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Breaking Down the Barriers When health-care providers exchange
electronic medical records, costs go down and patient care goes
up The Wall Street Journal By LAURA LANDRO April 13, 2010 To understand the potential of shared health
records, consider the Bottone family. Born prematurely with nonfunctioning kidneys,
4-year-old Jacob Bottone has been through dialysis, angioplasty
and a kidney transplant, and seen more specialists than most people will
see in a lifetime. His doctors and hospitals had electronic
medical-records systems, but no way to access each other's, so his parents had to
collect his growing paper medical records in a large accordion
folder, haul it from doctor to doctor, explain his medical history over and over
again, and often wait for hours while referrals and test results
were retrieved and faxed around to different providers. "It was getting to be a
bit of nightmare," says his father, Jason Bottone. Enter electronic information exchange.
Three leading health-care providers in
will allow them to share data on more than
a million
Permanente Colorado's physician group and
Exempla Healthcare, which operates to share their records on a secure network
that will allow clinics, doctors' offices and hospitals to
exchange data on common patients instantly, including lab reports, radiology images and
medical history. Instead of keeping a tattered list of Jacob's
medications in the boy's diaper bag, his mother, Heather, knows
that his doctors at either Kaiser or Children's Hospital can call them up instantly
on a computer. When the family rushed Jacob to the emergency
room in December, fearing a rejection of his transplanted kidney, they
called ahead to Children's, where staffers pulled up notes from
his latest doctors' appointments. (Fortunately, he was suffering only gas pains
caused by a virus common to transplant patients.) As for the
accordion file, dubbed "Jacob's Bible" by the family, "we don't have to carry it
around anymore," says Mr. Bottone. Still Rare Unfortunately, programs like this are still a
rarity. For starters, only about 10% of the nation's hospitals
and less than 7% of doctors' offices have full-fledged electronic medical records. And
those that have electronic records typically don't share them
with others unless they're part of the same health system. Among the reasons: With
dozens of different vendors, information systems often can't
easily talk to each other. In addition, health-care providers often view their
information about patients as proprietary. And concern about
violating privacy laws has made many hospitals reluctant to join
information-exchange efforts. But those barriers are expected to come down
as the federal government prepares to dole out $19 billion in
economic-stimulus funds for health-care providers to adopt electronic
medical records. To qualify, doctors and hospitals must not only
invest in electronic medical records, but also demonstrate "meaningful use" of the
systems, including the ability to exchange information with
other providers. If they fail to do so, their Medicare payments will be cut. By 2015, "Americans ought to be able to expect
there will be a relatively widespread exchange of health
information in a safe and secure way," says H. Stephen Lieber, CEO of the Healthcare
Information and Management Systems Society, whose members
include professionals in healthinformation technology. The stimulus funds include about $700 million
for states to help create information exchanges that would link
multiple providers in a state or region. At present there are essentially two
kinds of exchanges—though the terminology is fluid and some
arrangements overlap, making it difficult to precisely quantify the extent of
record sharing. Regional Successes So-called regional health-information
organizations, known as RHIOs, typically are overseen by a state
or local nonprofit organization that coordinates the exchange of information among
competing providers in their area over a common network. The
other kind of exchange is an agreement directly between competing health
providers to share data. This is often called an HIE, for
health-information exchange, though that term is sometimes used more broadly. The eHealth Initiative, a nonprofit group that
promotes health IT, counts at least 193 active initiatives of
all kinds to exchange information in the U.S., but not all are off the ground; 57
reported they were operational last year, a 36% increase from 42
in 2008. However, a study published in the journal Health Affairs last year found
that most RHIOs were focused on exchanging test results alone,
and only 41% reported receiving sufficient revenue from participating
providers to cover operating costs. The study concluded that
RHIOs' "scope remains limited and their viability uncertain."
To be sure, some RHIOs have been
successful. HealthBridge, started in 1997 in the greater
Cincinnati-northern hospitals and close to 5,000 doctors' offices.
They share lab tests, radiology reports and other results over a
secure electronic network that enables different information systems to
communicate with each other. Patients aren't the only ones to benefit: The
system saves its members an estimated $20 million annually just
in staff, fax and postage costs for records transfers, says HealthBridge's policy
director, Trudi Matthews. And HealthBridge is extending its
reach, working with three other
regional exchanges in access the test results and radiology notes. Direct exchanges of data between competing
providers also remain rare, according to a recent study by
research firm KLAS Enterprises LLC. Jason Hess, the study's author, says the
number is low in part due to technological barriers from
incompatible records systems. And several other issues have yet to be fully resolved,
including privacy and cost concerns. "If I am a hospital
exchanging information with a competing hospital down the street," Mr. Hess says, "at
what point am I not responsible for what happens to that
information?" It also isn't always clear who would pay for
what in an information-sharing system, or whether doctors would
be willing to accept images and tests from another hospital. Some doctors
might distrust a CT scan, for instance, from another hospital
system and be hesitant to base their prognosis on it. And hospitals make money from
doing their own tests and procedures, another disincentive to
share information. National Ambitions The ultimate goal is to move beyond regional
efforts and create a national health-information network, says
David Lansky, chief executive of the Pacific Business Group on Health, a coalition
of large health-care purchasers, and a member of a national
advisory committee on healthinformation technology. Such a network will need a set of
"policies, standards and services that allow the Internet to be
used for meaningful exchange to improve health and health care,"
Dr. Lansky says. "And that is about trust—coming up with rules
and agreements that give us the trust to share information with each other." The Denver-area providers say trust is largely
what helped them agree on their health-information exchange. And
they had another big
advantage: All three partners happened to
have medical-record systems purchased from the same vendor, Epic
Systems Corp. of There also were personal relationships to draw
on; both hospital partners admit many children who are patients
of Kaiser pediatricians, for example. Executives at Children's Hospital and Exempla
say the main hurdles in the deal were administrative and legal,
such as developing procedures for obtaining legal consent from patients to
transfer their records electronically when they register at a
hospital or clinic, and ensuring proper identification of patients, like those with
similar names. Though the electronic medical records were
already in place, the partners had to make some new investments.
Children's Hospital spent close to $50,000 to make the transition and invested
about 1,000 hours of labor; Exempla spent $200,000 on equipment
and labor costs for the project. "We never batted an eye at the investment,"
says Exempla's senior vice president and chief information
officer, David Pecoraro. "The impetus was to provide safer and
better care."
Ms. Landro is an assistant managing
editor for The Wall Street Journal and writes the paper's
Informed Patient column. She can be reached at
laura.landro@wsj.com. Copyright 2009 Dow Jones & Company, Inc. All
Rights Reserved
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