Health Information Exchanges (HIEs): The Right Information About the Right Patient at the Right Time

Michael J. McNamee, MD, Claudia B. Gruss, MD, and Jeffery A. Gordon, MD

Physicians need easy access to patient information in order to give comprehensive care. As a subspecialist in Pulmonary Medicine, I can interview a new patient to determine if they have ever had symptoms referable to lung disease, have smoked tobacco, have worked with asbestos, or have had exposure to environmental stimuli that engender risk of lung dysfunction. I can examine them to see if their lungs exhibit normal air movement or signs of lung disease. Most physicians remember the rigorous process of learning how to perform the “History and Physical;” to perform it with thoroughness, curiosity, compassion, and professionalism. There was a time when the “H & P” was not only necessary for the physician, but sufficient. That time passed long ago.

Now physicians need to supplement their encounters with reports from other physicians, vaccination history, laboratory and radiologic results, and medication history. Unfortunately, as we know, many patients cannot provide this information. Failure to have unrestricted access to all of this information risks duplicating diagnostic testing, elevating costs, straining resources, and choosing treatments that have already failed or carry unnecessary risks.

“Up to 18% of the patient safety errors generally and as many as 70% of adverse drug events could be eliminated if the right information about the right patient is available at the right time. Health information exchange makes this possible.” 1

The 2009 stimulus act passed by Congress included measures to encourage health care providers to adopt electronic health records (EHRs) in their practice. One of their main selling points was to enable the ability to share records across providers. This goal has not yet been achieved. A KLAS Research report in 2016 found that, “only 6% of health care providers report that information accessed from exchange partners on a different EMR is delivered in an effective way that facilitates improvement to patient care.” 2

The difficulties created for physicians and patients are persistent and interfere with the development of a trusting patient-physician relationship. They also add time and expense as the physician and staff attempt to track down the needed information. Patients assume that because their doctors have EMRs, that they all have access to their medical records.

Here is an example of the problems that occur when there is incomplete information at the time of a consultation: A patient referred for consultation because of an abnormal CT scan of the chest is surprised to find that the physician has no access to review the scans. The images are not immediately retrievable despite the radiology office being part of the same hospital system as the provider. The patient had recent lab work, but the referring doctor did not fax over the results. The patient is unsure of what medications he/she is on. The visit is completed, but the availability of the physician’s opinion needs to be deferred to another visit, after the CT scan images and other records have been retrieved by mail, fax, or by the patient. In the end, the patient perceives that the referring physician and the specialist have failed to communicate.

One would surmise that the electronic medical records would have connectivity so that physician groups and hospital systems could provide seamless access to one another. Patients should not have to waste their time and assume medical risk due to the absence of information. Physicians should not have to waste their time and be unable to eliminate medical risk due to the unavailability of information. Instead, physicians should be able to devote their time to providing patient care and identifying gaps in the patient’s care.

Having accurate and reliable information at the point of care is critical to improving patient outcomes. The clear solution to this problem would be a comprehensive health information exchange (HIE). Connecticut physicians now have access to an HIE through CTHealthLink. The Connecticut State Medical Society (CSMS), in partnership with KaMMCO Health Solutions (KHS) has established CTHealthLink, a physician-led HIE, utilizing a model with a proven track record. The technology comprises an interoperable HIE, a personal health record for patients, extensive data analytic tools, including certified electronic clinical quality measures, and a CMS approved Qualified Clinical Data Registry. This robust tool gives physicians the ability to coordinate care and identify gaps in care, identify high-risk patients, manage resource use, and potentially reduce readmissions and adverse events. It also can be used to report quality measures to various registries and payers, including CMS. Physicians

Physicians and their patients deserve 21st-century technology that can break down the walls that now exist between electronic health information systems. CTHealthLink has the potential to result in better care for our patients and more time devoted to patient care.

REFERENCES

  1. Kaelber DC, Bates DW. Health information exchange and patient safety. J Biomed Inform. 2007;40(6 Suppl):S40–5.
  2. KLAS Enterprises. Interoperability 2016: From a Clinician View - Frustrating Reality or Hopeful Future https://klasresearch.com/resources/ press-releases/2016/10/11/do-clinicians-have-the-interoperability-they-need. Published October 11, 2016.