Tennessee’s State and Regional Demonstration Project

The State of Tennessee, with additional funding from the Agency for Healthcare Research and Quality, is engaged in planning, implementing, and evaluating a state-based regional data sharing and interoperability service interconnecting the health care entities in the three counties surrounding Memphis in the southwest corner of Tennessee. The State has formed a consortium with Vanderbilt University to manage this Project. Completion of this project will depend on the success of governance structures that address both state-wide issues and regional control, an information management architecture that supports data sharing and interoperability, and tools to help healthcare entities incorporate standards into their local systems, thus enabling true interoperability over time.

After some preliminary analysis, the project group targeted hospitals and emergency departments in its first phase, with the following organizations as active participants:

• Baptist Memorial Health Care Corporation - 4 facilities
• Christ Community Health - (4 primary care clinics)
• Methodist Healthcare - 7 facilities including Le Bonheur Children’s Hospital
• The Regional Medical Center (The MED)
• Saint Francis Hospital & St. Francis Bartlett
• St. Jude Children’s Research Hospital
• Shelby County/Health Loop Clinics (11 primary care clinics)
• UT Medical Group (300+ clinicians)
• Memphis Managed Care-TLC (MCO)

Evaluation Overview

The project team recognizes that a successful, sustainable, and worthwhile data exchange program will improve health care in the region. Discussions with southwest Tennessee stakeholders have disclosed the following drivers motivating their involvement:

• Incomplete information increases admission rate and ED LOS
• Poor communication impacts ED efficiency
• Less patient data at the point of care impacts the rate of test ordering
• Less patient data at the point of care impacts clinical outcomes

Furthermore, exploratory analyses of claims data in our region, coupled with demonstrated savings published in the peer-reviewed literature suggest that data exchange could result in significant overall savings from reduced inpatient hospitalizations, improved distribution of ED encounter summaries, reductions in duplicate laboratory and radiology tests, and reductions in Emergency Department expenditures. These measures form our initial evaluation strategy.

• Organizational readiness
• Overall costs (personnel, training, equipment, meetings, software development, customizations)
• System usability
• System use
• Clinical improvements

In addition to data being collected from log files and other "quantifiable" sources, we plan to utilize qualitative methods to assess many of the key measures. Specifically, we would like to qualitatively assess:

1. Changes in activities conducted by clinical staff before and after the introduction of health information exchange (HIE)
2. Barriers and facilitators to the use of health information exchange tools in the emergency department
3. Value proposition of HIE to physicians and staff in the Emergency Department (ED) and how this changes over time. Examples may include:
   1. Identification of clinical conditions/ patient characteristics that would have otherwise gone undetected.
   2. Improved decision-making with more robust clinical information.
   3. Faster processing of patients with access to recent test results from other facilities.
   4. More effective triage of patients based on better clinical data.
4. Systemic/organizational impact of information from HIE, and how this changes over time. Examples may include:
   1. Design of new care plans for drug seeking patients.
   2. Development of new policies related to the use of e-Health data.

Links: Volunteer eHealth Initiative (new window).

Primary Contact: Mark E. Frisse, MD, MBA, MSc.