Connecting to Maine’s Health Information Exchange to Improve Care Coordination: Coastal Women’s Healthcare

Rationale / Objectives

Diagnostic test duplication and time spent on medical record management are wastes that can be minimized through enhanced health data sharing. Coastal Women’s Healthcare wanted to connect to Maine’s Health Information Exchange (HIE) in order to improve data sharing between themselves and other healthcare providers, thus advancing towards Stage 1 of Meaningful Use (MU). [1]

Project/Program Description & Major Achievements

Coastal Women’s Healthcare worked with their EHR vendor, implementing changes needed to meet MU objectives in the process of connecting to Maine’s Health Information Exchange (HIE). They exchanged clinical information, reconciled medications and provided care summaries for transitioning patients. Coastal Women’s Healthcare became the first independent women’s healthcare provider to connect to Maine’s HIE in 2012, and in so doing, saved $215,000 a year due to the resulting staff efficiencies. Medication reconciliation was done for more than 50% of transitioning patients. Coastal Women's Health saved an average of $100 per patient due to reduced diagnostic test duplication. [1]

Lessons Learned

Coastal Women’s Healthcare designed their examination room with patient care and comfort in mind, so that the technology was not a distraction. Extra notations and patient photos also added a personal touch to the medical record, and allowed the practitioners to reclaim some individuality that they felt was lost to the standardized system. They discovered that they had to be flexible with staffs’ learning styles and learning rates. Super users were paired with those who experienced more challenges adapting to the system. The practice’s collaborative management approach smoothed the HIE connection process by empowering all staff to be problem-solvers. [1]

Further Description

Coastal Women’s Healthcare is located in Scarborough, Maine. It is an independent practice that consisted of 8 physicians, 2 nurse practitioners, a midwife and support staff treating over 22,000 patients in 2011. The practice transitioned to a collaborative care team management approach concurrently with this project. They attested to Stage 1 Meaningful Use in 2011, and HealthInfoNet connected them to the HIE via a bidirectional interface in May of 2012. Coastal Women’s Healthcare approached this project by forming an MU team and by enlisting the assistance of their EHR vendor, Greenway, in creating workflows and monitoring the project’s progress via an EHR dashboard. The EHR dashboard reported to Coastal whenever providers connected to the HIE updated their notes in the system. In order to enhance the EHR’s meaningful use, the practice enabled free text details to be added to the record when entering a patients’ diagnosis in the problems list on the easily accessible face sheet. E-prescribing software connected the practice to the pharmacy database. Changes to the medication list were communicated to the EHR dashboard on a daily basis.  Additionally, patients were able to log into a secure portal to access their health data. Prior to implementation, the practice notified their patients by secure email and standard mail of their plans to connect to the HIE. Training sessions were conducted which focused not only on the specifics of the HIE, but also on the consent process and how best to communicate with patients about the changes and address their concerns effectively. [1]

Major Achievements

Metric Result Additional Detail
Medication reconciliation Accomplished for more than 50% of transitioning patients [1]
Current problem list maintenance 98% of the time Compared to the typical 88%  [1]
Time spent on medical records management Decreased by $75,000 per year [1]
Savings due to reduced diagnostic test duplication $100/patient Average [1]
Time spent on billing Decreased by $140,000 per year [1]
Insurance billing time Decreased from 19 to 4 days [1]