Move to electronic medical records could save money, lives
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BY MARK ANDERSEN / Lincoln Journal Star
Nebraska’s health care providers — hospitals, physicians, pharmacies, labs, imaging centers — are about to test a system supporters say will ultimately save millions of dollars and thousands of lives.
If a 90-day Omaha pilot scheduled for mid-January goes as expected, Nebraska could become the first state to realize the longtime dream of sharing patient records electronically. An Idaho effort is perhaps weeks ahead of Nebraska, which is finalizing privacy and security policies.
About 40 networks nationwide already serve smaller area-regions.
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Nebraska health information exchange
The health information exchange would link health care providers and make for a quick digital exchange of patient information. (Katie Nieland, Journal...
The mid-January pilot of the Nebraska Health Information Initiative will involve four Omaha health systems: Alegent, Nebraska Medical Center, Methodist and Children’s. These will link to a physician group practice, independent physicians, a free-standing radiology center, a pharmacy and a laboratory. The pilot will last 90 days, followed by 30 days of evaluation, and then the initiative will begin to roll out statewide.
Ultimately, these and others will join to form one national medical records repository, an initiative President George W. Bush set as a goal in 2004.
If the pilot succeeds, Nebraska’s hospitals and other providers across the state would be added as early as June. Lincoln’s hospitals could come online mid-summer.
Dr. Harris Frankel, an Omaha neurologist and a leader in the Nebraska effort, says the move away from paper will put the right medical information in the right hands at the right time, saving lives and eliminating costly duplicate tests.
“Ultimately, the real benefit is for the patients, to put them in a position to have higher quality, cost-effective care,” he said.
For any patient ever forced to haggle over records in the wrong place at the wrong time, it’s big.
In emergency rooms, doctors soon will be able to view recent X-rays, know a patient’s medications.
Deb Bass, project consultant, says electronic records will change the conversation between patient and family doctor. Instead of a lecture, the physician will pull up the lab report — here, this is what happens when you don’t take your diabetes pills.
A neurologist, Frankel frequently sees people who’ve had a CT or MRI but don’t know it. “Patients don’t remember if they’ve had a CT scan or where they got it,” he said.
In today’s paper-dependent health industry, he said, records request drag on. A physician has staff fax records requests to various points, and then people there gather the reports, alphabetize them and fax them back for delivery.
If a doctor needs to see an X-ray to make a decision, he said, he’s likely to order a new one, even if the patient got one the day before.
“The potential exists,” Frankel said, “to slow the rising costs of health care.”
To get the Nebraska Health Information Initiative (NeHII) to where it’s ready to hit the switch, participants across the state overcame mountainous issues of technology, cost, privacy and culture.
NeHII began in 2004 but stalled.
“It’s such a big problem,” Bass said. “Where do you start to eat the elephant?”
And then a year ago, something sparked the initiative.
“The project is really to the tipping point,” Frankel said.
Technology
Before visiting Las Vegas, Frankel might use Orbitz or Expedia to compare hotels, flights, car rentals. It’s all available with a few clicks.
A health information exchange works similarly. Acting with patient consent, Frankel said, the doctor gets access to lab reports, pharmacy records, hospital histories.
Over time, as more providers join and histories grow, the database becomes increasingly useful.
For medicine, said Bass, the consultant, “The technology is finally there.” Records will flow over the Internet, using security similar to that for online banking.
Axolotl out of Silicon Valley will provide NeHII’s platform.
Company spokeswoman Nicole Spencer said Axolotl formed in the mid-1990s after doctors in Santa Cruz, Calif., went shopping for a records exchange and found nothing adequate. So they gathered investors and built one. It now covers much of the Bay area, she said.
The company’s biggest achievement is HealthBridge, the nation’s largest health records exchange, linking 32 hospitals and 5,000 doctors in greater Cincinnati and northern Kentucky.
Axolotl recently unveiled a component to allow users to push patient information to users of competitive systems, Spencer said. “So like e-mail, it doesn’t matter what system you’re using.”
In Nebraska, Bass said, the pilot will be judged largely on three tasks:
* Clinical messaging — sharing laboratory results and X-rays, both numbers and images.
* E-prescribing — what drugs does the patient take?
* Physician referral — electronics will bypass the negotiations that consume staff time.
While other benefits can be obtained from electronic records, Bass said, these provide an immediate return on the investment.
Cost
A 2007 report supporting Oklahoma’s conversion to electronic records estimated savings of roughly $1 billion after five years, or about 5 percent of total spending on health care. It would do so in part, the report said, by avoiding 29,000 adverse drug events, 21,000 provider and hospital visits due to adverse drug events and by saving 1,300 lives that would have been lost to adverse drug events.
The Oklahoma report notes the savings will be especially apparent among the uninsured, whose health care is perhaps most disconnected.
But that’s after five years.
Wiring together 90 percent of Nebraska’s care providers over six years is expected to cost a total of $20 million, Frankel said. Savings wouldn’t be realized until 2012.
Bass estimates an additional $1 million will be needed over the initiative’s first 18 months. So far, funding has been provided by expected future participants, led by Alegent Healthcare System and Blue Cross and Blue Shield of Nebraska.
A big hurdle for similar projects elsewhere, Frankel said, has been the development of a sustainable business model.
Of the 130 existing and budding electronic records projects nationwide, according to the 2008 Survey on Health Information Exchange, 80 percent struggle to operate without government aid.
In its initial years, NeHII hopes to augment user fees with funds from private and public grants. Frankel hopes Nebraska’s project will sustain itself by 2013.
The pricing structure, not yet finalized, would be based on expected benefit. In Oklahoma, about half the savings is expected to occur at hospitals. For Nebraska doctors or critical access hospitals, the cost would be nominal, Frankel said.
Pushing some interest in electronic records, beginning Jan. 1, Medicare will give bonuses to doctors that e-prescribe.
Once the network matures, other savings might be obtained by teasing trends from the data.
Security
Security worries have been the Achilles’ heel of many early efforts.
Would insurers or employers use the data to discriminate?
“(Some people) think the payer is going to have access to information that they haven’t had previously,” Bass said. In fact, she said, we all sign numerous authorizations. “It’s not like they’re going to be able to access information they haven’t already had access to,” she said.
Frankel argues that electronic records favor privacy. It’s easier to control who sees and alters records.
Axolotl’s Spencer said each community handles security differently. Some do more up front to limit access. Others punish violators afterward by reviewing computer logs.
Last spring, more than a dozen employees of UCLA Medical Center faced termination for viewing Britney Spears’ medical records.
In public opinion surveys, Bass said, a majority favor electronic records, “particularly when it comes to saving them money.”
That said, Nebraska’s pilot date remains tentative, pending approval of security policies.
It’s uncharted territory, Bass said. Hospitals and physicians are working out issues at a much higher level than ever before.
Culture
A project like this, Bass said, is 15 percent technology and 85 percent politics. It takes an entrepreneur; business, health care and technical knowledge; political savvy and governmental contacts.
“For once,” she said, “so many of the characteristics of the state of Nebraska that have held us back have enabled us to get this done.”
It’s a state with fewer people, with can-do leaders, who know one another and know the foundations.
“We can get a lot done quickly.”
For those in health care, Frankel said, “There’s been a consensus that this is the right thing to do.”
But it took a “decision accelerator” meeting in 2007 to restart the engines that flamed out in 2005.
Once it’s running, there’s still the question of how quickly Nebraska’s nearly 90 hospitals and roughly 3,300 physicians will join.
There’s been concern over learning the technology, Frankel said.
Hospitals and insurers see a clear benefit, he said. In large part, physicians do, too, but from the standpoint of a learning curve, there will be inefficiency.
Older physicians in the waning years of their career might be reluctant to change, he said, though some are eager. Those at mid-career are eager. Younger doctors just coming out of training, he said, “That’s all they’ve known.”
Reach Mark Andersen at 473-7238 or mandersen@journalstar.com.
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Curious wrote on December 3, 2008 8:29 am:
As long as patient privacy is kept I think that this could be a very good thing. "
NS wrote on December 3, 2008 8:53 am:
r wrote on December 3, 2008 9:38 am:
Tender wrote on December 3, 2008 9:42 am:
Mike McDermott wrote on December 3, 2008 1:03 pm:
Having had my own paper medical files altered, I am extremely concerned about the ability of hospitals and doctors to alter electronic records to their advantage, or to cover their hineys after the fact. For this reason, I would rather see legislation that would mandate the patient receiving medical, signed papers within 24 hours following his/her operation or dismissal from the hospital. This would have the affect of keeping people honest and accountable. "
KK wrote on December 3, 2008 1:23 pm:
lucky wrote on December 3, 2008 1:52 pm:
patient wrote on December 3, 2008 4:25 pm: