Laura Adams
President & CEO
Rhode Island Quality Institute
What do you do at RIQI?
Our mission is focused on large-scale infrastructure projects that significantly improve health and healthcare in Rhode Island. We call this our triple aim: better health, better healthcare and lower costs. Add to that practitioner joy in work and you get a good sense of what we’re focused on at RIQI.
Specifically, how are you working to meet those aims?
With CurrentCare, Rhode Island’s officially-designated statewide Health Information Exchange (HIE), we’re working hard to close the gaps between healthcare providers to make sure the data follows the patient. Think about it: You can access your bank account on practically any street corner in the world, but if a patient walks into the emergency room with acute chest pain, doctors may be left flying blind without access to the patient’s health history. This translates to delays in diagnosis, higher risk for medical error, and often having to repeat costly and avoidable tests and imaging.
How is CurrentCare breaking this cycle?
With CurrentCare, data flows instantaneously from all acute-care hospitals in the state, from commercial and private labs, and retail pharmacies -- all with patient consent for viewing. We’ve connecting competing systems across geographic, payer, and proprietary boundaries and data flows into one database, as the systems now “talk to each other”.
CurrentCare is helping to ensure that there are no gaps in a patient’s health record, and that no matter where you’re going for treatment, your doctor and care team will have a complete, accurate and up-to-date picture of your medical history.
So what’s in the data; who uses it?
The data is every interaction a patient has with the connected healthcare system starting from their consent. This means every doctor or emergency department (ED) visit in Rhode Island, every prescription, every diagnosis a patient receives from a participating Rhode Island provider.
CurrentCare is unique from other states’ HIEs because of the Rhode Island provider community’s willingness to put patients first and share data, including the Providence VA Medical Center, and our mental health provider community.
Because of this collaboration and our commitment to a strict privacy and security framework, CurrentCare is one of only a handful of HIEs in the nation that includes patients’ mental health information, data about sexually transmitted diseases, and alcohol and substance abuse treatment information.
This gives healthcare providers -- doctors, nurses, mental health professionals -- access to a consented patient’s more complete medical history even if they’ve never treated this person before. So, for veterans who seek care outside of the VA, for example, providers at the VA can call up the veterans’ records across other institutions in the state and get a much more complete picture. And it goes both ways: Patient data from the VA is accessible to the community-based providers -- often with them never having to leave their own electronic health records to access the data -- allowing the data gaps to be filled no matter where a patient is being treated.
And, it’s not just retrospective. We’re alerting providers in real time when a patient is admitted to or discharged from any hospital or ED in the state. Community-based providers can intervene and/or follow up immediately because the right hand knows what the left hand is doing. They’re also able to see how many times in a certain period their patient has had a hospital or ED admission, giving them the ability to identify high-risk patients and anticipate their needs so that they don’t have to end up in the ED or hospitalized time and time again.
Do you expect this data to change Rhode Island’s research landscape?
Absolutely. Take the Framingham Study -- the famous study that watched a certain cohort of subjects over time and periodically sampled their health information. With CurrentCare, we put booster rockets on that study. CurrentCare gives us health data from a half million people in the state and it’s a constant flow of information -- not a just a periodic sampling.
This has huge implications for research studies. Researchers can look forward to the future possibility of a system that helps find and match potential research participants for a study. Honoring the privacy rights of the patients, we look forward to setting up mechanisms where individuals would consent to receiving information about opportunities to participate in clinical trials and studies.
We’re also working with the Biomedical Informatics Core of Advance-CTR to create access to de-identified data within CurrentCare, so researchers can get information that they may need for their research all within the boundaries of our consent model. Finally, we’re working on developing patient-supplied data within CurrentCare, which would give us feedback directly from patients on their health outcomes, social determinants of heath, etc.
If you think about what we’ll be able to give to researchers as time goes on, the database keeps getting richer and richer.
What does the future look like for healthcare in Rhode Island?
We’re getting excited about the application of artificial intelligence in healthcare. Envision what patient care would look like if you had an Alexa or Siri in the exam room sitting on top of the CurrentCare database and all of its privacy protections. Imagine a physician not having to turn away from a patient or have their back to them in order to consult the medical record, as they often have to do today. Instead, they’d have a “personal clinical assistant” in the room that’s an expert on each patient. Doctors would never have to break their attention from the patient, yet could call up, for example, the results of Ms. Jones’s last cholesterol test.
We’re also looking at predictive analytics, as well. Imagine having IBM’s Watson go into CurrentCare to pull out critical pieces of information and decipher trends and relationships in the data that will, instead of alerting practitioners to when patients are going into the ED now, tell them who will be in the ED three months from now if the patient receives no clinical intervention.
Finally, wearable technology. CurrentCare can integrate these and shoot alerts to clinical care managers in real time as a high-risk patient’s health changes significantly. Clinicians could intervene early, adjust medications or treatment plans, and avoid a patient having to be admitted to the ED or hospital with a serious -- and often preventable -- problem.
What do you want RI researchers to know?
Researchers who see the current and future value of this system and want to see more developments and innovation can advance it by advocating for it. We have something extraordinary here, and if the research community is aware of the benefits, it can support CurrentCare both privately and publicly.
When the community asks “what is the value of CurrentCare?” or “how can we use it to produce even more value for our state?” the research community could be hugely influential if they speak up assertively and publicly about the societal and economic contributions we stand to make if we fully lever CurrentCare.
I want to create a culture where sharing data is like giving blood. I’d love for people to see opting into CurrentCare not only to benefit themselves and their families, but also to give a gift of health and healing to all those who come after them. If researchers are vocal about the asset that CurrentCare is and why we should continue to grow it, they can significantly influence its future. Rhode Island respects and regards the voice of the research community.
What is the best advice you ever received?
Persist. Keep going. Don’t get discouraged or distracted. Stay focused. Don’t let anyone tell you it’s not possible. No matter the turmoil swirling around us, improving health and reducing suffering will never be the wrong thing to do, strategically or morally.
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