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Reconnecting healthcare through health information exchange

Posted Sep 15 2010 12:13pm

by Paul Abramson, MD

The clinical scenario is familiar to many doctors.

An elderly man arrives at California Pacific Medical Center's emergency department in San Francisco at 11 p.m. on a Saturday by ambulance, unconscious and severely ill. A neighbor had called 911 after he failed to answer the phone or door. No friends or relatives are available, and the man has never visited this emergency department before.

The treating doctors must start from scratch to diagnose and treat this patient, with no knowledge of his other physicians, past medical history, medications, or previous medical care. This process is expensive and inefficient, because historical information is missing.

In fact, he just saw his primary care doctor two weeks prior and had lab tests done at a commercial lab that doesn't interface with the hospital's computer system. He was also admitted to St. Mary's Medical Center, only two miles away, three months ago for pneumonia and congestive heart failure. His cardiologist did an echocardiogram and stress test last month in a private cardiology office.

These previous encounters with the health care system produced a rich data set describing this man's medical, family, and social history in wide-ranging detail.

But none of this information is available to the treating physicians during his current medical emergency. Nor can the information necessarily be obtained at all, since the man is unconscious and no other historians are present. His primary care doctor and other specialists do not know he's been hospitalized and may in fact never find out.

Enter "Health Information Exchange"

A new effort is afoot to improve the exchange of health information at the point of care in the United States, from the national level down to local communities. This concept of Health Information Exchange ultimately aims to make the above story play out differently.

Here's a future scenario: The same man arrives at CPMC by ambulance. The paramedics locate his name and birth date from a driver's license and the emergency department triage staff enters this into their computer. After a local search fails to find a record at that hospital, the computer automatically sends a request to the San Francisco Health Information Exchange, a local non-profit secure network linking all healthcare entities in San Francisco.

The SFHEX network authenticates the query as coming from a valid hospital emergency department, and then polls its network of data sources, returning lab results from Quest Diagnostics, a recent hospital discharge summary and discharge medication list from St. Mary's, echocardiogram and stress test reports from the cardiologist, and recent progress note from his primary care doctor including a current problem list, allergies, and medication list.

It's easy to see how this information, obtained in seconds and even before the emergency department physician arrives at the bedside, could radically improve the quality and efficiency of medical care for this man at the point of care. It might even save his life.

After he is resuscitated and admitted to the hospital, his hospital clinical notes, test results and other data are sent in real time by "push" notification to his primary care doctor's and cardiologist's electronic health records system in boxes. When the patient is ultimately discharged from the hospital, the outpatient physicians providing follow-up care are already fully informed of his change in condition, discharge medication changes, follow-up needs, and are more likely to be able to arrange appointments in a timely fashion.

When you compare these two scenarios and the difference it can make for the patient and physicians, it's clear to me that we need to move ahead with Health Information Exchange, on local, regional, and national levels. There's no turning back, but as I'll discuss in the next segment, serious issues of privacy, security, and financial sustainability must be addressed along the way.

Paul Abramson, MD, MSEE, is founder and medical director of My Doctor Medical Group , a private medical practice in San Francisco. He also works as a hospitalist at California Pacific Medical Center, serves on the clinical faculty at UCSF and sits on the Governing Board of the San Francisco Health Information Exchange, the Physicians Advisory Committee on Information Technology at California Pacific Medical Center, and the Security Steering Team advising the California Privacy and Security Advisory Board. Follow him on Twitter @paulabramsonMD .

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