Rhode Island is a state with about 15 hospitals, 3,942 physicians and 1,545 square miles. You can drive across it on the diagonal--all 59 miles from Westerly to Woonsocket--in 67 minutes. But it's a state with giant ambitions in deploying healthcare information technology, a complex activity in which the state's tiny size gives it major advantages over its sister states, according to key players in the IT drive.
A coalition composed of many of Rhode Island's top healthcare leaders is working to connect every provider and, eventually, every patient's home in the state to a universal healthcare information ingrastructure.
These leaders, typically 20 to 25 people at each monthly meeting, have convened for more than two years as members of the Rhode Island Quality Institute, a not-for-profit organization based in Providence that is coordinating the ambitious interconnectivity scheme.
"All the key players in the state are there," says Edward Quinlan, president of the Hospital Association of Rhode Island and an institute member from its inception. "You have leaders from providers to employers to payers, all at the table meeting for a common cause. I think a state of our size, a million residents, one dominant payer, the ability to traverse the state in a hour, we're an ideal laboratory."
While clusters of connectivity to the degree envisioned by the Rhode Island leaders are developing elsewhere on a regional level, few, if any, have been planned from the start as a statewide enterprise, and none have reached, on a percentage basis, the penetration level that Rhode Island could soon achieve with one of its efforts, e-prescribing.
One key element of the Rhode Island effort, participants say, is a supportive state government. It is represented at institute meetings by Lt. Gov. Charles Fogarty and state Health Department Director Patricia Nolan, M.D., both institute board members, and Nolan's deputy, William Waters, who oversees Rhode Island's public data-reporting program. Fogarty says some of the state's major healthcare players are already taking big steps into healthcare IT.
Lifespan, for example, a Providence-based four-hospital health system, has a computerized physician order-entry system in one of its hospitals and has CPOE rollouts well under way at two others. Its affiliated physicians can access patient records via its LifeLinks Web portal; its medical informatics director, Reid Coleman, M.D., recently won a national award for excellence in applied informatics from the Association of Medical Directors of Information Systems for leading clinicians through these and other IT projects.
Recently Fogarty testified before a state House committee in support of a $250,000 appropriation to pay for designing "a statewide interoperable healthcare information infrastructure." The bill also would create a state healthcare IT infrastructure advisory committee, and the institute "could actually be the vehicle to drive this forward," Fogarty says.
About nine months ago, taking baby steps toward the institute's broad connectivity goals, the first of what are now 245 physicians began writing electronic prescriptions--with a notable enhancement.
In most other places, e-scripts end up being converted to faxes because the computers at the receiving pharmacies can't interface with the numerous script-writing tools on the market. What makes the Rhode Island project exceptional is that physicians' prescriptions are delivered electronically from the physician's computerized script-writing tool into the computer systems--not the fax machines--of Rhode Island pharmacies.
In collaboration with the institute, SureScripts, a joint venture of retail pharmacy organizations, created a key interface between the pharmacy computers and the physicians' script-writing tools, completing the last link in the chain of electronic prescription writing.
The quality institute and SureScripts have induced about 70% of the state's pharmacies to upgrade their computers to receive the e-prescriptions through the interface, says Laura Adams, president and chief executive officer of the institute. Those pharmacies handle about 90% of retail prescriptions in the state, Adams says, but the institute is going after the rest.
According to Adams, institute project doctors are using two e-prescribing software packages: Rcopia from DrFirst of Rockville, Md., and OnCallData from InstantDX, a physician-led firm from Gaithersburg, Md.
In a few weeks, another 600 physicians will be joining the program, Adams says. When that happens, "We're about halfway home," she says, noting there are about 1,800 physicians actively prescribing in the state.
Adams serves as a faculty member of the Institute for Healthcare Improvement headed by Donald Berwick, M.D., a member of the Institute of Medicine's Committee on Quality of Health Care in America. Adams says she initially came to Rhode Island as a consultant to help get the institute up and running, but stayed on as its only full-time employee.
The institute had a budget of $400,000 last year. "It's inadequate funding," she says. "I don't want to leave people with the impression you can do this with that amount of money. I'm exhausted."
The institute is applying for two grants from the Agency for Healthcare Research and Quality, which announced in April it was looking to fund statewide or regional connectivity pilot projects (See story, p. 4).
One grant request, for $200,000, will be submitted by the institute for planning future IT efforts. The second request, for $1 million annually over five years, is being submitted by the Rhode Island Health Department in collaboration with the institute. That money will be used to create a master patient index for the entire state, Adams says. The index will be the foundation for future connectivity, she says.
Coleman, the Lifespan physician informaticist, says the conceptual model for the future Rhode Island connectivity system is a switchboard, routing access to the databases of the participants.
Access, Adams says, will be controlled through a "lockbox" with digital "keys" from both the patient and the provider needed to gain entry.