eHealth Initiatives Streamline Medical Record Sharing

Trend Report: Medicine

Recently, a Man dIagnoSed wItH an aggReSSIve foRM of cancer walked into a Memphis hospital looking for a second opinion. Rather than immediately ordering a battery of tests to confirm the diagnosis, his doctor logged on to the MidSouth eHealth alliance, a new health information exchange (HIe) that lets Memphis area hospitals share patient medical records. the doctor discovered that the requisite tests had already been performed at a nearby medical center and that their results were instantly available through the HIe’s electronic database. Using existing test results, he was able to quickly confirm the patient’s diagnosis without subjecting him to additional and unnecessary discomfort.

for years experts have argued that the U.S. could offer better and more cost-effective health care if it could find a way to electronically aggregate patient records—often scattered in the far-flung file drawers and hard drives of family medical practices, specialists’ offices, clinics, pharmacies and hospitals—and make them readily available to health-care providers everywhere. when HIes provide patient records electronically, a doctor in california will be able to immediately access the medical history of a visit-ing Pennsylvanian needing care. cost savings would accrue by eliminating duplicative medical tests—enabling faster and more complete diagnoses—and by reducing the time spent tracking down and sharing hard-copy medical records. costly mistakes could be minimized too, if a doctor knew, for example, that a new patient was allergic to certain types of medications.

this is becoming an increasingly realistic goal with the develop-ment of regional HIes like the one used in Memphis. dozens are springing up across the country, representing the leading edge of the growing eHealth movement, which seeks to use information technology to improve the quality and reduce the cost of health care. other common eHealth initiatives include ePrescribing, which uses the Internet and other online tools to create and

new health information exchange technology promises to improve the quality of health care and reduce costs.

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sign prescriptions electronically. eHealth experts say it can reduce medical errors, decrease pharmacy costs and increase efficiency, in part by giving prescribers real-time information about potential drug interactions and allergies and eliminating mistakes associated with the interpretation of handwritten prescriptions. ePrescribing reduces the need for phone calls between doctors and pharmacists and provides patients with safer care. telemedicine leverages telecommunications technology to enable long-distance patient consultations and delivery of clinical diagnosis and other medical services. for example, physi-cians can employ videoconferencing to consult with and in some cases examine and treat patients in remote locations who otherwise might not have access to their expertise. this reduces the need for travel by patients and physicians, facilitates faster and more consistent treatment of injuries and illnesses, and allows some patients to be treated at home rather than in a hospital.

States Take the LeadState governments are providing leadership in bringing eHealth’s promise of broadly shared electronic medical records to reality. as partners with the federal government in administering Medicaid and the State children’s Health Insurance Program and as employers of millions, states are among the largest buyers of health-care services in the country. Rising health-care costs, which now consume about 16% of U.S. gross domestic product, have a direct impact on their budgets. “we have to be involved in this,” says dave goetz, commissioner of finance and administration for the state of tennessee who oversees its eHealth advisory council. “Making health care more effective and affordable is a worthwhile goal for us as a purchaser and as a government.” cara campbell, a policy analyst for the national governors association’s center for Best Practices says, “States perceive health information exchanges to be the top priority for the next two years.”

tennessee is among the leaders of the movement to create state-wide HIes. Its governor, Phil Bredesen, co-chairs the State alliance for eHealth, an organization created by the national governors association to increase the efficiency and effectiveness of health information technology initiatives developed by states. In addition to helping fund the MidSouth eHealth alliance, tennessee has contributed money to the launch of a regional HIe in eastern tennessee and is overseeing the development of the tennessee eHealth exchange Zone. the Zone, a statewide HIe, is intended to enable ePrescribing as well as the sharing of high-density medical images and secure exchange of health information among all health-care providers in tennessee. announced at the beginning of 2008, the eHealth exchange Zone is scheduled to go live with its first users at as many as 400 sites before the end of the year. Its rapid launch was made possible partly by the decision to build the exchange on the back of the state’s existing at&t virtual private network (vPn), which reaches into all 95 tennessee counties. at&t has created a vPn-based portal for the network’s users and has tapped a third party—covisint, a division of compuware corporation—to provide a dual-factor user-authentication protocol to further ensure the privacy and security of the system. “It is very safe for the sharing of files,” says Melissa Hargiss, interim director of the tennessee eHealth advisory council, which is overseeing the initiative.

A National SolutionUltimately, forward-thinking health-care professionals and policymak-ers envision a day when americans will be able to reap the benefits of a national HIe. Before that can happen, though, the industry will have to overcome an array of technical, financial and social challenges. for example, beyond figuring out how to get many different medical information systems to communicate with one another, the industry will have to persuade patients and health-care providers alike to

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State eHealth initiatives are making it possible for doctors to access patient records electronically, saving both time and costs.

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Trend Report - eHealth Initiatives Streamline Medical Record Sharing __________________________________________________________________________ 2

HIEs aren’t the only promising eHealth initiatives, of course. Telemedicine applications that allow health-care providers to deliver their services electronically are also becoming popular. Such applications let doctors meet with patients remotely via videoconferencing; receive readings from their diabetic patients’ glucose monitors via the Internet; send advice to their patients’ cell phones via text messaging; and share high-resolution medical images with other physicians via high-speed Internet connections. Read more about these innovations in the Healthcare Research Library from AT&T at www.att.com/healthcare.

Trend Report Note

participate in the effort. despite the seemingly obvious benefits, that hasn’t always been an easy sell. Some patients harbor privacy and security concerns, and some health-care providers worry about the cost of participation and the return on their investment.

that said, a true national HIe would seem to be inevitable, and if governments do not make it happen, private enterprises might. at&t is among the companies working on a solution. Healthcare community online, at&t’s patented vPn-based eHealth network and portal platform, will enable patient data located in disparate systems to be aggregated into a single-patient view. It will also provide secure access for caregivers to patient information and eHealth applications such as electronic Medical Records (eMRs) whenever and wherever it is needed. at&t has also partnered with Microsoft and covisint to develop a nationwide HIe aimed at individual users. It would allow them to use Microsoft’s Healthvault platform to store their personal health information and share it with any health-care provider connected to the at&t Healthcare community online. “It’s not that difficult to create a regional data repository that is beneficial to consumers,” observes tom eng, founder and president of Helia.com and the eHealth Institute, a private charitable organization that promotes eHealth initiatives. “But knowing how mobile people are, you really need to make this a national and eventually a global solution.”

developing the appropriate financial incentives to spur widespread adoption will help, and federal and state governments are working to create them. (See sidebar at right, “State and federal governments Push eHealth Initiatives.”) tennessee, for example, has offered grants—$3,500 per physician and $2,500 per midlevel health-care provider, such as a nurse practitioner—to medical practices that agree to join its eHealth exchange Zone. centennial Pediatrics, a practice with 13 locations in central tennessee, is applying those grants to the cost of medical-records software it will need to connect to the network sometime in 2009. “once we’re connected to that portal, we’ll be able to access patients’ information and understand their

medical history from a much more global standpoint,” says charlmain Johnson, clinical director for centennial Pediatrics. “this is a wonderful opportunity for the practice to take much better care of our patients in a more efficient and safe way.”

that, of course, is the great promise of eHealth, and the reason that government organizations and private entities alike are pursuing its implementation.

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A number of states have joined Tennessee in pursuing eHealth initiatives, many of them financed at least in part by the Federal Communications Commission’s (FCC) Rural Health Care Pilot Program, with $417 million aimed at furthering the development of eHealth programs.

Minnesota, for example, has passed a law requiring that medical-care providers embrace ePrescribing by Jan. 1, 2011, and is offering grants to support the creation of health information exchanges (HIEs) in rural and underserved communities.

Rhode Island operates KIDSNET, an HIE for children that integrates information from the state’s immunization and birth registries and health-care providers. Ultimately, the state plans to link it to an HIE for all Rhode Island residents.

Other states that have announced HIE initiatives in the past two years include Colorado, Connecticut, Kentucky, Maryland, New York, Pennsylvania, Oregon, South Carolina, Virginia and Washington. In addition, Arizona, Connecticut and New Mexico are among the states that have also announced ePrescribing initiatives.

Meanwhile, the FCC isn’t alone in driving eHealth initiatives at the federal level. In October 2007, the U.S. Department of Health and Human Services (HHS) awarded $22.5 million to nine state and regional HIEs to begin trial implementations of an envisioned Nationwide Health Information Network.

HHS also announced in July 2008 an ePrescription incentive program for physicians and other eligible health-care professionals who write prescriptions for Medicare patients. Beginning in 2009, doctors who use ePrescribing will receive a payment equal to 2% of their total Medicare billing. The incentive will drop to 0.5% by 2013. Those who have not implemented a successful ePrescription program by 2012 will incur a payment reduction.

State and Federal Governments Push eHealth Initiatives

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