SANTA CRUZ, CA – The health information exchange here makes it possible for healthcare providers to treat people with diabetes more quickly and accurately - all via an initiative that begun in 1995.

It was then that the healthcare providers in Santa Cruz decided to collaborate and connect electronically. The community of two hospitals, labs, radiology, pathology and transcription services today share information digitally using Axolotl technology.

A little more than a year ago, the community began using a tool from Axolotl to develop a diabetes disease registry. Providers can identify likely candidates for diabetes more easily because clinical data is accessible across the healthcare community.

Once candidates are identified, the tool triggers appropriate alerts to the providers so important precursors to the disease, such as blood sugar abnormality or hemoglobin, can be tested and monitored.

A core diabetic management system extracts test results such as cholesterol readings and puts the information into an electronic patient profile for the providers.

Robert Keet, MD, a practicing internist, president of Western Medical Associates and consulting medical director for Axolotl, said providers were surprised to learn who in the patient community might be diabetic. The community-built registry was able to identify diabetics who might not have been identified by the patients’ primary physicians.

Typically, a disease registry is populated by manually extracting data. The problem, said Keet, is that the physician is only looking at test data that he or she ordered versus what other providers in the community might have ordered for the same patient.

While health plans have their own disease and case management programs, many providers struggle over these systems. “We deal with 500-plus different insurance carriers,” he said. “That raises havoc.”

A provider-created system makes more sense, according to Keet. They are the ones taking care of patients and feeding the data to payers. Medicare, he points out, wants reporting from physicians for the same reason.

“This is a great reporting tool for pay-for-performance,” he added.

The secondary advantages of the disease registry are enhanced care management and open communication among providers. Additionally, a RHIO-based registry allows providers to drive the process electronically across the community without having to enter any data.

“We were successful because we are a local RHIO,” Keet said. “We wanted it to work. We kept it quite simple and we started with community buy-in.”

HealthBridge, a health information exchange (HIE) that serves the Greater Cincinnati tri-state area, was formed in 1997. The cash flow- net-income-positive group of hospitals, labs and physician offices is connected by a physician communication link system that was built without grant money.

When the Hamilton County health commissioner approached HealthBridge in 2005 to find a way to communicate with doctors regarding public health issues, the HIE was able to respond because of its existing infrastructure.

With a $30,000 grant, HealthBridge leveraged its physician link and added a capability that allowed 14 city and county health departments to issue public health alerts to either all the hospitals and physician offices or a targeted number of them.

HealthBridge leveraged its infrastructure one step further for the public health department, said CEO Keith Hepp. With a $70,000 grant from the Robert Wood Johnson Foundation in 2006, the HIE developed a beta system for three of its member hospitals to provide automated disease reporting.

The paper-based report had been mailed from the physician to the city and then rerouted to the appropriate department if the public health issue was not under the city’s domain. “It was inefficient and time-consuming,” said Hepp.

Using the physician link, HealthBridge can send a report from the hospital to public health as soon as the reportable disease is noted. For example, a case of cryptosporidiosis, contracted by a Kentucky resident in a local pool, would have taken eight days to report. With HealthBridge’s automated disease reporting system, the report was filed within five minutes.

HealthBridge is now hooking its remaining hospitals into the automated disease reporting system. By second quarter 2007, it plans to respond to alerts for all reportable diseases – some 100 in all.

HealthBridge also plans to add emergency department data reporting and registries to help providers participate in pay-for-performance programs.

“This was an easy step to take because we were working together,” said Hepp.