PROVIDENCE – In the world of health care, the role of the Rhode Island statewide health information exchange, known as CurrentCare, owned and managed by the Rhode Island Quality Institute, keeps evolving.

The nonprofit organization, founded in 2001 under the guidance of Sen. Sheldon Whitehouse when he was the R.I. Attorney General, was one of the pioneers in creating a statewide secure electronic database to enable medical records to be stored, shared and accessed, all while preserving a patient’s privacy.

The goal was to improve the delivery of health care by facilitating the integrated flow of electronic health data records for laboratory results, care coordination and medication histories across numerous platforms – including hospitals, nursing homes, group practices, community health centers and emergency rooms.

The initial challenge was to enroll patients, given the state requirements that residents had to opt into the system.

Another early challenge involved creating interoperability for CurrentCare data with the numerous competing electronic health record software systems, as well as easy access to logging onto the data.

A further challenge was then to create a sustainable revenue flow from federal and state sources – as well as private health care industry sources – to keep the organization current with the rapidly changing dynamics of health IT.

Now, approaching its third decade, the Rhode Island Quality Institute is lending its expertise to create data dashboards to facilitate better flow of data to help providers and patients communicate with each other in real time, with alerts.

It is also building a database to track social disparities in health care in Rhode Island, funded through the State Innovation Model initiative.

And, the Rhode Island Quality Institute is about to sign a contract with the state to bring all the statewide Emergency Medical Services data into CurrentCare.

At the helm
Laura Adams is the long-time president and CEO of the Rhode Island Quality Institute, whose core values include collaboration, innovation, passion, persistence and results. The board of directors of the organization is a veritable who’s who of health care corporate leadership in Rhode Island, including CEOs from hospitals and insurers, the health insurance commissioner, and the secretary of the R.I. Executive Office of Health and Human Services, among others.

ConvergenceRI recently sat down to talk with Adams to learn about some of the latest developments at the Rhode Island Quality Institute.

Adams began the conversation by praising a recent article in ConvergenceRI, written by Ian Knowles, the project director at RICARES, which laid out a detailed analysis of different approaches to implementing a harm reduction strategy. [See link below to the ConvergenceRI story, “A strategy of reducing harm and saving lives on the road to recovery.”]

[Under the Australian approach to harm reduction, the two basic components are pragmatism, providing polices and services that are effective, and a respect for the human rights of the persons who are using drugs, according to Knowles. It seeks to meet people where they are; it is tailored to the needs of the individual; and it is non-judgmental in its approach.]

“I opened up the story and began reading and I couldn’t leave it until I had finished. It showed how we need to be thinking differently,” Adams said.

Adams said she was particularly intrigued by the description of the harm reduction strategy as practiced in Australia, and wondered if there was a way to create a community conversation around it, to compare and contrast outcomes with what is being done in Rhode Island.

“One of the things that I learned from traveling with W. Edwards Deming [one of the early pioneers in quality and systems thinking], who was my mentor,” Adams explained, “[concerned a phrase] he kept using with me, which at first I didn’t get: a fish doesn’t know that it is in water.”

What he was trying to tell her, Adams continued, was that she was too absorbed in her own surroundings to see what was happening. Deming suggested that Adams bring a biomedical colleague to do an assessment of the family ICU waiting room at the hospital where she was working.

A few years before, the waiting room had been redone to make it more family friendly, according to Adams.

The first thing her colleague pointed out was the sign, which read: “Vandals will be prosecuted.” Adams had insisted that the sign be put up after a patient had vandalized a plant in the newly redone waiting room.

Adams said she quickly recognized that the sign was ill-advised in the effort to make the waiting room more family friendly; but for years, she had never really “looked” at the sign, even thought she had passed by it almost every day.

She said she then understood what Deming had been trying to tell her – that a fish doesn’t know that it is in water.

“[When it comes to harm reduction], I think we’re going to have a really difficult time thinking our way out of our own box,” Adams said. “I think that by introducing the Australian strategy, for example, it could help us see some entirely different ways of thinking about the problem [of substance use and addiction]. It could be one of the most productive ways that we could spend community time in conversation.”

Expanding access to new data sources
One of the upcoming initiatives that the Rhode Island Quality Institute is planning to undertake is to bring all the data from the statewide Emergency Medical Services system into CurrentCare, which is expected to begin in the next few weeks once a contract is signed with the state.

Under a Center for Medicare and Medicaid Services program, the contract involves what is known as a 90-10 match, with the federal government providing some $900,000 in matching funds.

As a result, Adams explained, using the example of someone who may have overdosed, when that patient is transported to an emergency department, the hospital staff can click on an icon on the dashboard and, for the patient that has consented, “reach in and grab any opioid-related information” that resides in CurrentCare about that patient.

At the same time, Adams cautioned about expectations and the ability to drill down on the data initially.

“I don’t know what the data will look like,” she said. “Usually, in the beginning, when it comes in, it’s a big mess, and we have to figure out how to organize the data.”

Because they haven’t see the data yet, and they do not know what it will look like when it begins to flow in, and because they won’t have access to see the data until the contract is signed, Adams was reluctant to put any timeline on when the Institute will be able to knit the data together.

“This is imminent,” Adams said. “We’re excited about the opportunity to bring in all the EMS data.”

The future of Big Data in health care
When asked about how much of the merger between CVS and Aetna might be being driven by the potential to combine and mine their existing databases, Adams called it a very plausible theory, but she said she did not know for sure.

“When I look across industry now, I don’t know of an industry sector that is not [investing] in their future based on their ability to gather, analyze, synthesize and overlay data with things like predictive analytics and artificial intelligence,” Adams said.

In terms of health care, however, the complexity of the challenges can prove to be daunting, she continued.

“For health care, when you think that there is a terabyte of data in a blood sample, it’s just an incredibly complex undertaking to do that,” Adams said. “We often get compared to credit care transactions. Well, that’s really simple compared to the challenges we have in sharing data.”

After you get all of the data, Adams continued, there is a need to know what to do with all of that data and where it is going to take us. “I think that is the question of the decade.”

Family and caregiver alerts in real time
One of the projects undertaken by the Institute that Adams said she was most proud and happy about is the ability to connect, in real time, with family members, when they are expressly designated, when they have been admitted or discharged from a hospital or emergency room.

An emergency contact, she explained, is not a legal permission to inform someone about your condition.

In response, the Rhode Island Quality Institute has developed a program with designated alerts, which it launched in 2017.

“When someone is being treated – it could be a woman in a nursing home who wants her daughter to know if she has been admitted to the hospital – they can freely designate anyone of their choosing to receive one of these immediate, real-time alerts, on the device of their choosing,” Adams said.

What has been the response?

Adams said that they have done a “soft” launch – there were not a lot of designee alerts, probably under 100 currently. “We’re going back to ask and to better understand: how did this work for you? And, what do we need to do to improve it.”