One of the Best HIEs in the Country

The biggest players in Billings’ health care system are working with the state’s largest insurance provider on a health information sharing pilot program that could pave the way for a similar statewide system.

Called a health information exchange, the pilot is spearheaded by Blue Cross Blue Shield of Montana and brings together St. Vincent Healthcare, Billings Clinic and RiverStone Health to create a system of safely and securely sharing patients’ medical information that they believe could help provide better and more efficient care.

“Everybody’s coming to the clear realization that information is essential to decision making,” said Dr. Jonathan Griffin, Blue Cross Blue Shield of Montana medical director. “Health information is fragmented. If you go to the doctor in one clinic and then you show up in another clinic, you have to repeat all of the same information. No one knows your history when you move from place to place.”

The health information exchange pilot in Billings is expected to go live sometime this fall. The concept has been gaining steam nationwide — and tried before at a statewide level in Montana — as federal changes to health care put more of a focus on value-based care and patient outcomes.

At its heart, the pilot aims to create an electronic medical records system to bring together useful patient and claims information from the providers and Blue Cross. It also looks to create a way to share that information across the different providers while also gathering population health data that can be used to identify trends and other group health issues.

The gathered information should help doctors treat patients more quickly because patients’ past and relevant medical history will be immediately available.

“You need to know what’s going on with patients,” said John Felton, RiverStone’s president and CEO.

Felton said the electronic records will prevent duplication of tests and services and reduce the chances of patients being treated with wrong medications.


But putting the system into place has presented challenges, chief among them ensuring patients’ privacy.

“How do you balance that immediacy of information with privacy and security?” Felton said.

Griffin said that’s where the technical design of the exchange is important.

On the privacy front, the stakeholders in the Billings effort have worked to address what information is made available and how to determine what is relevant, as well as ensuring the system allows access only when there’s a clinical need.

In addition, patients decide whether their information is shared with the other providers, although it can be used anonymously in population health data.

“We understand the importance of security, of patient privacy of information,” Griffin said.

Ensuring the data is kept in a safe place and that outsiders can’t access it is also key, said Mark Hinman, Montana division director of information systems Sisters of Charity Leavenworth Health System.

“My hopes are that the technology works the way we think it’ll work because the groundwork that we’re laying here will be very important,” he said.

That means including robust security and storage technology, the hiring of a digital security company, and a thorough vetting by all three health care organizations involved.

“This information has to uphold the absolute highest level of data and security standards,” Griffin said.

Other systems

Many of the challenges that have presented themselves since work on setting up the local exchange began almost a year ago have been at least partially addressed by a pair of other exchanges.

The pilot is based largely on and uses systems already set up for an established health information exchange in Oklahoma, called MyHealth Access. Griffin described it as “arguably the most successful in the country.” It includes about 350 partners and serves several million people.

In providing much of the framework used in the new pilot, MyHealth has helped to smooth over bumps that arise.

For example, Felton said that RiverStone, St. Vincent and Billings Clinic all use different electronic medical records management systems, meaning that even if the medical records were shared they wouldn’t be able to read them. However, MyHealth’s program and vendors already include the three systems used in Billings and have set up communication between those systems.

In addition, one of its executives is helping Blue Cross Blue Shield of Montana and the health care organizations troubleshoot any issues that arise.

“We are looking forward to seeing it come to fruition,” said Dr. Nicholas Wolter, Billings Clinic CEO.

Statewide interest

Health officials across the state will be watching the Billings project, as it could lay groundwork for a statewide exchange. Jean Branscum, CEO of the Montana Medical Association, said her organization has received a $50,000 grant from the Montana Healthcare Foundation to plan for such a system.

Like officials in Billings, she said they’ll be looking at easy access for medical staff combined with security and privacy for patients, and noted that the pilot could go a long way to showing how those can work in Montana.

“We’re thrilled about what’s going on in Billings,” Branscum said, adding her organization hopes to learn from the pilot project.

“Will it be sustainable? That’s the huge question on people’s minds,” she said. “Then the conversation will shift to, ‘How do we do this?'”

The Montana Medical Association and Montana Hospital Association are working to gather potential stakeholders for a statewide system. A forum is set for December in Helena to set expectations for a statewide exchange. Dr. David Kendrick, CEO of the Oklahoma-based MyHealth, will help facilitate.

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