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Information exchange improves medical efficiency

Doctors coordinate care through digital records

Sunday, November 25, 2012
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— Dr. Kallanna Manjunath loves what his hospital can do now that he’s hooked up to the Health Information Xchange of New York. He knows before a patient arrives at his office if they were recently in the emergency room at another hospital. With just a few keystrokes, he has access to their lab tests, X-rays and discharge notes from other health care providers.

He also loves what he and fellow doctors at Whitney M. Young Jr. Health Center don’t have to do anymore. They don’t have to waste hospital money on repeat tests and lab work. And they don’t have to worry about prescribing conflicting medications.

“We have heard many stories like this,” said Dr. John Bennett, president and CEO of Albany-based health insurer CDPHP.

Ultimately, they can plan their patients’ care better — which is really the ultimate goal of the Health Information Xchange of New York, a Latham-based medical records network better known as HIXNY.

HIXNY is just one of many networks that are transforming the way the health care industry does business. But the process of getting doctors, practices and health care providers all plugged into a network has proven to be a challenge nationwide. Even the switch from paper to electronic medical records is harder than it seems. Locally, the Capital Region is outperforming the rest of the country in these efforts.

“We are progressive in general compared to both the state and the rest of the nation,” said Bennett. “Even before there were financial incentives, we were progressive.”

The Health Information Technology for Economic and Clinical Health Act (enacted under the American Recovery and Reinvestment Act in 2009) set meaningful use standards for hospitals and providers to meet when adopting electronic medical records. This meant that they shouldn’t just purchase the software, install the technology and be done. Rather, it meant they should find ways to significantly improve care with these systems.

CDPHP first encouraged physicians to transition to electronic medical records (EMRs) at the turn of the century. In 2004, it signed on with HIXNY and today, Bennett serves as vice chair of the HIXNY board.

Although in the 21st Century it seems logical for medical records to move from paper to digital, the transition is not always an easy or welcome step for small practices and soon-to-retire physicians.

“They tend not to want to make that investment,” said Bennett. “And then there’s the change in workflow and change in processing. Remember that a lot of physician practices are small, and when you adopt an electronic medical records system it requires you to change your workflow. If you’re a small practitioner who’s only got a few years left, you don’t really want to do that.”

In 2006, CDPHP began awarding grants to large medical practices to help them purchase the systems. After some of the biggest practices had transitioned, the smaller ones continued to hold out for two reasons — resistance to change and lack of economic incentive. So in 2008, CDPHP committed grants to small and solo practices.

“We gave over $1 million to small, solo practices,” said Bennett. “There were no federal grants at the time.”

Once practices adopted electronic medical records, they needed a network to plug into — a place they could share these records with each other. Health care officials described it as giving everybody in a community telephones, but no power lines.

“When adoption of EMRs really first started, all that really happens is we replace paper files with electronic files,” said Mark McKinney, CEO of HIXNY. “We didn’t do anything to connect those systems so that one physician could access another’s records. Someone still had to go to one doctor, who puts information on a CD and takes it to another doctor. And that’s not a very secure way of transferring information to one another.”

At the time, HIXNY was focused on connecting all those systems together so that when someone ends up in the emergency room, the physicians could pull up their records from other hospitals across the community. HIXNY was tying all of the disparate information across the region together into one comprehensive patient record.

HIXNY really gained traction around 2009, when it made a significant investment in technology that enabled it to connect all of the electronic medical records systems. This was also around the time that the federal government offered as much as $22.5 billion in incentives under the HITECH Act for practices to adopt computerized patient records.

“Obviously, it was going to take time,” said McKinney. “Many of these institutions needed substantial investments in technology in order to make those upgrades. So what we are trying to ensure doesn’t happen is that these organizations that are being mandated to put these systems into place just pass down the cost to payers or patients.”

Several studies have shown EMR adoption nearly doubling from 2005 to 2010, when about half of all physicians in the United States were using EMR systems.

Part of the reason for this was the financial incentive offered by the Centers for Medicare and Medicaid Services. Physicians who don’t adopt EMR systems or cannot demonstrate “meaningful use” by 2015 will see their Medicare reimbursements cut by 1 percent each year.

In the past five years, CDPHP has already provided about $4 million of its own in incentives and grants for local physicians to adopt EMRs.

McKinney said that about 65 percent to 70 percent of Capital Region physicians have adopted the systems. Some are better than others and some are cheaper than others. Locally, physicians are using EMRs such as Allscripts, Medent, and Centricity EMR, which is developed by General Electric.

“There’s literally dozens and dozens of them, but there are a few that have a larger market,” said McKinney.

“Our region happens to be more connected than many regions around the country,” he said. “We hear over and over again from physicians that the information that can be delivered through HIXNY can help save lives. In the emergency department, as an example, it helps better coordinate care.”

About 50 percent of Capital Region physicians are tied into HIXNY, taking the push into the digital age one step further. More than 80 percent of hospitals in the region are connected to HIXNY, as well. In addition, more than a third of patients in the region have given doctors the go-ahead to use their health data in the HIXNY network.

Specialists in particular seem to benefit from the network. Patients who come to them independently or on referrals from primary care physicians don’t have to sit through an hour or more of providing history and background.

“When the information they need isn’t available, that can be a big probe for physicians and patients,” said McKinney. “We have dozens and dozens of practices that say, 'Hey, not having to go and try to research where a patient had a lab test or radiology test delivered is a huge burden lifted.’”

McKinney heard last week from a medical director who had been trying to track down blood tests for two patients whose records they couldn’t find in their own electronic medical records.

“They went into our system and found they had gone to other facilities in the region to have those tests done,” he recalled. “They had that comfort of knowing that those patients are getting the quality of care that they need. And the beauty of it was they didn’t have to call around.”

The next step in the digital push is right around the corner. For example, HIXNY is in the process of launching a patient portal that will allow people to access their own medical records.

 
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