Life-saving is hope of records sharing

Charlestown-St. Agnes computer link aims to improve care

October 19, 2007|By M. William Salganik | M. William Salganik,Sun reporter

Imagine an elderly patient arriving at a hospital emergency room with a stroke, says John Erickson, chairman and chief executive of Erickson Retirement Communities.

A "clot-buster" drug, administered in the first few hours, can improve the patient's chances. Definitely. Unless that patient has been taking blood thinners, has had very recent surgery or has a history of brain bleeding - in which case the drug could cause life-threatening hemorrhaging.

How is the doctor to know - quickly - the patient's medication schedule, recent surgical treatments and medical history?

"The single biggest disconnect in senior medicine is people arriving at the emergency room with five chronic conditions, and nobody knows anything about it," Erickson says.

Erickson's Charlestown community and St. Agnes Hospital are scheduled today to announce a solution - a computerized link between the medical records at the two facilities.

Both parties to the health-information exchange foresee expansion. St. Agnes wants to connect its doctors; about 800 practice at the hospital, including 40 community physicians who are employed by the hospital.

John Erickson has an even grander vision - more hospitals, more senior communities, nursing homes, doctors, labs, radiology centers, even individual members who would pay a small fee and get a password they could give to any care provider who needed the health record.

More steps will be announced within the next few months, Erickson said.

Erickson's push forward comes as other highly praised public and private efforts to build electronic records exchanges have slowed down or sputtered out altogether.

There is wide agreement on the concept of electronic-records exchanges.

In addition to quick and accurate decision-making in an emergency, exchanges are expected to save money by helping doctors avoid complications and by eliminating expensive tests that are given because test results are not available.

President Bush traveled to Baltimore in April 2004 to push for the idea, and named an electronic records "czar" that day to oversee the effort. The Maryland legislature approved a bill authorizing a pilot project this year.

But progress has been slow, nationally and in Maryland.

Dr. Victor Plavner, an Anne Arundel County physician, has been heading an effort for six years called the Maryland/D.C. Collaborative for Healthcare Information Technology. With the three biggest hospital systems in the state - Johns Hopkins, MedStar and University of Maryland - two giant insurers - CareFirst BlueCross BlueShield and Aetna - physician groups and six community hospitals, the group seemed to have critical mass to launch a statewide exchange.

But now, despite a $3 million pledge by CareFirst and $1.2 million by Hopkins, "we're dissolving our collaborative," Plavner said this week. "Everybody was interested in quality and safety, but we could not all agree on the right project."

While some members of the collaborative plan to work on their own smaller projects, Plavner said he saw those efforts not as moving toward a big exchange, but, potentially, preventing one. "Personally, I think the more entropy, the more institutions will get ensconced in their own technology, and it will be more difficult to get them to share."

Dr. Rex Cowdry, executive director of the Maryland Health Care Commission, has also been working on the issue for several years. Before coming to the commission, he worked on health policy at the National Economic Council, and was part of the Bush entourage on the trip to Baltimore.

He's more optimistic than Plavner about the movement toward a statewide system, but said this week that consensus first needs to be built around several key policy problems. As a result, he concluded, "We are a number of years away from a statewide exchange."

Among the questions to be answered, Cowdry said, are: Who owns the data? Who should have access and under what circumstances? Is it an "opt-in" or "opt-out" system; that is, do patients have to give their permission to be included, or should they be included unless they decline?

"You've got to resolve these questions if you're going to avoid a bust-up of the system over trust," he said.

Financing is barrier

Financing the system is also a barrier, those involved said. Insurers can save money by making care more efficient.

But it's often the care providers - doctors and hospitals - who are expected to front the cost of hardware, software and training. Bonnie Phipps, chief executive officer of St. Agnes, estimates the cost at $25,000 per physician. "For individual practices, it is very difficult to document a return on investment in terms of dollars," Plavner said.

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