Federated-model HIE Connects 16 Unaffiliated Hospitals

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When the 16 hospitals of the Western North Carolina Health Network (WNCHN) sat down to create a federated model for a health information exchange (HIE) four years ago, they could find no examples of unaffiliated institutions sharing health data, so WNCHN essentially began with a tabula rasa.

“At the time we were developing this, there were no HIEs that were being built among disparate systems, so a lot of this we set with a blank piece of paper.”
—Dana J. Gibson, MPH, CPHIT, CPHQ, vice president, Data Link Services, WNCHN, Asheville, North Carolina

imageAndrew Well, MD
imageDana J. Gibson, MPH, CPHIT, CPHQ
imageHarold Moore, CIO

Building on a federation founded to collaborate on quality-improvement goals and, later, to achieve economies through group purchasing, Dana J. Gibson and the 16 member hospitals built an HIE called Data Link, which gives approximately 1,500 physicians in the region access to admission and discharge information and to laboratory, microbiology, and radiology reports, as well as to information on patients’ medications and allergies, discharge summaries, histories and physicals, and other transcribed reports, such as consultative notes. Gibson, MPH, CPHIT, CPHQ, is vice president, Data Link Services, WNCHN, Asheville.

The next steps will be to add physician-office electronic medical records (EMRs) to Data Link and, significantly for the radiologists in the network, to provide access to diagnostic-quality medical images. “We are in the process of identifying specifications and identifying companies that would like to participate in that development and deployment,” Andrew Wells, MD, radiologist, Margaret Pardee Memorial Hospital, Hendersonville, explains.

How It Works

Data Link is surprisingly simple. WNCHN worked with MEDSEEK, a Birmingham, Alabama, software developer, to create a piece of software that sits on the hospital server and communicates with an independently hosted Data Link server.

“I envision it as a large electronic card catalog where patients have a record, and the record can occur across any of the 16 hospitals,” Wells says. “The application creates the master patient index and the locator tool that allows any provider with the proper credentials to log in, query a specific patient, and then get the results back from the card catalog saying they have events across two hospitals or six hospitals.”

He continues, “At that point, no data are pulled; it’s just that the pointers are identified, so it’s extremely fast to find the events and the history. It’s really important that so far, you haven’t pulled anything out of the host computer system: All you are doing is turning the crank on the card catalog and indexing tool. It’s extremely quick, and it’s not until you say, ‘I want to see this,’ that it actually engages the host repository or host archive to pull it out and then present it. It’s a small question and a small file, and it gets there quickly.”

Minimal Hospital IT Requirements

From the hospital IT perspective, the HIE required very little effort to implement. As Harold Moore, CIO, Margaret Pardee Hospital, explains,“They developed a little piece of software that we load on our server, which basically allows us to communicate with the hosted Data Link system.” Data Link periodically queries the hospital information system (HIS) for each of the 16 hospitals and receives some basic patient information to populate the index.

“Once a user finds the patient at, for example, Pardee Hospital, the user clicks that in Data Link, and Data Link does another query into our hospital system and extracts the appropriate data,” Moore says. “It was quick and easy for us to get up and running. We use the MEDITECH hospital system here, and we just plugged it in and did some testing; it worked out of the box very quickly. We were up and running before we knew it, so there really were very minimal requirements on our part.”

It is quick and easy by design, Wells says, because the software developers worked with the requirement that individual hospitals would not need to upgrade their equipment or software to participate.

“The thing that makes this powerful is that the umbrella was developed with the clear expectation that no hospital would change its HIS,” Wells explains. “No hospital would have to do some monstrous custom thing to participate in this federated collecting of data. The beauty of it is that the 16 hospitals have multiple HIS platforms, and the work was done to make the