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PHIN Initiative
8/15/2005
Rural Health Network SCNY
Patient Health Information Network (PHIN) Initiative
July 2005
Without sufficient and efficient technology, physician offices can easily get bogged down in the world of faxes, phone calls and paperwork, taking them away from their primary concern: Patient care. Rural communities such as those in Tioga, Delaware and Broome Counties of South Central New York are especially faced with this challenge. People in these remote areas often use more than one hospital system for their health care needs. It can be a burden for one provider to obtain a patient’s history from another provider, and may take hours or even days to aggregate all the information - this puts the patient at a disadvantage. Conversely, having access to critical health information at the time of services increases quality of care and reduces the likelihood of unintended outcomes, the need for repetitive diagnostic testing and the cost of providing services to both the patient and the healthcare delivery system.
How can these problems be rectified? Technology. Unfortunately, the most up-to-date equipment isn’t always available in these remote areas.
But a successful initiative is working to make access to healthcare data easier: It’s called the Patient Health Information Network (PHIN). The mission of PHIN is to develop an electronic patient information system to serve healthcare providers. Currently United Health Systems (UHS) and Our Lady of Lourdes Memorial Hospital, Inc. are the principle participants. The ultimate goal is to have patient medical information easily and readily available to these providers, regardless of where the patient received care in the past.
PHIN was made possible through a Federal Healthy Communities Access Program Grant (HCAP) awarded to Our Lady of Lourdes Memorial Hospital with the assistance of the Rural Health Network of South Central New York (RHN). RHN is a non-profit organization dedicated to positive changes in rural health policy and to the provision of health services at both the community and individual level. One of the goals of RHN is to promote technological innovations that lead to improved communication linkages among primary care sites, walk in clinics, and hospitals in order to improve coordination, patient care and outcomes. The PHIN project was a natural application of the mission of RHN.
Edna Boone, Manager of Clinical Systems at UHS and Tom Ellerson, IT Director at Lourdes spearheaded the effort as members of the Rural Health Network’s PHIN Workgroup. In organizing the Workgroup, RHN brought together stakeholders from key constituencies: IT leadership from competing health systems, public health officials, primary care physician and non-profit health and human service organizations.
The PHIN initiative took off in 2000 with a survey to find out the status of Internet connectivity in rural community hospitals and primary care sites in Broome, Delaware and Tioga counties. Results were poor. Less than 50 percent had Internet capability; those that did were using a dial-up connection, and service was provided only in the business office, not in clinical areas.
“Technology equals data and you need data to make good quality decisions. So data equals quality,” said Boone.
After this initial survey, the PHIN team conducted another study on how to connect the hospitals and their primary care sites to high speed Internet. The group approached Time Warner Cable, a local Internet service provider. In a magnanimous gesture, Time Warner agreed to waive the installation fee and give these rural-based physicians’ offices the home rate for Internet access rather than the business rate. This represented a 50 percent discount.
In addition, the PHIN grant was used to purchase several starter PC’s for physicians who didn’t have computers in their clinical areas.
Before the project could develop further, a critical breakthrough had to take place: Collaboration. The PHIN workgroup, led by Boone and Ellerson, worked toward breaking down the competitive barrier among the hospitals.
“The CEO’s were great and have been very positive. We really got past the politics,” said Ellerson.
In the fall of 2002, Lourdes and UHS moved forward in the effort to develop a way to share patient information and a PHIN pilot program began in Tioga County. It was successful and the initiative branched out into Broome County. PHIN utilizes the technology currently in place at each hospital system. Lourdes stores patient information in Quick Access and UHS utilizes Physician View. The common standard HL7 Interface feeds the clinical repository.
“HL7 takes transactions and puts them in a common database (repository) that keeps forever. And it takes burden off the backend system to have to keep that much data. You can purge the files but never the warehouse. It gives you a nice web view of the aggregated data,” said Ellerson.
Through a password protected shared Internet site, authorized personnel can view and print clinical data. The system uses a roles-based security, which means that information is available on a “need-to-know” basis. In addition, Lourdes applies ‘Break the Glass’ technology. Any time someone accesses a patient file, the person’s ID is recorded as well as the information they viewed.
Currently 15 hospital based clinics and 35 doctor’s offices are involved, spanning 65 miles from Candor to Deposit.
The systems are HIPAA compliant and hospitals share five pieces of critical data: demographics, insurance provider, medical problem list, medication list, and medication allergies. To ensure HIPAA compliance, the computer program Title 42 is used. It blocks chemical dependency and mental health data except to the appropriate people.
In August of 2003, $150,000 of HCAP funds were directed towards the expansion of the PHIN connectivity project. Funds were awarded to UHS and Our Lady of Lourdes for the purchase of hardware, software and interfaces that would enable increased availability of the five key data elements referenced above.
The IT departments trained area physicians and nurses on how to log on to the systems and obtain the necessary data.
“The beauty was that training was minimal,” said Ellerson. “We’ve had docs just come down and sign paperwork and just walk away. They got it. The system is very intuitive.”
Resources are still limited but in the future, the PHIN project hopes to create either an independent data repository that all hospitals could access, or to beef up QuickAccess and Physician View. Another goal would be for both hospitals to complete their patients’ electronic medical records and make them available to both parties; then the sharing of information could be a technical possibility, albeit one that would require further negotiation between the hospitals.
Dr. James Skiff, a UHS physician in Tioga County and a board member of the Rural Health Network says being part of the PHIN initiative has greatly improved patient safety.
“It prevents careless errors from being made. The bottom line is the more information you have, the less likely you’re going to do something wrong.”
Diane C. Albrecht, President of the RHN Board says, “PHIN reinforces the value of health systems working together to benefit the common good. The Rural Health Network understands the power of partnerships and continues to explore opportunities for facilitating positive change.”
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