Dr. Lisa Simpson, a pediatrician and medical school professor at the University of South Florida Health, and her colleagues had been collaborating with local health care providers and businesses in Tampa on the development of a personal health record for pediatric patients when they reached a new conclusion. In addition to improving children’s health care, a platform made to embed child health care information could benefit the entire community.

That’s because a rise in childhood asthma, for instance, may signal weaknesses elsewhere in the community health care supply chain. “If a child is hospitalized for asthma, it may indicate that primary care is lacking or not as good as it could be,” Simpson said. She emphasized the importance of developing and monitoring child health data.

She sees a broader purpose to the effort, too. “Children have different demands from the health care system, and the data needs for children’s health are complex. If we build around pediatric needs, that effort can help us build the technology to serve the rest of the population.”

Tampa’s integrated community care is the product of collaboration by the Florida Health Information Network (FHIN), the state’s Health Information Infrastructure Advisory Board and the Agency for Health Care Administration (AHCA), which helped connect the south Florida effort to others in the Tampa community. A year-long planning process yielded collaboration by multiple providers.

“During the planning process, we all started looking at the challenge from the perspective of not just moving data but improving outcomes,” Simpson said. “This makes it exciting as a clinician. Of course, trying to work through the multiple policies and processes of business, academic and government organizations takes time, and that was the purpose of the planning.”

The Tampa Bay Regional Health Information Organization (RHIO) is now a building block for the statewide network. The Tampa Bay Partnership Regional Research and Education Foundation collaborates with the University of South Florida Health, which includes the colleges of Medicine, Nursing and Public Health, and more than a dozen public and private health care, government and business organizations.

Competitors collaborate
In Florida, RHIOs are the intermediaries between community health care providers and FHIN. The RHIOs manage relationships with health care providers to provide data. RHIOs now exist in Tampa Bay, Miami, Big Bend and Pensacola.

“Collaboration was the main vision, and that’s exactly what is happening,” said Lisa Rawlins, who as chief of AHCA’s Center for Health Statistics manages the FHIN infrastructure. “We are seeing collaboration among competing health care providers.”

The participants envision a Web-based statewide network that integrates communications and data transfers among local RHIOs, establishes standards, and exchanges information among authorized health care providers. The network will provide grants to community projects in different areas of the state and develop a statewide infrastructure that will ultimately link the communities.

“We need to bring doctors and nurses the infrastructure to do their job,” Rawlins said. “Once this is implemented, quality of care will be increased throughout Florida.”

Like other e-health initiatives, FHIN has a goal of developing electronic health records (EHRs) for patients and reducing health care costs. The multiple collaborative projects in the state are producing benefits for technology initiatives and clinical practices.

The Tampa Bay RHIO is nearing the end of an intensive six-month development of a technology architecture to provide improved access to health care information. It is creating technical and clinical pathways to improve the quality and availability of health information for early intervention and disease management for people with three specific diseases: adult diabetes, childhood asthma and prostate cancer.

Tampa Bay uses Gold Standard’s eMPOWERx, a secure wireless patient care and e-prescribing software for Medicaid that integrates with personal digital assistant and Web-based interfaces. A server maintains a master index of patient records, and Web services enable the transfer of records for continuity of care.

Good governance
A critical catalyst of Florida’s health information network is a 12-member Health Information Infrastructure Advisory Board composed of health care providers and information technology and health care policy experts.

In its 2005 interim report, the advisory board recommended that AHCA use grants to facilitate development of EHRs and FHIN. Only 10 percent of the state’s practitioners use EHRs. The grant program provides money to initiate RHIOs and encourage health care practitioners to actively use EHRs.

The FHIN program provides grants to health-related institutions and organizations to plan, deploy and evaluate interoperable health information exchange projects in clinical settings. The program does not support the selection and installation of an EHR system or a laboratory reporting system. Florida-based not-for-profit organizations and institutions, universities and colleges, local government units, and public health departments are eligible to apply for grants.

The advisory board also recommended that AHCA create workgroups to develop clinical datasets and identify necessary data fields.

Planning and implementation projects promote health information exchanges among two or more competing provider organizations. They also demonstrate information sharing among physicians and other health professionals in the course of patient care. Training and technical assistance projects should increase the number of physicians and other practitioners who use EHRs.

In addition to recommendations for grant selection criteria and a timetable for implementing and evaluating test programs, the advisory board said the state legislature should establish a public/private organization to set standards for the statewide network and complete its development.

“Florida is a model that other states can emulate,” Rawlins said.