Safety Net
Creating a national patient record system is a daunting but worthy goal
Jason Schaffer is an emergency room doctor in Indianapolis. That alone makes him better equipped to do his job than many of his colleagues nationwide. Thanks to an online registry containing the healthcare records of 1.5 million central Indiana patients, Schaffer can instantaneously review a patient's medical background. When an individual is brought to Clarian Methodist Hospital's emergency room, Schaffer can learn all about his patient's recent hospitalizations and ER visits, medications, allergies, recent lab results, and previous diagnoses. All of it is instantly culled from a Google-type search of a patient's medical records from 21 area hospitals, 800 local doctors, and area pharmacies, imaging centers, laboratories, and public-health departments.
ER doctors typically don't know much about their patients. But the background Schaffer has at his fingertips may stop him from prescribing medicine that can harm or kill patients in certain situations, such as antibiotics infused into an unconscious patient on a blood thinner that would cause the anticoagulant to "get out of control," notes Schaffer, or nitroglycerin given to a man suffering chest pain who fails to mention he takes Viagra. Such a combination could cause severe or life-threatening low blood pressure. "Having that bit of information saves time, saves money, and potentially saves life," says Schaffer.
People can retrieve cash from an ATM anywhere in the world or find information on just about any topic online. But only a relatively few doctors and hospitals in the nation have electronic access to patient records. Schaffer and some 22,000 doctors, nurses, and healthcare providers using the Indiana Health Information Exchange are at the forefront of an effort to streamline the nation's chaotic healthcare delivery system. Electronically connecting the system, experts say, makes patient care safer, better, and cheaper.
Medical Internet. Today's fragmented system is rooted in paper and pen, with patient information exchanged by phone, fax, mail, and courier--or not at all. It's a big reason why tests and procedures are repeated or done unnecessarily, why patients get the right treatment for their condition only about half the time, and why nearly 100,000 U.S. hospital patients die by mistake every year. "Information technology seems to be the most promising solution," says J. Marc Overhage, a physician and CEO of the exchange.
The federal government wants what's happening in Indiana to be the rule rather than the exception. Last year, President Bush called on the healthcare industry to create a national electronic patient health record system by 2014, a sort of medical Internet that would ultimately allow a doctor in Cody, Wyo., for example, to pull a patient's record instantly from a hospital in Miami.
A medical Internet could also supply clinicians with treatment guidelines for cancer, asthma, and scads of other conditions. Such a tool also would help public-health officials detect disease outbreaks sooner rather than later. Moreover, says David Brailer, Bush's national coordinator for health information technology, "we're getting to the world of personalized healthcare." For several years, Anne Perlman of Menlo Park, Calif., has been scheduling doctor visits and viewing test results online through the Palo Alto Medical Foundation. "Looking at my record before I go to the annual physical helps me remember what I want to talk over with the doctor and lets me spend the time in the visit much more productively," says Perlman.
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.
This story appears in the August 1, 2005 print edition of U.S. News & World Report.