as they seek care from different health care providers. The vast majority of patients who split their care between the two organizations opt to participate in the system. SAFEHealth was designed through an AHRQ grant to maintain patient privacy and security while improving clinical outcomes, maximizing patient safety, enhancing service to patients, and reducing health care costs.

Since the grant ended in 2009, SAFEHealth has continued to thrive and grow. The system went live in June 2009, transferring clinical data between Reliant Medical Group and HealthAlliance Hospital. Since its launch, nearly 3,700 patients have participated and over 100,000 documents have been exchanged between Reliant Medical Group and HealthAlliance Hospital.

Built without a central clinical data repository, SAFEHealth keeps patients' clinical data safely stored behind the security firewalls of each health care provider's information system. SAFEHealth connects Reliant's electronic health records (EHR) directly to HealthAlliance's system. Included in the exchanged documents are visit notes, medication lists, allergies, problem lists, immunization history, code status, advance directive status, primary care physician contact information, vital signs, and recent test results. The system also has extensive audit trails to help monitor patient privacy.

Larry Garber, MD, Medical Director for Informatics at Reliant Medical Group and principal investigator for the grant, says, "SAFEHealth has been self-sustaining since June 2009. Our annual operating cost is only about $7,000, so it's highly sustainable for the two organizations that together have gross revenues of almost a billion dollars."

To help reduce operating expenses, SAFEHealth's core server and software are hosted in Reliant Medical Group's data center. This internally-developed software uses Microsoft's .NET service-oriented architecture software and SQL server, which have relatively small licensing fees.

SAFEHealth was designed to ensure that when patients require medical attention outside of their primary care physician's office, the treating physician is informed about the patient's health history. Likewise, when patients see their primary care physician, evaluations and test results that were performed elsewhere are automatically shared securely.

According to Garber, the success of SAFEHealth is due in part to its patient consent model, which fits into normal workflow processes. When the patient checks in at the registration desk for an appointment or emergency department visit, a local computer checks to see whether there are data at another organization and whether the patient has already signed a consent form. If patient data exists and consent has not been given, a form is automatically printed next to the registration clerk. The registration clerk obtains informed consent and enters what the patient authorizes into a Web portal.

Patients can opt to share data with all of their current and future health care providers, exclude certain providers, or just pick certain providers. This process allows new patient data to automatically flow instantly between the authorized providers until the patient revokes consent. The system is also capable of handling the consent of minors, which automatically expires on the patient's 18th birthday. Garber views the SAFEHealth architecture as the key to "hassle-free HIE" that does not require storing clinical data in a central place.

Garber says, "The physicians, staff, and the patients love this. Consent processing only occurs when it will yield potentially valuable new patient information, and it fits right into the workflows of even a busy emergency department. The fact that patient data flows directly into the EHR makes it easier for physicians and nurses to find this information as part of their normal workflow, without having to look elsewhere." Clinicians have instant access to all of a patient's medical records in emergency and walk-in settings without having to manually query for these records, thus enhancing care and reducing the possibility of errors.

Garber says, "In order for an HIE to be successful, it has to do three things: first, your costs have to be less than the benefit you're getting out of it, in order to show value; second, it has to be usable by fitting into the workflows of real-life health care; third, you have to develop trust among all of the stakeholders. SAFEHealth successfully addresses all three of these."

More information about SAFEHealth is available at http://www.safehealth.org/about/about.htm.