Healthy Sharing

Hospitals, doctors and insurers team up to exchange information; do patients need to worry about privacy?

Tucson Medical Center spokeswoman Julia Strange says there are two ways patients can now inform emergency-room staff about what medications they're taking.

"They bring in a brown bag with all the pills," she says, "or rely on memory. If they forget something, it can have a huge impact because of possible bad reactions with other drugs.

"If the ER could pull up a list of those medications as soon as the patient arrives," Strange continues, "it would save an enormous amount of time."

That would require the sharing of patient information among health-care providers. To accomplish that goal, 17 organizations, including hospitals and insurance companies, have come together to form the Southern Arizona Health Information Exchange (SAHIE).

At the same time, an information-exchange program is being developed for patients covered by the state's low-income health-care program, AHCCCS. To date, more than $7 million of federal grant money has been spent on a system which went into limited operation in September.

"The concept behind SAHIE is to improve peer-to-peer communication for clinical decision-making," states project director Kalyanraman Bharathan. "The people making these decisions sometimes don't know very much (because of the variety) of doctors involved.

"If doctors and nurses have an idea (of the patient's medical history)," Bharathan adds, "the chances of making a safer decision are greater."

Using what he terms a collaborative process being built from the bottom up, Bharathan says that the initial objective of SAHIE is to develop a system which utilizes technology to allow the sharing of information between doctors and emergency rooms. This knowledge of medications, as well as recently completed lab tests and patient allergies, would obviously help in the ER.

But the benefits of this electronic information exchange, Bharathan says, could continue after an ER visit. Once a patient leaves the hospital, their discharge summary would be entered into the system so it would be accessible at their next point of care.

"When we discharge people from the ER, some of them are still sick and confused," points out Katie Riley, spokeswoman for University Medical Center, "so they won't remember a doctor's orders. Having a primary-care physician able to pull up this information (from the ER) would really be a nice boon."

Riley believes the program could also help reduce costs, because already-preformed medical tests wouldn't have to be repeated. She adds that UMC is a member of SAHIE and has contributed about $60,000 to the effort so far.

Bharathan hopes to have medical information actually being electronically exchanged in Southern Arizona by next fall, and says that negotiations with a technology vendor are now underway. He anticipates an agreement for between $1 million and $2 million being signed by the end of the year to develop the necessary systems.

To pay for this effort as well as future operation costs, SAHIE will create an information-subscription service. According to a national survey conducted by the group eHealth Initiative, this is the principal way existing health-information exchanges around the country operate.

Both eHealth Initiative and Bharathan emphasize that financial stability is a key to the concept. "Some of them have failed in spectacular fashion," Bharathan says of health-information exchanges, "when their grant money ran out."

Bharathan says that those who benefit the most from the SAHIE subscription service will pay the most. The intent, he adds, is to have a sustainable business model for the organization.

At this point in time, individual physicians who participate are looking at minimal expenses. Bharathan indicates they won't be asked to help pay the capital needed to build SAHIE.

Steve Nash, executive director of the Pima County Medical Society, says organization members are generally supportive of the SAHIE concept. "It would keep doctors in the loop," he says, "because they don't get information from hospitals now.

"But there are a lot of concerns about security (of the information), and the cost," Nash adds. Saying there has been considerable outreach about the proposal, Nash indicates an affordable figure has been discussed for an individual physician to join SAHIE.

Bharathan is also concerned about protecting the personal medical information made available through the system. To ensure its security, he says all the doctors involved will have to become members of SAHIE and commit to only using the material for clinical decisions.

"SAHIE will definitely be obtaining patient consent in some manner," Bharathan says. "We have to leave it up to the patient to make his or her own decision."

Electronically connecting primary-care physicians and emergency rooms is the current goal for SAHIE. But Brad Tritle, executive director of Arizona Health-e Connection, a nonprofit group, believes there are future possibilities as well.

One example Tritle provides is a patient being able to download his or her own medical history. Another is an Arizona doctor communicating with a physician in another state.

"This could be extremely valuable with seniors and snowbirds," Tritle says. "They could (electronically) take the treatments they received in Arizona back home with them."

As for the current SAHIE concept, Strange from TMS indicates the hospital is an enthusiastic supporter and that improving the quality of patient care is the exchange program's biggest advantage.

"This is big stuff," she says.