implementation methodologies, confirming
technical feasibility, validating usability, and
integrating the HIE and clinical provider process workflows.
The evaluation of the demonstration returned
positive responses from the 1,000 clinical users
of the exchange network. Provider respondents
reported that unnecessary diagnostic tests were
avoided, time was saved, and patient safety was
The feedback was incorporated into a rede-
signed portal and system supported by a part-
nership of “best of breed.”
The original 2011 demonstration participants
included 50 percent of all hospital, emergency
department, and hospital-based ambulatory
visits in Maine. The health information ex-
change is anticipated to grow by 12 additional
healthcare organizations in 2011.
Thirty-one of Maine’s 39 hospitals are now
under contract with HealthInfoNet. The goal is
to have all Maine hospitals connected to the
statewide HIE by 2014 and 80 percent of all
physician practices connected by 2015.
Presently, HealthInfoNet serves more than
2,000 clinical providers and maintains over
980,000 unique health records in its central repository.
HealthInfoNet views itself as a voluntary initiative; providers and healthcare consumers volunteer to participate in the HIE. Because of the
focus on trust, participation is not mandated,
the concern being that mandating participation in the health information exchange would
have a negative effect on open and active participation.
After careful evaluation by a diverse group of
patients, providers, payers, businesses, and
government stakeholders across Maine, the
health information exchange chose an opt-out
consent policy. It was determined that an opt-out consent policy would be the most effective,
valuable, and viable consent option.
A unique aspect of HealthInfoNet’s opt-out
model is the fact that once the patient elects to
opt out of the health information exchange, his
or her health information is deleted, not hidden. Information is still sent to the health information exchange, where it is screened for
public health reporting; however, the HIE’s
rules engine identifies and destroy the health
information of individual’s that have opted out.
Patients can easily request to opt out of the
HIE online, via a telephone call, or by mail.
Since going live in 2008, only 1 percent of the
approximately 980,000 individuals in the
HealthInfoNet database have chosen to opt
Protecting Patient Privacy
The HIE uses a virtual private network not
connected to the Internet and protected by a
dedicated firewall. Data are encrypted at all
times in motion and at rest. Administrative
data are stored separately from clinical data.
The HIE has recently begun providing patients
with audits of all individuals who have accessed
their health records.
The future sustainability model for HealthInfoNet depends on developing and promoting
value-added, revenue-generating services built
on data analytic tools that will be designed to
serve and support new healthcare delivery
models and risk-sharing initiatives.
Culver shared a story that clearly demonstrates the value of the health information exchange. He received a phone call from a physician who was coming off an overnight shift in a
virtual ICU. The physician wanted Culver to
know that the previous night he had found a
piece of information in the HealthInfoNet’s database that was not available anywhere else.
Having access to that information saved his
patient’s life. n
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