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.

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