Safety Net
Creating a national patient record system is a daunting but worthy goal
Industry initiatives. Converting the current system to one in which patient data flow securely and seamlessly on demand is a "daunting task," says Micky Tripathi, CEO of the nonprofit Massachusetts eHealth Collaborative (and a founder of the Indiana exchange). While the feds are pushing hard on this goal, it largely falls to industry to make it happen. Janet Marchibroda, CEO of the eHealth Initiative, a nonprofit group bent on improving healthcare quality through technology, says more than 100 local, regional, and statewide initiatives are underway, triple the number of a year ago. Nascent efforts include plans to tie the computers of some 600 physicians' offices in Massachusetts to computers of local hospitals, nursing homes, home health agencies, and other providers in the commonwealth, as well as a test to link a handful of California emergency rooms. Tennessee has a similar initiative. Meanwhile, IBM plans to electronically string test sites in California, Minnesota, and Israel to iron out kinks in delivering patient data over long distances.
But there's one big sticking point: how to connect the resulting patchwork of records into a national database. It's not uncommon for one hospital to have different computer systems that can't communicate. But "the technological issue pales in comparison to the cultural issues," says Rick Wade, a spokesperson for the American Hospital Association. Healthcare organizations are highly competitive. "Every player is essentially an adversary in the market," says Tripathi. And the payment system rewards providers for testing and treating sick people, not for keeping people well. Providers have been slow to develop such costly information technology solutions. "Money is always an underlying issue," Wade notes of the cost to wire hospitals, which typically operate on very thin margins.
The Bush administration is working with industry to figure out ways to connect the potpourri of mini-networks, such as funding promising projects and helping set industry standards. Last week, the feds told doctors it would give them free software to computerize their medical practices to prompt physician involvement.
Back in Indiana, Overhage is beefing up the repository. "Completeness is something people would love to see," he says. It's targeting smaller players like local pharmacies and tailoring the data. A surgeon and a pediatrician, for example, would zero in on different aspects of patient records. Thanks in part to a $5 million federal grant, more of Indiana is plugging in and the exchange is supplying best practices and treatment information. Up next is a statewide public-health surveillance network; hospitals would share emergency department records. "The data is in these little islands or archipelagoes, and each one is different and distinct," says Overhage. Little by little, Indiana is wiring the state. The question remains whether the feat can be pulled off nationwide.
advertisement
