Colorado Medicine

by Sara Burnett

A typical day at Foresight Family Practice in Grand Junction used to start and end with Gregory Reicks, DO, up to his eyeballs in patient charts–some with lab results a week or more old and the paperwork often a less-than-complete record of the patient’s medical care.
But since the launch of the Quality Health Network (QHN), a nationally recognized regional health information network conceived by local physicians, a typical day is much different.
The paper charts are all but extinct. Instead, Reicks logs on to QHN just as he would log on to his e-mail. In his inbox he finds the results of tests he has ordered, most as recently as the previous day. He also finds notes from physicians from other practices or one of the city’s two hospitals who have seen his patients. Some visits Reicks may have been aware of, some not.
If a patient’s cholesterol is too high, Reicks can send the report to his medical assistant and ask her to contact the patient to discuss it, all with the click of a mouse. Another click and he can see every test that patient has had in the past three years.
“It’s quite a system,” says Reicks.
A collaboration between the Mesa County Independent Physicians Association (IPA), Rocky Mountain Health Plans (RMHP), and St. Mary’s and Community hospitals, QHN went live in 2005.
Since then, area physicians–more than 90 percent of whom are connected to the network–aren’t the only ones who have taken notice.
Earlier this spring, an adviser to the U.S. Senate Finance Committee helda teleconference with QHN leaders to learn more about the network.
Colorado’s Center for Improving Value in Health Care, or CIVHC, is also looking to QHN as an example of how to cut costs while improving quality of care. And Michael Pramenko, MD, former president of the Mesa County Medical Society and current co-chair of the CMS Physicians’ Congress Matrix Reform Plan Work Group, says he is pursing QHN as the template for CMS to use in its health care reform model.
“It’s a great model for how to at least get cranking with electronic connectivity,” says Pramenko. “And I think a lot of people around the country agree.”
How they did itThose involved with QHN say it was a long-standing spirit of collaboration that got the network off the ground.
That collaboration occurred, in part, because just about every doctor in town is a member of the Mesa County IPA, the provider network for RMHP, says Reicks. Others say it’s a natural outgrowth of being in a rural area. Separated from metro Denver by the Rocky Mountains, physicians here have always had to depend more on one another.
QHN Executive Director and CEO Dick Thompson credits the physicians and their willingness to investigate new ways to improve patient care and efficiency. “There are great physician leaders in Grand Junction,” says Thompson, “and they’re not afraid to try something new.”
Reicks says the conversation that sparked QHN started about 15 years ago. Mesa County IPA physicians started talking about how nice it would be to have one place for information about patients who see specialists or other primary care providers. It was around the advent of the Internet, so the possibility was there. But it still was too early, and Reicks says none of the early attempts really took off.
About three years ago, they decided to try again. The Internet had matured, as had the health information market. Funding was secured through Mesa County IPA and RMHP, and a beta site was selected.


From there, the network took off. Today it serves western Colorado and eastern Utah. As of February, there were 1,569 licensed users from 84 different organizations, including home health care, hospice, mental health providers and the public health department. In just the first two months of 2009, there were more than three million requests of the server.
How it worksQHN is a Web-based network, so once a physician has an authorized user account and password, he or she needs only an Internet connection to access it. The system is replicated, with a set of servers in California as well as Grand Junction, in case one set goes down.
Twenty-three sources of data feed into the network. The information includes laboratory results, emergency room notes, medications, discharge summaries, progress notes, radiology and surgical notes.
“We’re Federal Express on steroids,” says Thompson. “Nearly anything clinical that might be part of a medical record, we’re directing that data, pursuant to physician order, where it needs to go.”
Thompson says that roughly the first eight months of QHN’s existence, before the network went live, were spent working on privacy issues.
Any person requesting access to the network must file an application, which is processed and validated by QHN. Users are assigned a use level, with physicians having the most access, as well as a username and password. QHN monitors every keystroke. Just like FedEx, they can track everything, from who looked at a record to who moved one.
QHN has a board of directors and several subcommittees made up of leaders from all areas of the health care community. About half of its funding comes from the two hospitals. RMHP and Mesa County IPA each cover another quarter of the cost.
ResultsRMHP President Steve ErkenBrack says the investment is well worth it because it results in a better health care system.
The hospitals save money by not having to send lab results to dozens of different doctor’s offices. And when a patient comes into the emergency room, physicians can now see a full medical record, not just the care the patient previously received at that hospital.
More robust information also means fewer medication errors or duplication of tests for patients seen by different physicians or different facilities.
Proponents say the result is higher quality and more efficient care. In May 2006, a study by the Dartmouth Medical School and the Robert Woods Johnson Foundation (the Dartmouth Atlas) found Mesa County had the most costeffective delivery of Medicare services in the nation.
QHN’s next phase includes establishing more compatibility with physicians’ electronic medical records systems, so information may more easily flow in and out of the QHN repository. It also continues to work with health care communities on the Western Slope and eastern Utah to create “neighborhoods” of health information that may then be connected to the larger network.
In time, the hope is that the model will be replicated in some fashion across the state and the country. Thompson says it’s a thought process whose time has come.