Saturday, October 22, 2011

Health Information Exchange Enables Continuity of Care

George resides in Seattle Washington.  He suffers from asthma and high blood pressure, but these conditions are usually controlled with medication prescribed by his primary care physician.  George goes on a business trip across the country to Boston, Massachusetts.  He develops a pain in his chest and shows up in the emergency room at one of Boston’s major medical centers in the middle of the night.  He has never before been hospitalized and does not have a personal health record, his health history or a list of his medications with him.  He does not even remember the phone number for his PCP.  The ER physicians immediately do a cardiogram and see no indication of a heart attack.  They are puzzled and have no idea how to treat George without access to his medical information, medications, allergies, etc.

With extensive specialization in medicine, and continual changes in healthcare insurance coverage, most Americans receive their medical care from a number of different providers. In our current healthcare system, these consumers are encouraged to seek the advice of specialists and obtain second opinions. The different providers, all keep their own health record. Although those records may be digital, they typically cannot talk to one another. As a result an individual’s health information becomes stored in many silos. The solution is to establish networks of health information exchanges to enable mobilization of healthcare information electronically across organizations, within a region or community, and ultimately across the country. HIEs aggregate a patient’s record in a single data file that can be viewed by many primary care physicians, specialists, therapists and staff at diverse doctor’s offices, hospitals, pharmacies and  labs. The advantage to the patient is that there is continuity of care. The number of redundant tests is reduced, along with opportunities for medical error and misinterpretation of data.

Most Health Information Exchanges began as Regional Heath Information Organizations (RHIOs) that received their initial funding from grants to states. When the funds ran out, many of the RHIOs failed. Now, most RHIOS are being consolidated into state-wide networks. The ultimate goal is to create a national health information network NwHIN.  The technology is available, but funding issues and confidentiality of patient information hamper attempts to get this done.  The NwHIN represents a giant step forward in insuring that patient data is available at the point of care.  It also makes it possible to aggregate data to improve population health. 

For a more detailed commentary on health information exchange, see the recent article posted in the Journal of Participatory Medicine.

Monday, October 10, 2011

Brave New world of iPad Computing

After all of the discussion  and political debate about EHRs; the pros and cons, the deadlines, the training, the difficulty that so many doctors seem to have adapting their practice to a model that incorporates an electronic health record, and use of the computer during the patient visit, the world has changed once again. Enter the iPad.

In many physicians’ offices, patients arrive to find an iPad waiting for them where they can fill in current problems, allergies, symptoms, and medications with the touch of a finger. When the nurse takes the patient to an examining room to check vitals, that information is also recorded on an iPad. All of this data is instantaneously transferred to the doctor’s iPad and is available during the office visit. When the office visit is over, the doctor dictates notes directly into an iPad. The full set of patient data is then automatically stored in the patient’s electronic health record. Annoying issues of eye contact and personal communication with doctors who use desktop systems that can become a barrier to communication go away. The 1.3 pound iPad sits between the provider and the patient, can be seen by both individuals and does not become a diversion. 

iPads are also easy to use and maintain and do not require the learning curve or the overhead of larger computer systems that doctors have resisted for so long. Implementing an iPad-based electronic health record qualifies doctors for the stimulus money allocated by the 2009 Stimulus Package as long as they adhere to the meaningful use definitions. The Electronic Health Record software for the iPad is supplied by the familiar players:  Allscripts, Prima, Meditouch and Eclipse and other vendors who have been developing EHR software for years and have hopefully worked the bugs out of their systems.

In the brave new world of using IPads, physicians and hospitalists also take them right to the patient’s bedside where they can view the patient’s chart together and determine next steps. Doctors who make house calls to home-bound patients are using iPads loaded up with the patients’ electronic health records, x-rays, lab tests, and procedures, that they can share and discuss. IPads are even used today in emergency departments to track movement of patients and staff and record orders.

There is a downside to using an iPad that contains extensive patient data and can be carried in a pocket. Privacy of health information is serious. It is important that the data is encrypted, and that iPad users are diligent about insuring that their iPad is with them at all times, so it cannot be stolen. 

Did Steve Jobs ever envision that the iPad would become an important device in the delivery of healthcare? One can only wonder.