Devore Culver remembers the moment eight years ago when his wife told him she finally grasped what he did for a living. An emergency room physician, she was participating in a regional health information sharing project Culver had designed to make patients' medical information available to doctors electronically. An oncology patient had come into her ER at Eastern Maine Medical Center and Culver's wife was able to view the patient's medical history on a computer in real time along with the patient's primary care physician and a specialist, who were both checking in from home.
"She said it was amazing, she had a complete view of the patient," Culver says. "She said, 'I finally understand what you do.'"
That pilot project was part of Culver's decades-long dedication to improving access to health information as a way to advance patient care. His commitment has most recently culminated in the July launch of Maine's HealthInfoNet, a centralized system that allows health care providers to share and view patients' electronic health records. The initiative, five years in the making, has been called the largest and most comprehensive clinical health information exchange in the country. Only Delaware and Vermont are operating similar statewide exchanges.
HealthInfoNet's current demonstration project includes the state's four largest hospital systems, Central Maine Health Care, Eastern Maine Healthcare Systems, MaineGeneral Medical Centers and MaineHealth, as well as Martin's Point Health Care, Franklin Memorial Hospital and Maine Center for Disease Control and Prevention. The project will run to mid-2010 and then expand to providers throughout the state. Once it expands, the nonprofit HealthInfoNet is expected to save roughly $50 million in health care costs annually as caregivers order fewer unnecessary and duplicative tests, procedures, prescriptions and hospital admissions.
Culver had been out of the state for three years, working in the private sector in Rhode Island, when he was asked in 2006 to return to become HealthInfoNet's executive director. He'd previously served for two decades as Eastern Maine Medical Center's chief information officer, and his promotion of similar regional health information exchanges made him a perfect fit for the job. But Culver hadn't been around to witness the increasing collaboration among the state's health care providers fueling the exchange's development. "Out of the blue comes this phone call from Maine saying, 'Gee, would you ever consider coming back to run HealthInfoNet,'" Culver recalled, peering over his glasses as he spoke in the conference room of his Old Port office. "My initial reaction to the inquiry was, 'Go away, that's ridiculous.'"
The implementation of HealthInfoNet has faced monumental challenges, including convincing health care providers to co-mingle their data and stop competing on patient information, privacy concerns, and the expense of syncing disparate information systems. But Culver was finally convinced, and left a lucrative job — while he had two kids in college — to return to Maine to head up an effort he still calls "a long shot at best." "Multiple times we've been within weeks of financial failure," he says matter-of-factly.
Though HealthInfoNet has finally gotten off the ground — and under Culver's leadership won $1.7 million in funding from the Legislature, despite massive state budget shortfalls — challenges remain. Fundraising continues, and the organization is trying to convince employers and insurers of the benefit HealthInfoNet offers to their bottom lines. Technically, staffers are constantly working to standardize the presentation of medical data to improve consistency (though that's not Culver's forte: "I know very little about computers," he says.) Then there are the often conflicting goals of making the data user-friendly — doctors have proven unwilling to click a mouse more than three times to access information — while also maintaining consumer trust in the exchange's security, Culver says.
But Culver believes all of that work will one day improve care of the sick in Maine. He clasps his hands together, interlocking his fingers, to underscore the potential of aggregating all of those test results and patient histories scattered across the state. "The most important thing we do is organize it around the person," he says.