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Pioneering rural health care via Internet

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A small Duluth non-profit is making health care history by carrying out President Obama's idea of using health information technology to improve health care delivery and cut costs.

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Previously, it did what President Bush called for when it formed a regional health information group to promote collaboration between the various institutions concerned with health care in that region.

Now, using the new National Health Information Network standards for connectivity, developed by federal agencies and technology experts, it is pioneering in linking institutions via the Internet so that needed medical information can be exchanged securely while guaranteeing patient privacy. Time, money and even lives will be saved.

And all this in a rural area filled with lakes, forests, farms and five Indian reservations -- 30,000 square miles averaging 22 people per square mile. Many are lower income and older, on Medicare and Medicaid.

The more affluent live in small cities or on lakeshore properties.

In 1997, Community Health Information Collaborative brought together representatives of county and Indian public health agencies, hospitals, clinics, long-term care groups, doctors and academia in an 18-county area stretching from the Canadian border to the far northern suburbs of the Twin Cities and west from Duluth. The goal was to promote sharing of information between institutions using the new electronic technology.

It wasn't easy. Doctors and hospitals were using paper records and the telephone. X-rays had to be hand carried from one place to another.

Results of medical tests were either sent by fax or the test repeated -- and the government or insurance company billed -- when a patient went from one institution to another. Parents had to keep track of their children's shots -- or go back and find records to present for school immunization records. Patients drove miles to see a doctor, farther to a hospital.

Today CHIC has 375 sites sharing immunization data -- schools, public health agencies, hospitals, clinics, and long-term care facilities. This is a ready platform and model for the area's participation in national emergency preparedness and in tracking epidemics such as swine flu.

This summer CHIC is launching a pioneering project called HIEBridge, pronounced "high bridge," the name a take-off on the bridge that spans Duluth to Superior under which ore boats and other Great Lakes vessels traverse around the Duluth harbor.

Written, HIEBridge denotes a Health Information Exchange bridging distance through technology to provide timely and quality health care efficiently at less cost.

Starting with 11 sites -- hospitals and a long-term care facility all using a variety of internal computer programs -- authorized people clicking a few computer keys can obtain needed, occasionally crucial, information on a patient, sometimes even before the patient arrives.

Is the injured person arriving in an emergency room allergic to any medications or latex; is she diabetic? Has he or she had a tetanus shot lately? What illnesses or disabilities does the aged -- perhaps even demented -- person arriving at a nursing home have and what medications have been prescribed for him? Is he on Medicaid as well as Medicare?

Patient privacy is guaranteed. No central data base of medical information is being created. Only a limited number of authorized people at each CHIC site can pose such questions to another authorized agent at a collaborating site. Questions and answers are limited to needed information on a specific patient or client.

Patients can "opt out" of this system but few do. They understand medical records stay where they are; only relevant bits of needed information are transmitted. A doctor referring a patient to a specialist over a hundred miles away may need information from that specialist on recommended follow-up treatment.

When fully operational, 18 hospitals, some with affiliated clinics; three Indian tribal health services; and a health care group with a number of sites are expected to be part of the initial project. CHIC's goal is to connect all its member organizations.

"It's all about consumer empowerment, making health care available to all, wherever they live or work, while saving time, money and, in some cases, lives," Dr. Cheryl Stephens, CHIC's executive director of CHIC said recently. "What's exciting is that a small nonprofit in Duluth serving a sparsely populated area can help shape the future of effective medical record use across the country."

Arvonne Fraser is a senior fellow emerita at the University of Minnesota's Hubert H. Humphrey Institute of Public Affairs.

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