Sharing medical data about patients in real time between competing medical institutions may reduce the amount of errors and improve the quality of care
Marianne Kolbasuk McGee, InformationWeek
The project carried out in Santa Barbara County proves that information can be shared securely - says Karp, Chief Information Officer of the California Health Foundation.
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About 280 doctors in Santa Barbara, California, currently enjoy access to medical data about patients via the Internet. The information includes results of recent tests, x-rays, radiological tests, sound opinions of experts, treatment summaries and drug data. However, the real innovation is that doctors can access information through the Santa Barbara County Medical Data Exchange even if the patients were treated or examined at a competing clinic, or at a medical facility that is not one of the Santa Barbara County clinics or hospitals.
The doctors' access to information even before the start of the test or during it, can help them make more informed decisions about the continuation of the treatment and prevent the administration of contradictory drugs or those that may cause an allergic reaction. The quality of treatment improves, the amount of mistakes decreases and the expenses and hassle as a result of repeated tests, in case another doctor has already performed a similar test, are small. "The goal of the project is to improve the quality and safety of the care provided to the residents of Santa Barbara County," says Sam Karp, Chief Information Officer of the California Health Foundation, a non-profit philanthropic organization that donated $10 million to fund the infrastructure of the medical data exchange. "The project proves that it is possible to share medical information between different providers in a secure manner."
Similar projects are currently underway in several medical institutions in the country. However, the Santa Barbara County Exchange, just seven months old, is a fairly rare example of the sharing and integration of medical information about patients between competing institutions. The goal is to share information from diverse systems and set an example for other providers.
"The sharing of information is very important for patients," says Dr. Carol Diamond, chairperson of Connecting to Health - a private-public organization that brings together 90 medical institutions that strive to improve medical technology and electronic information sharing. "Patients usually move between different medical institutions, and if the information is not available, this affects the quality of treatment," says Dr. Diamond.
Dr. George Heister, a physician at Central Coast Family Clinic in Santa Maria, California, already benefits from the services of the Santa Barbara County Medical Data Exchange. Heister, who was a member of the committee that provided the medical perspective for the exchange project, says the technology was not the most difficult part of the project. "The first challenge at the top was to get the doctors to trust each other," says Heister. The doctors had to convince themselves, and convince their colleagues, that access to information about patients would not result in patient theft, Heister explains. "We have been working on the project for over three years, and during that time the doctors' concerns have diminished. They realized that sharing the information does not cause their competitors to steal patients from them."
Regional projects such as the one done in Santa Barbara County, which began four years ago, are a good starting point for a future national exchange of medical data about patients. Such projects make sense because they are compatible with the nature of medical care - which is carried out in a local market where regional institutions such as laboratories, hospitals, pharmacies and health insurance plans cooperate, explains Jerry Rankin, director of marketing development at Care-Science, the company that implemented the project and developed the software for the Santa Barbara County Medical Data Exchange, and served as project manager and prime contractor.
The central part of the medical data exchange is a Napster-like communication mechanism: a computer-to-computer pull technology that develops, locates and provides secure access to medical data in the original system, whether the data is stored on a local web server, whether in a traditional system or in an application service provider environment. Ownership of the data and control over it are not affected, because there is no need to store the data or reproduce it in a central database. The queries are performed in the original databases. The medical data exchange actually constitutes a uniform interface for different systems that allows information about relevant patients to be found, while maintaining security, privacy and property - says Nicholas Augustino, VP of Care-Science.
Here is a typical scenario that illustrates the way doctors use the data exchange: every day, the medical staff use the Internet to enter the list of patients who have appointments. Queries are made in the databases of the laboratories and pharmacies connected to the exchange and a virtual chart is created for each patient. You can view the diagram on your computer screen or print it. The doctors can view the information in any desired configuration, according to their needs or the needs of the patients. The exchange is linked to the large organizations that handle payments to the pharmacies, in order to display information about the drugs provided to the patients. Through the exchange, doctors can also access administrative data, such as information on referrals and eligibility for insurance coverage, but overall, the information shared by the medical service providers on the exchange in this area is not much, compared to the information that is commonly shared in the industry electronically. The sharing of medical payment data has accelerated significantly in the last year or two, not least following the federal law for the transfer and accounting of medical insurance, which regulates electronic transactions, ensures patient privacy and defines information security.
The sharing of medical data about patients for medical purposes lags behind due to many reasons, partly due to competitive considerations that discourage medical service providers from sharing the information they have about their patients. Sharing is also made difficult by the fact that a large part of the information available to doctors, hospitals and other entities about their patients is still only written on paper. "The truth is that only about ten percent of doctors use electronic records, and the rest of the doctors are reluctant to switch to digital records," says Diamond from Connecting to Health. The providers also wonder who will make the necessary investments for electronic sharing of the data.
However, following the Medical Insurance Transfer and Billing Act, at least the snowball of electronic medical transactions has begun to roll, and medical institutions have begun to think of ways to share information electronically. "The privacy guidelines stipulated in the law for the transfer and accounting of medical insurance make it difficult, on the one hand, to share information, but on the other hand they introduce automation into the system" and help to change many of the traditional attitudes of healthcare providers towards technology - says Dan Lucarini, VP of Marketing at Information Management Research, a supplier of document management products.
Meanwhile, the doctors are debating how much medical data and what types they should share with each other. In Santa Barbara County, for example, some of the doctors have started providing data that includes digital summaries and information about diagnoses. However, at least at this point, most clinics still do not provide access to their medical information, largely because it is still based on paper - says Tom Colbert, Chief Information Officer of Sansom Clinic, which participates in the Santa Barbara County Medical Information Exchange.
Still, even if the doctors do not provide information to the exchange, as long as they have access to the Internet they can view the records. About 140 clinical work specialists in Santa Barbara County have been trained to use the data exchange and operate appropriate equipment. A group of medical providers that participated in the trial that took place from April to early October formed a committee responsible for running the exchange by the end of the year, says Rankin of Care-Science. The committee will decide whether to continue working with Care-Science on continued development and support. Doctors can access the exchange for free, and large medical institutions such as hospitals and laboratories pay to support it. The method is suitable for doctors and their needs. "The investment required from us is small, especially compared to other investments we make in information technologies" says Sansom McColbert. "And the expected return is high."
Other challenges facing those trying to convince doctors to share data include the issue of ownership of the information: does the fact that more doctors can access the results of laboratory tests from a variety of sources mean that the ownership of the patient's data must be transferred to a central database? And from a technological point of view, doesn't the large variety of separate systems and different applications used by medical institutions, even within the same company - due to the many mergers and acquisitions - make it difficult to operate the stock market and make it more expensive?
For Sather Health, which operates 33 hospitals in Northern California and serves 4.5 million patients, it took six years for all facilities to switch to using a common laboratory system, says senior vice president and chief information officer John Hamel. Sather operates a team responsible for building a unified interface for separate applications for communication and data sharing.
Santa Barbara County's project to share medical data between competing health care organizations is rare, but it is not the only one - nor the first - dedicated to this issue. The Regenstrief Institute, in collaboration with the Indiana University School of Medicine, developed a digital medical record system in the late 14s that is used by about a thousand doctors in several large joint clinics and XNUMX competing hospitals operating in the region.
With the consent of the patients, the system collects information from a common database of the medical providers that participated in the system and reproduces the electronic medical data that is sent. Following a query about a particular patient, the system laboratory produces a one-page summary of data recorded in the various places the patient has been during the past 12 months, says Dr. J. Mark Oberhage, an associate professor of medicine at the Indiana University School of Medicine and a Bergenstrife Research Scientist. A doctor treating a pregnant woman may request, for example, a summary of the results of all the tests she has undergone, in order to know which areas should be focused on in further treatment, Overhage says. If the extract contains warnings regarding the results of the EKG tests, the doctor will refrain from administering certain medications for fear that the woman is suffering from heart problems. In the summary, it will be stated in which institute the EKG tests were done, and if necessary, the doctor will be able to review the results.
Using the medical records system, the Regenstrief Institute has been investigating the impact of information technologies on patient safety for the past three years. The research is funded by a grant the institute received in November 2001 from the Agency for Medical Research and Quality of the Ministry of Health. The project focuses on patients suffering from two common and expensive diseases: heart failure and asthma. Oberhage and his staff use the medical record system to identify potential errors in the care patients have received and to recommend changes in the care provided by the health care system that may reduce potential errors.
In New England, the work carried out to adapt the electronic transaction systems to the requirements of the federal law for the transfer and accounting of health insurance may constitute a framework for sharing medical information between local medical institutions, says Dr. John Helmke, senior vice president for information services, chief information officer and physician at Care- Group Healthcare System, which operates five hospitals in the Boston area. The New England Medical EDI Network is a consortium of about forty regional entities that have designed and implemented an electronic commerce platform that meets the requirements of the Federal Medical Insurance Transfer and Accounting Act and reduces administrative costs through electronic payments for medical services. Now the task is to enable doctors to use the network architecture to share medical information as well. Presumably, an initial emphasis will be placed on sharing medical data that will help emergency room doctors make decisions quickly.
Although compliance with the requirements of the federal law for the transfer and accounting of health insurance caused a lot of inconvenience and cost a lot of money, its side effect is increased sharing and integration. "The positive side of the federal law for the transfer and accounting of medical insurance is that it is based on standards. And in order to share and integrate, you have to work according to standards" says Ted Delaviche, Senior Vice President and Chief Information Officer at Care-First Blue Cross Blue Shield in Maryland.
Sather Health's chief information officer, Hamel, says that under the influence of the federal law for the transfer and accounting of medical insurance, the government may pressure the health industry to share medical data: "Electronic records will eventually be implemented, but that is the responsibility of the government."
The federal Health Insurance Portability and Accountability Act has already raised awareness of one important issue: patient identity verification. One of the main challenges in sharing information about patients is the ability to ensure that the information the doctor receives actually refers to the patient in front of him and not to someone else with a similar name or a similar social security number. "Credit card fraud is very unpleasant, but incorrect medical data can cause death," says Andy Thomas, vice president of service implementation at Healthlink, an information technology consulting company that provides services to medical institutions.
The original proposal of the federal Health Insurance Portability and Accountability Act included the assignment of medical identification numbers on a national basis to all patients. The proposal was dropped due to privacy concerns, but several medical institutions, including those of Santa Barbara County, Sather Health and Sharp Healthcare, which operates several hospitals and medical groups in San Diego, are taking steps to ensure the accuracy and completeness of medical data through the development of Main patient index. "Sharing medical information on a national basis without a national identification mechanism could create problems" says Bill Spooner, Senior Vice President and Chief Information Officer at Sharp.
Still, ambitious regional projects such as the Santa Barbara County project may convince other parties to promote national sharing initiatives. As Karp of the Health Foundation in California says, "We are in the early stages of a highly potential community partnership."
For an article in Information Week
Translation by Benny Ran, for InformationWeek-Israel
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