Health Forward Foundation

Local Safety-Net Providers Participate in Electronic Health-Information Exchange

Ten local safety-net providers are playing a key role in the development of Missouri’s electronic health-information exchange, a turnaround from a situation that threatened to end a groundbreaking partnership that had endured for a decade.

The group, which includes Truman Medical Centers and the Kansas City Free Health Clinic, is part of an initial test by Missouri Health Connection to share patient information over a secure electronic network. Missouri Health Connection, a nonprofit group with a board that includes state human-services officials, is creating the statewide health-information exchange largely with a $13.8 million federal grant.

Along with the Kansas City participants, Missouri Health Connection is gauging interest among roughly 30 other organizations around the state to participate in a six-week pilot scheduled to begin in late March, according to Melissa Johnsen, interim chief executive officer of Missouri Health Connection, which is based in Columbia.

Early testing of the system will focus on three capabilities: generating patient summaries, exchanging lab results, and submitting prescriptions. It is Missouri Health Connection’s goal to have the system fully implemented by early next year, meaning participating providers would also have secure access to a patient’s medical record, if the patient agreed to allow his or her provider to exchange their health data with their other providers.

Missouri Health Connection is waiving the one-time connection charge and six-months of the recurring participation fee for organizations that participate in the initial test. Johnsen could not provide a cost-saving estimate for the Kansas City participants since the fee structure remains under development.

In addition, the charter members would help shape the policies and procedures for the system, which Johnsen described as an opportunity “to be at the headwaters of the development of the services as they are being implemented and really shape how they can impact in a positive way the state of Missouri.”

Missouri Health Connection’s pilot came at a good time for the network of local safety-net providers. They were winding down KC CareLink, a nonprofit established in 2001 to facilitate electronic referrals among them. During the New Year’s holiday, KC CareLink ceased operations and its participating agencies switched to Cerner Direct, which will allow them to continue to share information securely via computer and will facilitate the transition to the pilot.

Long before the current push to improve patient care and wring out inefficiencies from the health care system with electronic health records, the safety net providers in Jackson, Platte and Clay counties created a computer-based network that replaced faxes and voice mails to coordinate services among their patients. At its height, KC CareLink handled nearly 8,000 referrals annually.

The original technology was still functioning well but needed an upgrade, said Linda Davis, the president who ran KC CareLink from beginning to end.

About four years ago, KC CareLink developed a modernization plan that would have cost less than $2 million. The problem, Davis said, was that the members could not find a feasible financing plan for it. One difficulty was recruiting new users who could increase the referral network and generate more revenue through additional user fees.

By the start of 2011, the organization was at a crossroads: It could continue with outdated but functional technology, finally figure out a way to finance the upgrade, or start phasing out the system. They chose the latter option for financial reasons, Davis said.

Truman’s Chief Information Officer Mitzi Cardenas, who is co-chair of Missouri Health Connection’s Technology and Operations Workgroup, helped lead the transition along with KC CareLink board member Marcia Johnson, who is associate administrator for strategy, planning and performance analytics at Truman.

A veteran of a number of system implementations, Johnson said this one has gone “fairly smoothly.” The biggest problem was handling the large number of open referrals.

The stop-gap system does not have all the features of KC CareLink, Johnson said, such as the ability to check a patient’s eligibility for Medicaid. But those improvements are in the works, she said.

For Davis, the orderly transition demonstrated the value of the working relationships the KC CareLink organizations developed by collaborating for so long.

“That they have stayed at the table with each other and have planned the migration to something else,” she said, “to me that is a huge success.”

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