By Roland PiquepailleIn this long article, CIO Magazine reports that some cities, such as Indianapolis, are creating regional health information networks to share medical records between doctors and hospitals to save lives and money. In the example of Indianapolis, the "emergency rooms of the city's five major hospital groups share patient data via an electronic medical network," and 1,300 doctors have partial access to this network. The first goal of such networks is of course to save lives, but in the case of central Indiana, it also could save more than $500 million per year. Of course, there are many hurdles to overcome, many of them financial: finding money to fund the networks or convincing doctors to invest in new technologies. But the two biggest obstacles are human. First, less than a doctor over five is currently using electronic medical records (EMRs). And obviously, in our world where banks and payroll companies more or less routinely see some of their records leaked to the general public or even criminals, it's a little bit scary to think about your medical records flying over not so secure networks. But read more...
Let's focus on the Indianapolis example first.
In Indianapolis, the emergency rooms of the city's five major hospital groups share patient data via an electronic medical network. And more than 1,300 doctors in the metropolitan area use an electronic messaging service, which is an extension of the ER system, to share laboratory results and other clinical information about their patients.
In Indianapolis, the three hospitals linked up to a pilot electronic medical network saved $26 per ER visit. And as the medical data-sharing system expands, the central Indiana region could save $562 million per year in health-care costs, says Dr. Marc Overhage, CEO of the nonprofit Indiana Health Information Exchange (IHIE), formed to oversee that region's data-sharing network.
Of course, it's not that easy. You need to find money to deploy these networks, and many large departments of health or hospitals in the U.S. put their cash into other projects they think have higher priorities. And there also some local politics. Look at this example.
Doctors aren't the only barriers to electronic information sharing. Over the past four years, those working to build Indianapolis's medical data exchange have faced multiple roadblocks. According to Edward Koschka, CIO of the Community Health Network (a group of five hospitals in the Indianapolis area), the clinical messaging project was "doomed for failure" at three points over the past two years. The first time was when hospital CIOs met in June 2002 to talk about collaborating. "Everyone said, Wait a minute -- this conflicts with my strategic plan for my hospital," Koschka recalls. His team devoted three meetings to convincing the CIOs that they needed to collaborate on clinical messaging in order to reduce costs.
It's also hard to convince doctors to invest money in these regional health networks.
Doctors must pay anywhere from $10,000 to $30,000 to buy hardware and software and transfer their paper records to an EMR, says Dr. David Bates, chief of general medicine at Brigham & Women's Hospital in Boston and a member of the organization working toward a statewide clinical data exchange in Massachusetts. Bates expects that insurers will reward doctors who share electronic records by paying them higher rates once they've installed the systems.
And it should be the hardest part, considering that doctors are not really using such systems today.
The biggest obstacle to medical information sharing, however, is the way that most doctors currently practice medicine. Right now, only 5 percent to 15 percent of doctors use electronic medical records (EMRs), and many physicians work in small practices with few extra resources or ties to large medical institutions. Doctors in such small practices don't have the financial incentive to invest in the expensive hardware and software necessary to link into an electronic medical network.
But even if such medical networks are built, and save lives and money, will you trust them? Will your medical records be safe? Here is a doctor's answer.
For Dr. Pierson in Whatcom County, the key to guaranteeing patient confidentiality is to offer patients and providers an audit trail of who has looked at the records. Under Whatcom County's "shared care plan," doctors and patients and their families have access to computerized records, and patients can note changes in symptoms or medications. If there is a breach in patient privacy, those responsible must be harshly punished, he says. "If someone breaches, they lose their job. There have to be significant penalties."
So what's your take? Do you think this kind of medical networks should expand? One personal clue: my answer is yes.
Source: Susannah Patton, CIO Magazine, March 1, 2005 Issue
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