More Health Care Plays

Health care providers underuse information technology, and it shows. Your local oil change mechanic has better access to your car's records than doctors have to those of their patients. As a result, doctors make decisions with incomplete information, order duplicate tests and procedures, and make simple errors that computers can easily check.

Patients often experience these problems as an inconvenience. They wait for prescriptions to be filled, miss doctors' calls about test results, and fill out endless health histories. But the failure to exchange information electronically imposes a huge cost in terms of lives and dollars that could be saved by using a health information network.

• About 130,000 life-threatening events occur each year when various doctors unknowingly prescribe dangerous combinations of prescription drugs for a given patient.
• Hospitals spend about $30 billion on patients who are admitted due to missing information about their health care problems and existing treatment.
• Doctors order more than $8 billion worth of duplicative lab tests, X-rays, and prescriptions that could be eliminated through the use of a health information network.
• Estimates for national savings from a health information infrastructure range from $80 billion to $160 billion, or about 5 percent to 10 percent of the country's total health care spending.

Public health suffers, too. Real-time analysis of trends that may signal outbreaks of disease, like the avian flu, SARS, and acts of bioterrorism, is simply not possible with a paper-based medical information system.

"Delaware is committed to assuring its citizens the quality-enhancing benefits of networked, real-time clinical information, with a guarantee of confidentiality. The system will also provide state health officials with an enhanced capability to identify the first signs of a bioterrorist attack or a new infectious disease like SARS." -- Lt. Gov. John C. Carney, Jr., Delaware

The main obstacle to a system for exchanging health information electronically is not the cost or availability of technology. Similar systems are at work in many other aspects of our lives from using an ATM to checking out a book from a library. Instead, the problem is trust. Who can be trusted to convey your private, medical information electronically?

Delaware is one state attempting to answer that question. Delaware's Health Care Commission recently deployed a health information network for a core group of users, including three hospital systems and five physician practices. In September of 2006, Delaware launched the first state-wide health information technology project to connect all major sources of clinical information. The network gives patients control of the access to their records and gives privacy advocates veto power over how the network works. The Delaware Health Information Network has developed a model for a clinical information sharing utility that moves medical information between hospitals, physician offices, pharmacies, labs, and insurance companies, but only when the doctor needs the information and the patient gives authorization.

Based on previous efforts to promote sharing of health care data, leaders like Delaware's Lt. Gov. John C. Carney knew that such initiatives had to include everyone from patients and doctors to public health officials. Employers and insurance companies are also participating since they would greatly benefit from the network's potential savings. In the near future, the Delaware initiative expects to award a contract for the operation of a state-wide network.

Governor Chris Gregoire (D-Wash.) and the Washington state legislature have approved $4.4 million for a health record bank pilot project. A health record bank is a secure location for patients to deposit and store a complete electronic copy of their medical records from all sources. The banks will send a complete copy of a patient's medical information to the health professionals whom the patient authorizes.

Washington state's health bank is a model for federal legislation. The Independent Health Record Trust Act sponsored by Rep. Dennis Moore would certify trusted third parties for aggregating and distributing medical information with patients' consent. As PPI's David Kendall explains in a report, "Building a Health Information Network," health record trusts would give patients control over who has access to their records as doctors convert to digital record keeping:

When a patient sees a doctor, she should be able to give the doctor an access code and a password to her private medical history. The doctor should then be able to view all of the key information contained in that history, ideally on a single computer screen. In the course of providing treatment, the doctor should be able to feed new information into the system to keep the patient's medical history up to date. Eventually, these patient-controlled electronic medical histories could become hubs at the center of a national health information network that seamlessly connects not just doctors and patients, but also hospitals, pharmacies, medical labs, and health insurance companies -- that is, all entities that offer medical services of any kind to American consumers.

One way to jumpstart the creation of a health information network is by using medical information that is already available in an electronic form, but is locked away in the computers of insurance companies, medical labs, and state vaccination registries. Patients' prescriptions, lab results, diagnoses, allergies, and vaccinations should be available in real time to a doctor once a patient authorizes access. One organization that is providing access to this information is the Patient Safety Institute (PSI), a nonprofit organization that represents patients, physicians, and hospitals. It is successfully in place at Swedish Hospital in Seattle. Open to all who wish to participate, PSI can work with any software system. It can operate through simple Web-based access, or it can be fully integrated with electronic medical record software.

Health insurance plans and large medical clinics whose computers hold a great deal of digitized information from medical claims are beginning to make this information available directly to patients through personal health records (PHR). For example, Palo Alto Medical Foundation in California and Empire Blue Cross Blue Shield in New York both provide a PHR that patients can view through a secure website. But so far, these PHRs have not been linked to a network that can exchange personal information among a larger number of doctors' offices and hospitals.

One system that PHRs could link to is in Indianapolis, home to one of the nation's first networks for sharing medical information. The Indianapolis Network for Patient Care includes all five major Indianapolis hospital systems, which together operate a total of 11 geographically separated hospitals. A well-respected local research organization, the Regenstrief Institute, spearheaded the network. A new organization, the Indiana Health Information Exchange Inc., is expanding the Indianapolis network throughout the state. As part of a Markle Foundation project, it has also worked with other local networks in Boston, Mass., and Mendocino, Calif., to test pilot the backbone for a national network. Kentucky is also home to a project that could become a nationwide network. Kentucky has passed legislation sponsored by State Sen. Dan Mongiardo to launch a statewide health information network. Sen. Mongiardo's long-term vision is to make Kentucky a national center for research and technology for improving health care quality and safety. The recently created Kentucky e-Health Network Board has launched a grant program to encourage doctors to prescribe medications by creating a secure and interactive communication system between physicians and pharmacies.

Another initiative making good progress is the Massachusetts eHealth Collaborative. Formed in 2004 as an initiative of the physician community, it has grown to include 130 medical practices in 3 communities. Using startup funding from Blue Cross Blue Shield of Massachusetts, it has created a data exchange system that independent medical practices use to share health care data. By the end of its demonstration project phase, it hopes to have built a sustainable model for health information technology.

The development of a health IT strategy does not have to take a long time. In August, 2005, Arizona Gov. Napolitano issued an executive order to establish a statewide task force, and within nine months, she received a comprehensive road map for action. It led to the creation of the Arizona Health-e Connection, in January, 2007. This multi-stakeholder umbrella organization is designed to set common standards across the state for regional health information organizations and facilitate the adoption of health information technology.

Nationally, about 100 regional efforts have emerged to serve as local networks. The U.S. Office of the National Coordinator for Health Information Technology has provided limited seed money for some of these efforts, but so far the federal government has not stepped forward with significant funding. An alternative source of financing is the savings from using the network. Health plans and employers stand to benefit from reduced duplication and hospitalizations, but they need to be assured that the savings will in fact occur before they will help finance the network. One of the top priorities for emerging networks will be to account for savings and distribute network costs accordingly.

For example, the East Tennessee Health Information Network has developed a financing plan in which stakeholders invest to create a local network in proportion to their expected return. It has received start-up funding from a private physicians' foundation to launch a network that is self-financed from the savings generated by eliminating the duplication and waste of health care services. For the state's part, Tennessee Gov. Phil Bredesen has established an eHealth advisory council to support and coordinate the many initiatives across the state. Like the Markle Foundation, Tennessee is hosting one of the five federally funded sites for testing the creation of a national information network.

Just as the Internet made computers more valuable, so too, can health information networks spur the use of information technology throughout the health care world. With a push from state and federal governments, a whole new health care system can arise: online appointments, email visits with physicians, computerized safety systems, and performance reports about doctors, hospitals, and health plans.

Resources for Action

Sen. Tom Carper, "Health Information on Demand," Blueprint, April 15, 2003
http://www.dlc.org/ndol_ci.cfm?contentid=251495&kaid=137&subid=900014

Idea of the Week: Someone to Trust with Electronic Medical Records, Democratic Leadership Council, December 14, 2001
http://www.dlc.org/ndol_ci.cfm?contentid=250053&kaid=131&subid=207

Delaware Health Information Network
www.dhin.org

"Health Record Bank,Washington State Health Care Authority
http://www.hca.wa.gov/hit

Washington State records bank legislation
http://www.leg.wa.gov/pub/billinfo/2007-08/Pdf/Bills/Senate%20Passed%20Legislature/5930-S2.PL.pdf Healthy Washington Initiative
http://www.governor.wa.gov/news/news-view.asp?pressRelease=477&newsType=1 David B. Kendall, "Building a Health Information Network," Progressive Policy Institute, May 24, 2007
http://www.ppionline.org/

Indianapolis Network for Patient Care
www.regenstrief.org/medinformatics/inpc/

Kentucky Senate Bill 2, Regular Session 2005
www.lrc.state.ky.us/record/05rs/SB2.htm

Kentucky e-Health Network
www.chfs.ky.gov/ehealth/

Massachusetts eHealth Collaborative
http://www.maehc.org/

Gov. Janet Napolitano, Arizona Health-e Connection Roadmap, Executive Order 2005-25, August 30, 2005
http://azgovernor.gov/dms/upload/EO~090105~2005-25.pdf

Arizona Health-e Connection
http://www.azhec.org/

Office of the National Coordinator for Health Information Technology
www.os.dhhs.gov/healthit

Connecting for Health Common Framework, Markle Foundation
www.connectingforhealth.org/commonframework/index.html

eHealth Initiative
www.ehealthinitiative.org

HealthAlliant
www.healthalliant.org

Additional Reading

"A Big Opportunity for Health IT?" Health Policy Wire, Progressive Policy Institute, December 6, 2007
http://www.ppionline.org/ppi_ci.cfm?contentid=254530
&knlgAreaID=111&subsecid=900033

Daniel Castro, "Improving Health Care: Why a Dose of IT May Be Just What the Doctor Ordered," Information Technology and Innovation Foundation, October 2007:
http://www.innovationpolicy.org/index.php?id=88

Jane Larson, "Health Files To Go High-Tech," Arizona Republic, April 3, 2006
www.azcentral.com/arizonarepublic/business/
articles/0403biz-Health-e0402.html

Tools for Health Information Exchange Networks, Markle Foundation
www.connectingforhealth.org/resources/guidance.html

"The Collaborative Response, Connecting for Health," Markle Foundation, January 18, 2005
www.connectingforhealth.org/resources/
collaborative_response/toc.php

Contacts

Gina Perez, MPA
President
Advances in Management, Inc.
16856 Yawl Court
Lewes, DE 19958
(302) 645-1490
gina@aim2bbest.com

January Contreras
Policy Advisor for Health
Office of Governor Napolitano
1700 West Washington, 8th Floor
Phoenix, Arizona 85007
602-542-1626
JContreras@az.gov

David B. Kendall
Senior Fellow for Health Policy
Progressive Policy Institute
4021 Heritage Way
Missoula, MT 59802
(406) 543-2265
(772) 679-0652 (fax)
dkendall@ppionline.org