When asked what a powerful health information exchange (HIE) is built upon, one might immediately think of computer accounts, files upon files of paper medical reports converted into megabytes, laptop, screens and data synapses sparking the air between them.
When Anjum Khurshid, director of the Crescent City Beacon Community (CCBC) and director of the Health Systems Division at the Louisiana Public Health Institute (LPHI), is asked this same question, he draws upon another concept entirely: the idea of "trust capital."
LPHI launched Greater New Orleans Health Information Exchange (GNOHIE) in November 2012. The exchange is still growing, but it's composed of more than 250,000 individuals and a range of primary and hospital providers. The exchange has introduced an entirely new level of collaboration throughout the healthcare community, says Khurshid, as it's increased the collaboration between a patient's care providers, and it is proving to be a tool in the elucidation of population health trends.
The success of the Greater New Orleans HIE is founded in trust, says Khurshid – and a foundation of trust has been solidifying in the Greater New Orleans health community for some time now, explains Karen DeSalvo, New Orleans City Health Commissioner.
Selected as a Beacon Community in 2010, LPHI and the community's federal and health leaders have been working with primary care providers in promoting innovation in public health and collaboration among staff and patients.
The results have been initiatives tied to the Beacon program like txt4health, a text-based system focused on diabetes management, as well as the employment of Care Management and Care Team Strategies to provide focused and efficient care for patients with cardiovascular disease and diabetes.
This sort of collaboration among consumers, designers and providers in the changing and growing field of New Orleans' health served as a powerful first stone in the path to completely integrated data sharing in the area. As with the other Beacon initiatives, hospital and primary practice staff members, consumers, and other leaders and participants in the community worked alongside LPHI as members of an advisory board. The groups worked together to forge an HIE that reflects provider workflow, and respects patient desires and privacy.
"They've been engaged from the very beginning. We told them from the start that we needed their support in order to be successful," said Nebeyou Abebe, project manager for CCBC, and associate director of LPHI's Health Systems Division. "This is not an LPHI initiative; this is a community initiative. I think that's one of the reasons we've been so successful."
"In our case we've had a tremendously positive reaction from the physicians," said Khurshid. "This is demonstrated by the fact that we accomplished a full operation of the exchange over a short period of about six months." The functionality included setting up the technology and testing it with clinical settings, and putting in place policies around how the information will be shared, who will have access to that information, and how the information will be secured to maintain patient privacy and confidentiality.
Primary care providers are strongly integrated into the HIE, and the exchange has already begun to streamline care transitions and provide physicians with deeper, valuable medical profiles of their patients, but Khurshid and DeSalvo are looking to put the exchange to greater use in the coming quarters.
They cite a need for the integration of a patient's behavioral health with his or her medical profile. In some cases, privacy and legal issues prevent this synthesis; Physical health providers are often prevented from engaging with a patient's behavioral health record through an exchange.
"We have worked with the city health department and Dr. DeSalvo and our community partners to start implementing health projects that try to bring behavioral health data with medical data," said Khurshid, emphasizing the importance of holistic health records to ensure proper, whole care for an individual.
DeSalvo, too, is looking to improve the cost system surrounding the exchange. She hopes to delineate the ways that HIEs can generate clear returns on investment, and grapple seriously with: "Not just how are we going to pay for it, but how are we going to make it something that saves the health system money, as opposed to just adding cost?"
Abebe, Khurshid and DeSalvo agree that these changes will come – especially through the collaboration that marks the Greater New Orleans community. LPHI is looking ahead to working continually with advisory boards, increasing consumer engagement and the overall addition of "trust capital" to generate the care practices that the community is asking for.
"In each of the areas of people, processes and technology, we have challenges," said Khurshid. "The most important challenge to address is people, because people have to change. People change when they see the value. In order to work together they have to have trust. But you can choose to call this a challenge or an opportunity."
