Utilization of a health information exchange to enhance care and improve health outcomes among HIV+ individuals in rural NC

Background: The Regional Health Information Integration Project (RHIIP) has developed the Carolina HIV Information Cooperative regional health information organization (CHIC RHIO), which coordinates communication among the geographically distant network of HIV care providers in rural North Carolina. CHIC comprises one medical clinic and 5 AIDS Service Organizations serving clients in seven rural counties.

Objective: The CHIC RHIO was implemented to improve both patient care and patient health outcomes. These outcomes include improved medical appointment adherence, increased medication adherence, higher trust in physicians and more coordinated programs and care.

Methods: Communication among CHIC members is facilitated by CAREWare software; information such as medical appointments, lab results, ADAP status, case notes and medications are shared among medical and ancillary care providers. Baseline data were collected for eight months prior to CHIC's implementation; an interrupted time series (ITS) evaluation design, including patient interviews and chart abstractions, will evaluate CHIC's effectiveness and patient health outcomes.

Results: The RHIO's composition has changed over the project's lifetime, with important communication and partnership lessons being learned. The importance of relationship building and organizational trust has proven crucial to the success of the RHIO development. Qualitative data was collected at baseline RHIO development and will be followed up in March 2011. These organization-level findings will be discussed.

ITS data collection will conclude in April 2011 with approximately 1400 interviews conducted on about 700 unique patients. Individual-level outcome and medical chart abstraction data will be used to determine how increased information exchange affects patient care and health outcomes.

Conclusions: Innovative strategies such as health information exchange can be used in rural communities to increase communication between providers. Increased communication is likely to improve medical and ancillary care provider relationships and trust. With increased communication comes the potential for improved health outcomes and in turn healthier communities.