Sunday, February 19, 2012

Why not here in ______?

In the blank above, insert the name of your state and ask the question.  As reported by Lena Sun in the Washington Post: 

Maryland’s 46 acute-care hospitals will soon be able to share basic patient information among themselves and with credentialed doctors, a key step that health officials and clinicians say will improve patient care and cut costs.

The development, announced at a news conference Friday at Holy Cross Hospital in Silver Spring, is being led by the Maryland’s health information exchange, a statewide system that is working to promote the secure electronic sharing of health information among approved doctors’ offices, hospitals and other health organizations.

If you ask the question here in Massachusetts, the answer is clear.  The dominant provider network had for years an interest in not permitting its patients to be easily seen by other hospitals and physicians.  Indeed, that corporation made note of its proprietary information system as part of an investors' conference several years ago, in support of its case for being fiscally strong.

Perhaps that has changed.  Maybe someone will post a comment and let us know.

The minimum goal is that it should be possible to be seen at any emergency department in the state and have those ED doctors and nurses be able to get access to your medical record from your home institution and physician's office.

Beyond that, if we want to foreclose ACOs from having a strong hold on patients by making it hard for them to be seen by competing systems, we need "dial tone."

As long as proprietary electronic medical record systems exist, a given provider network can control the degree to which patients can choose lower priced or higher quality doctors and hospitals outside of that network.

Instead, we need the equivalent of the "magic button" described in this post by our CIO, John Halamka, demonstrating interoperability between our hospital and Atrius, the state's largest multi-specialty practice:

By working with Epic and Atrius, we enabled a
"Magic Button" inside Epic that automatically matches the patient and logs into BIDMC web-based viewers, so that all Atrius clinicians have one click access to the BIDMC records of Atrius patients.

If this capability existed among and between all provider systems, consumer choice would be possible. Without it, a dominant network will remain dominant.

As the Post story indicates, it takes time to have a fully functioning interexchange system, but if you don't start it doesn't ever get done.


Bruce Ramshaw said...

It is absolutely essential that information is shared. But it is even more essential that the information is pertinent, accurate and efficient. I have reviewed patient charts from around the country over the past 15 years and I can tell you that the current electronic record systems make it nearly impossible to get reliable information in a timely manner (much worse over the past five years as electronic records have become more prevalent). The volume of information is ridiculous (the vast majority completely irrelevant) and trying to sift through it to find out what is pertinent and accurate is sometimes overwhelming. I just reviewed a case today as an expert and the major academic medical center (very prominent) that received a patient in transfer took almost two days before figuring out what the patient really needed (and the patient died). Of course if the referring physician could have talked directly with the appropriate attending physician this probably would not have happened, but that is another one of our many current health care system problems.

Anonymous said...

Whoa. What a new technological tailspin we are in.

On the one hand, we have medical professionals who graduated only a decade or two ago using the equivalent of Achulean hand axes to chart their patient's course, and on the other, emerging business practice of mining an Everest of data for that magic margin of health savings.


You ask why information cannot be shared, but I am not convinced at all that it is in the patient's interest to do so. Doctors don't use the information appropriately. Nor do they know how. They, insurers and hospitals are not epidemiologists. They are not scientists. They aren't mining your past history to learn more about disease process. Their interests cannot be glossed over as academic.

Sure, this is an impediment to all in search of continuity of care. But this is like arguing that Facebook wants my high school love letters to protect me from former suitors.