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Starting to Click

By wmadministrator

It’s so standard we think nothing of it. Check in at a new doctor’s office, get the obligatory clipboard of paperwork, asking for every detail of our insurance background and medical history.

But who really can recall exactly the date of their last tetanus immunization? And why do we have to remember and report this information over and over again, anyway?

The current system puts the burden of relaying medical history on the patient, agreed Dr. Kimberly Williams, vice president for medical affairs at St. Claire Regional Medical Center in Morehead. “But we are lousy historians as patients. It’s difficult to keep all the information straight. And then trying to regurgitate it at every doctor’s office on a clipboard, not only is it redundant, it’s inaccurate,” she said.

Soon, though, the doctor’s office clipboard and its companion stacks of paper-based medical records files may be a thing of the past.

That’s the goal anyway of Kentucky’s e-Health initiative, which hopes to transition all Kentuckians’ health information records from paper to electronic format by 2011, said Dr. Carol Steltenkamp, chief medical information officer with UK HealthCare and co-chair of the Kentucky e-Health Network Board. The push coincides with a national effort, cited by President Bush, to establish a nationwide uniform electronic records system by 2014.

While critics question whether a national electronic health records system is attainable in just six years, Kentucky is making real inroads in meeting its earlier statewide goal.

“We can lead the nation in the changes that the health care system has to have, if health care is to survive in this country,” said Lt. Gov. Daniel Mongiardo, who along with David Williams co-sponsored Senate Bill 2 in 2005, which launched Kentucky’s e-Health initiative by calling for the establishment of the Kentucky e-Health Network Board.

Working under the leadership of the University of Kentucky and the University of Louisville in conjunction with the Cabinet for Health and Family Services, the e-Health Network Board in turn established the Kentucky e-Health Corporation (KeHC) in September 2007 and charged it with implementing, developing, and operating Kentucky’s health information network.

By the end of this year [2008], the KeHC expects to have up and running a Web portal that will allow instantaneous, secure sharing of a patient’s health information to both health care providers and health care administrators throughout the state, said Trudi Matthews, the state’s e-Health coordinator and the KeHC’s acting president. The project was funded in part by a $4.9 million federal grant.

The Web portal will mark the beginning of a new era in medicine, one in which eventually a patient can go from her primary care physician’s office to a specialist, whether just across the hall or across the state, and have her entire medical records waiting there when she arrives. No need to fill out duplicative paperwork. No need to explain what the primary care physician said or did, or why he sent the patient for the consultation. No need to wait on a mailed copy of lab work or test results. All of the information will be available to the specialist through a secure Web site with a click of the mouse – and with no clipboard in sight.

A Medical Revolution
With the new electronic records system, for the first time a truly comprehensive record of a patient’s entire health care will be available. Instead of a series of hard-to-transfer paper folders with pieces of medical history strewn piecemeal among physicians’ offices, dentists’ offices, walk-in-clinics, and hospitals, the e-Health system will consolidate a patient’s medical records in one place.

Allowing doctors to instantaneously access a patient’s complete medical history will lead to better health care, said St. Claire’s Williams, whose background is in emergency medicine. “The more accurate information I have about a patient, the faster I’m able to take care of them, and the better I’m able to take care of them,” she said.

Eventually, the KeHC’s long-term goals would include allowing individuals to access their own medical records via the Web portal, Matthews said. But that access is down the road. For now, the corporation is focusing on ways to manage file security with a limited number of authorized users, namely health care providers and administrators, including insurance companies and other payors responsible for covering the cost of the care.

Being able to view and share comprehensive patient information electronically is just one advantage of the proposed e-Health network. Making use of the network’s e-prescribing capabilities, doctors will also be able to send prescriptions to pharmacies electronically – eliminating not only patients’ wait time for their drugs, but also the possibility of sometimes hard-to-read handwritten prescriptions being misinterpreted and improperly administered. Furthermore, the e-prescribing software would alert doctors to possible negative drug-to-drug interactions based on prescriptions already present in a patient’s file.

“About half of the estimated 48,000 to 100,000 medical errors that result in death each year are drug related,” Matthews said. “So, moving to e-prescribing is seen as basically a low-lying fruit in health care. If we can eliminate those handwriting errors and make sure no drug-to-drug interactions occur, we could cut nearly in half the number of medical errors that occur.”

The North Fork Valley Health Center in Hazard started using e-prescribing in November as the first step in its plan to introduce a complete electronic medical records system there, said Dr. Baretta Casey, president of the Kentucky Medical Association and director of the UK Center for Excellence in Rural Health.

Eventually, the center will have the ability to share electronic patient files with the local Hazard hospital, ARH Regional Medical Center. Then, when a patient is discharged from ARH and follows up with her primary care physician at the Health Center the following week, all the hospital records, including lab work, discharge papers and the like, will be readily accessible to the physician. Previously, often the records either weren’t available at all, or someone had to walk over to the hospital and wait an hour or more to retrieve them, Casey said.

Keith Hepp, vice president of business development at HealthBridge, a health information exchange corporation based in Cincinnati that facilitates electronic medical information sharing between hospitals, labs, physicians and clinics in northern Kentucky and southern Ohio, sees the move to an electronic health records system as nothing short of a revolution. “Essentially it’s like health care taking the leap that we all took from paper memos to everyone being able to communicate seamlessly via email,” he said.

But the switch from paper to electronic records isn’t cheap: it can cost anywhere from $10,000 to $30,000 per provider, Matthews said. So, a practice with five clinicians can expect to pay $50,000 to $150,000, while it might cost a hospital tens of millions of dollars to adopt a comprehensive electronic medical records system.

Currently, only about 25 percent of Kentucky physicians use an electronic medical record, Matthews said. The rest still rely on paper. So, much of KeHC’s current work is aimed at offering incentives for going electronic, including two series of grants so far to assist clinics and hospitals in introducing e-prescribing capabilities.

And while the technology exists for secure electronic file sharing – after all, it’s in place already in online banking and other applications – what the health care field lacks currently is the infrastructure and standardization to make widespread information-sharing possible.

“Standardizing is a big goal,” said Preston Gorman, director of information technology with Bluegrass Family Health and a member of the KeHC, who noted that currently “every payor has its own system. It’s the definition of inefficiency.” Eventually, the KeHC’s goal is to bring all private payors – including insurance agencies like Humana, Bluegrass Family Health, and others – and public payors, like Medicaid, together into one Web portal that can serve all stakeholders, Gorman said.

The Cabinet for Health and Family Services has estimated that Kentucky needs between $30 million and $40 million over the next three years to develop the infrastructure for a comprehensive e-Health network. It has requested $17 million in state funding and anticipates finding the rest through private sector investments.

Matthews likens the move to an electronic health records system to building a transportation system. “In essence, we still live in the horse and buggy days, and we’re trying to move toward having modern-day interstates where you can send information,” she said. “You can’t do that overnight.”

The Bottom Line
But, as costly as the transition to an e-Health system may be, it will eventually reap dividends for Kentucky health care providers. For proof, just ask HealthBridge’s Hepp.

Cited as a leader in connecting hospitals and physicians by HealthLeaders magazine in 2006, HealthBridge is one of the only health information exchanges or HIEs (the term for a business that facilitates electronic health information transfer within a given region) anywhere in the country to have found a way to stay net income positive, and they’ve done it without grants. Other Kentucky HIEs include the Northeast Kentucky Regional Health Information Organization (RHIO) and the LouHIE (Louisville Health Information Exchange), which is set to begin offering pilot services this year.

“We’ve figured out the cost model. And I think we’re really the nation’s leader in explaining to hospitals and labs why this makes sense to them,” Hepp said.
In a given month, HealthBridge has 76,000 log-ins and sends some 2.3 million health information results to health care providers, 94 percent of which are electronic. One million of those are in Kentucky. Those results might be from a patient’s lab work from any one of 28 hospitals, two national labs, or numerous radiology centers.

In the past, these same results would most likely have been mailed to physicians, causing delays and costing both paper, ink, and postage. With the instantaneous electronic transfer, the company helps its clients save not only time but also money.

“In hard cost savings, we save [clients] at least 70 cents for each printed report [that’s instead sent electronically],” Hepp said. And 70 cents times roughly two million results a month adds up to a lot of savings for HealthBridge’s clients within the local health care industry.

There are other savings as well. Matthews predicts employers’ costs for health insurance for their employees will go down as a result of eliminating the need for duplicative services like lab work and x-rays across various medical offices. As such, the e-Health system could save between $2 billion and $6 billion in Kentucky in wasteful, ineffective care, Matthews said.

There’s also the boon to Kentucky’s economy that everyone hopes e-Health will be. “The field is wide open. About 16 percent of our gross domestic product goes to health care. And the vast majority of it is paper based,” Matthews said. “So as we move this nearly $2 trillion industry over to an electronic sector, there are a lot of opportunities for businesses to reap.”