Lousiana exchange sets pace for regional networks

With the devastation of Hurricane Katrina still very much in evidence, Louisiana is developing a prototype of a local health information exchange between New Orleans and Baton Rouge.

The proof-of-concept project will be a component of a larger Gulf Coast Digital Health Recovery Project that includes four states and could be a model for other regions around the country.

Before Katrina's floodwaters subsided, it was obvious that hundreds of thousands of paper and electronic medical records had been destroyed.

'Computers and servers were underwater, and if they didn't have a good back-up system, those records were lost as well,' said Roxane Townsend, a physician and deputy secretary of the Louisiana State Health and Hospitals Department in Baton Rouge.

Townsend worked with stranded evacuees in the New Orleans Superdome, trying to sort out the white slurry of melted and soggy medications that individuals carried in plastic bags.

While federal, state and private health IT groups pitched in to re-create medication lists and histories for evacuees through KatrinaHealth.org, the need was clear for a permanent method of recovering or re-creating patient records in the event of another disaster, she said.

Townsend is leading the development of the Louisiana Health Information Exchange, which is also a component of the larger Gulf Coast Digital Health Recovery Project. It will let Alabama, Louisiana, Mississippi and Texas'the states most affected by last year's hurricanes'exchange health information electronically.

Live demonstration

Later this month, Louisiana will demonstrate the capabilities of its health information exchange with live data for representatives from the Health and Human Services Department's Office of the National Coordinator for Health IT. Physicians will transmit patient information between a hospital and a primary care clinic, Townsend said.

The Louisiana exchange comprises eight hospitals plus federally qualified health centers, community health safety net partners and Blue Cross/Blue Shield of Louisiana in New Orleans and Baton Rouge, which is the receiving area for the evacuation of people who might require medical care.

The participants are publishing data on continuity of patient care into the health information exchange for local databases in each of the two markets. That includes data about medications and diagnoses, and information used to identify patients.

The master patient index and record locator service reside in another server, so a physician in Baton Rouge can submit a query through a Web portal for a patient from New Orleans or obtain nonidentifiable health data'such as the number of people with flu symptoms'across the system.

The prototype also can reach into databases located within participating providers, she said. For example, the Medical Center of Louisiana has discharge summaries and medical histories that physicians have dictated available electronically.

'Without storing all that information centrally, we can long-arm it from Charity Hospital's server if a physician requests it,' Townsend said.

That capability provides better privacy and security, because it can pull the data in so the physician can see it, but the data does not reside in the warehouse.

The $3.7 million contract from the State of Louisiana's Health and Hospitals Department through HHS' Office of the National Coordinator for Health IT for the prototype ends at the end of this month, Townsend said.

Enhanced services

With funding over the next year, she said she expects to enhance services, attract more providers and prepare the system for operations in New Orleans.

The group steering the larger Gulf Coast Digital Health Record Recovery Project next summer will produce a road map with formative steps for what the interstate health network will look like, said Lee Stevens, federal policy director for the Southern Governors' Association in Washington.

The health care redesign collaborative is made up of the Southern Governors' Association and representatives of the governors of Alabama, Louisiana, Mississippi and Texas. It is funded by the Robert Wood Johnson Foundation and Louisiana's DHH through HHS' health IT office.

'This started on the heels of Katrina, and a lot of the folks working on this have been intimately involved with the recovery. There is just an overwhelming workload for anybody in the Gulf States at this point,' Stevens said.

The health network aims to handle day-to-day clinical applications, but emergency response, especially after Katrina, has become critically important, Stevens said.

In its first big milestone as it meets next month for only the second time, the collaborative plans to submit to HHS secretary Mike Leavitt the concept for a large Medicaid waiver to remove regulatory impediments to facilitate the project, Townsend said.

Three working groups are setting the foundation for the interstate project.

The finance and sustainability group is studying existing regional health information organizations in Memphis, Tenn., and Indianapolis. The group will make its first recommendations in January.

The governance and legal group is evaluating executive orders and memoranda of understanding that are necessary for interstate exchange, especially related to the Health Insurance Portability and Accountability Act.

The clinical and technology group is studying the elements of data sets, the difference between emergency and daily-operational data sets, common best practices for keeping careful records in electronic format and technical standards for exchanging this data.