The Promoting Rural Health Care Quality through the Effective Use of Information Technology project aims to ensure that rural and safety net health care providers can participate in the development of regional, state, and national health information exchange (HIE) initiatives that will benefit underserved rural communities.

In 2006, the Northern Sierra Rural Health Network (NSRHN) conducted a comprehensive assessment to identify how the use of health information technology could improve the health care delivery systems of community clinics, rural hospitals, public health and private health care providers across a nine-county, sparsely populated region of Northeastern California. As a result of the NSRHN survey and assessment three health information exchange applications were identified as priority areas:

• Electronic Prescribing (ePrescribing between providers and pharmacies)
• Regional Disease Management (diabetes registry for disease management)
• Remote Access to Health Information (web portals to patient information)

With funding from the Blue Shield of California Foundation, the goal of the Promoting Rural Health Care Quality project is to create a regional, coordinated health information exchange system. Clinicians will receive tools that will enable them to utilize health care information technology to improve health care quality, impact reimbursement rates, and result in more efficient patient management systems.

Medical providers across the region typically struggle with the inability to share health information even with their closest neighbors, e.g. local hospitals and clinics. This results in providers’ inability to access critical health information such as medications that may have been prescribed by other physicians, creating the potential for adverse treatments or drug events. (1) Although providers may have access to such tools, they may not be able to exchange health information with other health care organizations and suppliers. For example, a provider with electronic prescribing (eRx) capabilities may be limited by the local pharmacy’s inability (or unwillingness) to receive electronic prescriptions. In other cases, immunization and disease registries (e.g. diabetes) are in place, but are not compatible with other facilities’ systems, resulting in the inability to aggregate and/or share this information.

For these reasons, clinics, rural hospitals, public health departments and private providers across the NSRHN region have agreed to partner to ensure the safe, secure and effective exchange of health information through three pilot programs with the following benefits:

ePrescribing
• Improved workflow and communications between providers and pharmacies
• Reduction in number of prescription errors
• Reduction in number of Adverse Drug Events (ADEs)
• Proactive means of addressing the problem of drug-seeking behavior across the Northern Sierra region

Regional Disease Management Registry
• NSRHN-specific tools for gathering and reporting on population-based diabetic clinical measures and outcomes
• Reporting on four clinical diabetic measures for up to twelve providers on a regional basis
• Training and support for eight clinics to collect and report chronic disease data as part of the Accelerating Quality Improvement through Collaboration project
• Improved adherence to evidence-based treatment of diabetes and controlled diabetic outcomes
• Greater opportunity for patients with diabetes to self-manage their disease

Remote Access to Patient Health Information
• Web portal enabling clinics and physicians with access to patient health information (PHI) from urban hospitals
• NSRHN-specific toolset, e.g. technology resources and legal agreements, to facilitate the extension of a web portal to providers
• Increased ability for transient patients, or those in rural or frontier areas, to receive treatment remotely or at specialized facilities

The goal of the NSRHN health information exchange (HIE) program is to improve the health of underserved rural communities through better access to information. Although there is a clear value proposition for HIE, NSRHN members have valid concerns and questions, such as, “Who will have access to my health information, and how will it be used?”

Consumers can be assured that thorough security measures will be taken to ensure the privacy of their health information. PHI used in these programs will be exchanged within the parameters of HIPAA (2), and will be transmitted in a secure and encrypted manner. Medical providers will be the only program participants with access to PHI, and will have access solely for the purpose of treating their patients. PHI viewed by organizations for the purpose of piloting the specific HIE programs will be shared in de-identified and/or aggregated form. Electronic prescription information transmitted between physicians and pharmacists will be encrypted. Diabetes information will be shared among participating organizations as de-identified, aggregated population-based data for the purposes of improving population health and adherence to evidence-based treatment. PHI made available through remote hospital portals will be made accessible only to those health care providers who require information for patient treatment.

Pilot program participants include:
• Diabetes Disease Registry: Siskiyou Family Healthcare, Inc. Karuk Tribe of California, Canby Family Practice Clinic, Fairchild Medical Center, Miners Family Health Clinic, Sierra Family Medical Clinic, Seneca Healthcare District, Southern Trinity Health Services, Surprise Valley District Hospital, Tahoe Forest Health Services, Warner Mountain Indian Health, and Western Sierra Medical Clinic
• ePrescribing: Hill Country Community Clinic, Mercy Medical Center, Mt. Shasta, Fairchild Medical Center, McCloud Healthcare Clinic, Plumas District Hospital and Siskiyou Family Healthcare, Inc.
• Remote Access to PHI: Shasta Regional Medical Center and Mercy Medical Center in Redding.