Innovative health information exchange brings world-class healthcare to rural Louisiana

Federated data model enables fast deployment, lowers costs and supports advanced telemedicine

Published on 01 Nov 2010

Validated on 16 Dec 2013

"Ultimately, we have a healthier population across a region that long suffered from lack of quality care and limited resources. Without this healthcare portal, that would not be possible." - Jamie Welch, CIO, Louisiana Rural Health Information Exchange

Customer:
LARHIX

Industry:
Healthcare, Government

Deployment country:
United States

Solution:
Smarter Planet

Smarter Planet:
Smarter Government, Smarter Healthcare

IBM Business Partner:
CareFX

Overview

Deploying a decentralized Web healthcare portal that enables 24 rural hospitals and a major urban medical center to share records and improve patient care through telemedicine.

Business need:
After Hurricane Katrina shut down New Orleans' healthcare facilities, Louisiana State Health Sciences Center in Shreveport took on the sole responsibility of caring for the state's 1.5 million rural, uninsured, poverty-line patients by teaming with 24 rural hospitals in central and northern Louisiana. They sought to leverage the Center's specialist expertise to these remote hospitals through telemedicine

Solution:
LARHIX chose Fusionfx Portal from IBM Business Partner Carefx for real time data sharing between hospitals to deliver a single, unified view of a patient’s medical record. The solution runs on IBM WebSphere Portal and uses a federated data sharing model that aggregates a patient’s comprehensive medical record from different hospital systems without moving any data from native applications – thus avoiding prohibitively complicated and costly patient privacy requirements.

Benefits:
Improved quality and continuity of patient care • Reduced duplicate testing by 93 percent• Slashed time to specialist consultations from weeks and months to just days• Shorter hospital stays and fewer admissions save millions of dollars• No investment in new systems required, enabling fast roll out and low deployment cost.

Case Study

As healthcare facilities around the country seek to share patient data electronically to improve care and cut costs, they typically confront the same barriers involving data ownership, disparate information systems, privacy and security. The traditional approach of centralizing patient data to enable data sharing is particularly fraught with these challenges.

In Louisiana, a coalition of hospitals that faced an urgent need to improve rural healthcare overcame these barriers with an innovative federated data-sharing strategy and Web portal solution that serves as a model for any organization seeking to link diverse systems and provide real time access to complete patient medical records.

A strategy to provide remote specialty care
Providing quality healthcare to rural populations is always a challenge, but in Louisiana it had become particularly acute. Much of the state’s rural population lives below the poverty line and is uninsured or on Medicaid and isolated from quality care. Specialists are particularly scarce in rural areas.

The situation worsened in 2005 when Hurricane Katrina shut down New Orleans’ healthcare facilities. The Louisiana State University Health Sciences Center in Shreveport (LSUHSC-S) became the state’s sole Level One specialty care facility serving uninsured patients and quickly became overwhelmed.

Faced with this scenario, LSUHSC-S partnered with 24 rural hospitals across central and northern Louisiana to create the Louisiana Rural Health Information Exchange (LARHIX) and improve access to specialty care across the region.

LARHIX sought to enable rural patients to visit their local hospitals and receive remote clinical evaluations from LSUHSC-S specialists via telemedicine. To make this strategy viable, however, LARHIX needed to link its member hospitals online and provide doctors with access to a single, aggregated view of a patient’s record (considering that many of the region’s patients visit multiple medical facilities and thus have fragmented medical histories).

“It simply didn’t make financial and clinical sense to offer telemedicine without a cutting-edge health information exchange,” said Jamie Welch, LARHIX CIO. “When a specialist in Shreveport is evaluating a patient remotely and needs to make a clinical decision, he requires an immediate, accurate, longitudinal view of the patient’s record.”

Disparate databases, one patient record
LARHIX chose Carefx, developer of the Fusionfx suite of healthcare workflow solutions, with headquarters in Scottsdale, Arizona, to build a Web portal that provides real time data sharing between its member hospitals and delivers a single, unified view of a patient’s medical record.

The Fusionfx solution, which runs on IBM WebSphere® Portal, uses a federated data-sharing model that aggregates a patient’s comprehensive medical record from across heterogeneous hospital information systems without moving any data from its native applications. The more common centralized data repository demands that data be moved, replicated or modified in order to provide a single view, meaning greater risk of security, privacy or confidentiality breaches.
“Keeping the original data in place enables each organization to maintain ownership and control and thereby eliminates the data ownership issues that continually stall health information exchange efforts,” Welch said. “With the Carefx solution, thanks to the network across the region, physicians now can interact with a single, virtual view of patient data that continues to reside in multiple databases.”

WebSphere Portal is crucial to enabling that view. “This healthcare portal is used 24/7, so reliability, stability and security were crucial factors in choosing WebSphere for this implementation,” said Karen Friedrich,
vice president of strategic alliances at Carefx.

With a federated model, no investment is required in new systems and no changes to legacy applications, which saves money and enables fast roll out. To date, LARHIX has brought 14 of its member hospitals online, each in a matter of months.

Data delivered in clinically-relevant workflows
The portal delivers a comprehensive view of patient data in a clear, clinically-relevant workflow that doctors can access whenever and wherever needed. The real-time view may include a full history of lab results, prescribed medications, radiology images and reports, allergy information, input and output data, and clinical notes and instructions from various doctors.
“The solution has the intelligence to gather data from multiple locations and present it as a flowchart so doctors get the most logical, clinically beneficial view possible,” Friedrich said. For example, rather than have to look over various dates to assess lab results, the solution presents a flow sheet of all lab results across one screen--allowing doctors to readily see critical trends. Likewise, it can present all vital signs, pulled from all hospital locations and visits, trended over time.
The portal also provides powerful analytics. In the next phase of its development LARHIX will implement a dashboard to help manage chronic diabetes, which has a huge incidence in Louisiana. The dashboard will allow patients to enter their home glucose test results and doctors to monitor and analyze trends in those results.

It will also provide automated alerts to help keep patients on schedule with crucial testing, treatments and appointments.

Profound impact on availability, quality and cost of care
The Carefx and IBM portal has enabled LARHIX to significantly improve access to specialty care, via telemedicine, across rural Louisiana, and improved patient outcomes. The solution enables more immediate specialty care and better continuity of care, since primary care physicians can now instantly see discharge notes and results from specialists so they can provide proper follow-up care, and specialists can continue to monitor their patients remotely.

“The portal solution helps provide the option of telemedicine to more than 1.5 million rural Louisiana residents,” Welch said. “Patients in this medically underserved region finally have local access to radiologists, cardiologists, neurologists and other specialists.”

Because physicians can now see a patient’s complete medical history, the solution has resulted in a 93 percent reduction in duplicated testing at participating hospitals. “Reigning in testing will have a profound financial impact at our hospitals, ultimately saving millions of dollars on unnecessary imaging and laboratory investigation,” Welch said.

Prior to the portal, rural residents often waited weeks or even months to see a specialist in person in Shreveport, and may have traveled as many as 200 miles to do so. Now, a remote specialist consultation can take place within 24 to 48 hours of the general physician’s request, in the patient’s community.

The telemedicine capabilities that the portal supports have shortened patient stays at LSUHSC-S and improved bed availability since the hospital can now discharge patients sooner and provide follow-up care remotely. Shorter stays and reduced admissions have yielded significant budgetary savings.

“Ultimately, we have a healthier population across a region that long suffered from lack of quality care and limited resources,” Welch said. “Without this healthcare portal, that would not be possible.”


The Inside Story: Getting There

Seeking a Completely, Truly Federated Solution

To speed the implementation of its health information exchange and avoid the obstacles that often derail such initiatives, the institutions that comprise LARHIX agreed early on to use a feder­ated approach to sharing patient data.

“If we had opted for a centralized data-sharing model, it would have taken two to three years just to work out the data repository,” said Jamie Welch, LARHIX CIO. “Given Louisiana’s healthcare crisis, we didn’t have time for that.”
Carefx won the bid to build the LARHIX portal as the the only company to propose a true federated system--with a solution that provides an aggregate, scalable view of patient information without moving data from native systems.

“Carefx uses absolutely no centralized data repository in any way, shape or form,” Welch said. “That was the clincher for us.”
LARHIX issued a request for proposals that stipulated a federated data solution and received over 16 responses. While many vendors claimed to use a federated model, all but Carefx in fact submitted solutions that would have pulled data and temporarily cached it, creating the same privacy, security and data ownership problems experienced with a central repository.

Smart is...
Deploying a decentralized Web healthcare portal that enables 24 rural hospitals and a major urban medical center to share records and improve patient care through telemedicine. Faced with a crisis in providing adequate specialty care to poor rural residents, the Louisiana Rural Health Information Exchange (LARHIX) engaged Carefx, a Premier IBM Business Partner, to build a portal to support an ambitious telemedicine initiative across northern Louisiana. The portal enables doctors to view a single, real time patient record aggregated from the disparate databases used by the hospitals, enabling them to provide diagnosis and treatment based on the most complete, accurate medical data available. The solution provides a logical, clinically beneficial view of all lab results across one screen--allowing doctors to readily see critical trends. It can also present all vital signs, pulled from all hospital locations and visits, trended over time. The joint portal and telemedicine initiatives have dramatically improved the availability of speciality care in rural Louisiana, slashed duplicate testing, and relieved hospital overcrowding and budget pressures.


Components

IBM products and services that were used in this case study.

Software:
WebSphere Portal

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