From the July/August issue of Government Health IT.

Playing the role of sometime-cartographers, healthcare policymakers and stakeholders have been working for several years to draft a new kind of national roadmap.

Known as the Nationwide Health Information Network (NwHIN), this map will someday connect communities – not with roads and bridges, but through technology that enables healthcare providers to span borders and share patient data.

Each state, however, has developed its own regulations for how health information can be stored and shared. And while the goal is to develop an information network that will enable the exchange of patient data throughout the nation, there may be as many paths to achieving that end as there are state-designated HIEs. 

A Country Tale: Maine's HIE

Like most health information exchanges, Maine's is young. It began as a collaborative study in 2004, when an array of public and private healthcare organizations joined forces to determine whether the state was ready, in terms of both potential infrastructure and organizational interest, to build a statewide HIE.

Out of that discussion came a larger, stakeholder-based process, the goal of which was to develop a more thorough understanding of what it would actually take to develop an effective HIE. That discussion resulted in the establishment, in early 2006, of HealthInfoNet, an independent, non-profit organization dedicated to developing and sustaining that HIE.

Two years later, the organization launched its first demonstration project, connecting the state's largest providers. The project, which concluded successfully last year, collected approximately 50 percent of all healthcare activity across the state.

Maine, in fact, now has more than 800,000 individual records in its secure central repository, which accounts for about 67 percent of the state's population. Conveniently for the state, most of those people reside either in the southern end of the state or clustered elsewhere around larger communities.

HealthInfoNet expects to sign at least another 10 providers by year's end, said communications manager Amy Landry. But the relatively easy part of bringing providers into the network is over.

According to a survey completed last year by researchers at the University of Southern Maine's Muskie School of Public Service, 46 percent of Maine's ambulatory care providers do not have an electronic health record. Not surprisingly – and as in many other rural regions across the country – the majority of those providers are small and scattered across the state's more isolated counties.

In addition to being Maine's sole, state-designated HIE, HealthInfoNet is also one of the nation's 62 federally-funded Regional Extension Centers. So as it works to help providers who do have EHRs get connected to the Maine network, it also will be helping other providers make the perhaps more challenging transition from paper to electronic records.

City Lights: Bronx RHIO

For Maine healthcare stakeholders, the ultimate goal is to develop a single HIE that will connect all of Maine's 1.3 million residents – who also happen to live in a state that is 97 percent forest. Such figures might bring a smile to the faces of participants in the Bronx Regional Health Information Organization (BronxRHIO), seeing as how that one New York City borough has a population of 1.4 million.

BronxRHIO already serves approximately 85 percent of the Bronx's medical community, said Charles Scaglione, BronxRHIO's executive director.

In the Bronx, most doctors are employed by institutional providers such as hospitals, community health centers, long-term care providers and home care providers. Naturally, the organization is looking to continue expanding its membership, but Scaglione said a decision was solidified at the beginning to "make sure we have enough data in the system to make it worth the (smaller providers') time to come look."

BronxRHIO got its start in 2004, with initial funding coming from that year's Health Care Efficiency and Affordability Law (HEAL) for New Yorkers Capital Grant Program. Unlike HealthInfoNet, BronxRHIO is not New York's only HIE.  Rather, it's one of a dozen RHIOs covering the state, from Buffalo to Long Island.

Currently, cross-RHIO exchange of information is not possible, but Scaglione said BronxRHIO is working with the four other RHIOs in the New York City area on planning an information exchange pilot project.

Scaglione pointed out the irony that while the Bronx has a largely "poor population with high rates of bad health," its preponderance of large, institutional providers gives it an "incredibly high EMR penetration rate."

Indeed, BronxRHIO doesn't encounter many providers who haven't moved from paper records to EHRs, and most of the large BronxRHIO members have the capability for patient portals, but Scaglione said discussions are still underway as to whether patient portals should be specific to institutions or shared across the BronxRHIO network.

Perhaps the largest single difference between BronxRHIO and HealthInfoNet is that the Bronx organization is involved in broader, regional and national health information network discussions by dint of its membership in the statewide New York eHealth Collaborative (NYeC). A public/private entity, NYeC received and administers federal HITECH funding, and to it falls the task of developing connections between New York's RHIOs and HIEs in other states and regions.

CONTINUED ON NEXT PAGE