An Alaska Overview

When you leave Alaska and use an ATM machine in Seattle, the banking system recognizes you, your bank and your financial records. These personal, private, and secure financial records are shared and available. On the other hand, imagine if you needed emergency care in Seattle. The information also needs to be personal, private, and secure. How would your medical record history, drug allergies and other relevant data be made available to the emergency room doctor who treats you? In our current situation, the medical history you would want available to the doctor, unfortunately, is not. Important medical information is still inaccessible on paper files or in stand alone databases.

Although information technology has become part of our daily lives and allows access to information around the globe, many times lack of information in health care can cause delayed treatment, increased cost and even death. It is estimated that medical errors and drug-interactions account for approximately 100,000 deaths annually.

We are embarking on a project in Alaska to exchange health information securely and timely while still protecting privacy. The Alaska Regional Health Information Organization (RHIO) was formed as a project under the Alaska Telehealth Advisory Council. The project has federal funding plus monetary support from strategic partners including: the Alaska Federal Health Care Partnership, the Alaska Native Tribal Health Consortium, Premera Blue Cross/Blue Shield, Providence Alaska Medical Center, and the State of Alaska Division of Health and Social Services.

In an effort to facilitate electronic health record implementation throughout the state, the Alaska RHIO also works in close partnership with the Alaska EHR Alliance, the Alaska Primary Care Association, Mountain Pacific Quality Health and other organizations throughout the state. These organizations provide planning, implementation and support of electronic health records in physician practices and community health centers.

The Alaska RHIO mission is to facilitate health information exchange (HIE) among consumers, employers, clinicians, hospitals, pharmacies, nursing homes, payers, and other health care providers. There are two basic components to providing secure health information exchange;

Functional, standardized electronic health records
A coordinated, secure health information exchange network

Everything related to the patient that was historically kept on paper in a physician office or hospital record repository can be held in an electronic health record (EHR). The EHR is a digital version in a database that allows faster searching, more robust analysis, and easier access for medical treatment. The EHR for a person easily generates a master problem list, current medication list, allergies, vital lab data, recent hospital and clinic summaries plus much more. It can be generated during hospital visits, clinic visits, specialty physician visits, imaging center testing, contract lab testing, agency payers, or in personal health records in a secure, protected and backed up format. While it is not necessary that every health practice use the same EHR, it IS important that all EHRs use standard protocols to communicate.

Health information exchange (HIE) is the coordination of appropriate electronic health information for the health needs of patients and providers. HIE tools organize, integrate and retrieve data from existing sources of multiple electronic health records associated with a single patient using secure data transfer. HIE security is governed by patient and facility permission levels. However, the best technical decisions and implementations cannot succeed if the basic agreements are not reached between the participants to share their data. HIE requires collaboration and trust among the providers of health care in the form of shared agreements and contracts which clearly define the data elements and exchange principles.

Our technical vision of an HIE initiative is best described as a network through which all authenticated participants may securely exchange information without loss of meaning:

* All message senders and receivers are authorized and authenticated.
* All messages are signed and encrypted.
* All messages are actively acknowledged or rejected by the receiver in real time.
* All messages meet conformance tests for use case specific standards that can support the exchange of clinical information between disparate information systems capable of different levels of interoperability.

All information is exchanged in accordance with a set of principles, policies, and procedures to which each participant has agreed in a binding contract. The Certification Commission for Health Information Technology (CCHIT) has developed EHR evaluation criteria to reduce the risk of health information technology investment by physicians and other providers and to ensure interoperability (compatibility) of health information technology products. EHR and HIE technologies for Alaska will be selected from CCHIT certified products.

Larger healthcare institutions operate a Master Patient Index to keep track of patients and their records. When more than one institution in a region participates, multiple problems arise with matching patient records. The HIE can provide a record locator service independent from each institution’s clinical databases which serves as a type of proxy server for patient demographics and accurate record linking across all institutions in the region. Standardization of terminology services will enable health care applications to use an interface application to identify, access, and use disparate terminologies.

In Alaska with our small population and vast spaces, we have a unique opportunity to become a model for the nation in the development of an integrated EHR through an HIE initiative. The Alaska RHIO is well poised to become the facilitator of the HIE process. Larger health care facilities have already implemented or are implementing EHR systems. The EHR Alliance, APCA and PMQH are fully prepared to provide the EHR capability for the remaining clinicians who are interested in implementing EHR systems but do not have the capacity to do so on their own. The Alaska RHIO will provide the final mile connectivity to share the health information that is being collected through these endeavors.

Alaska faces many challenges to its health care systems. Health expenditures are increasing. The quality and safety of patient care are in need of improvement. Information that might provide solutions to such challenges is simply not available to all participants. Electronic health information exchange will result in better health care at lower cost and with fewer medical mistakes. It will also prevent the loss of critical health records through natural disasters, as happened in 2005 in New Orleans. The Alaska RHIO initiative will assist Alaska in making the health care changes necessary to provide the best possible healthcare and preventative services to the citizens of this state.