New York City Mayor Michael R. Bloomberg has announced that the city is ready to equip doctors with computer software that can track patients' medical records in order to provide better preventive care. The new system would let doctors do much more than is possible with paper charts by integrating a patient's medical history, lab results and current medications into one electronic interface. The system will also provide up-to-date information to doctors through a series of alerts, as well as share data with other doctors and provide information about the current best practices for treating illnesses.
Establishing rules around patient consent and privacy is one of the most difficult aspects of establishing a healthcare information exchange. That was the message delivered by Irene Koch, executive director of the budding Brooklyn Health Information Exchange, or BHIX, who spoke at HIMSS 2008.
Formed in 2006, BHIX is an effort to share data among several nursing homes and home care agencies with Maimonides Medical Center and Kingsbrook Jewish Medical Center. The presentation provided insight into why data exchanges often struggle. For example, BHIX initially had hoped for a "universal consent" process. In this model, having one provider in the exchange gain a patient's agreement to participate in the exchange would automatically enroll all other providers, and thus streamline sharing data among the multitude of potential participants.
However, after reviewing other exchanges, BHIX opted for a "provider-by-provider" consent process. In this method, the provider gaining patient consent would be able to view information generated by other providers.
There were other difficulties encountered beyond the logistics of gaining informed consent, however. For example, Koch pointed out how the lack of a standard clinical vocabulary makes interpreting shared records difficult. Pertaining to medications, "start date" and "effective date" mean different things at different organizations.
The Brooklyn project is among some nearly 400 similar ventures underway in the U.S., according to HIMSS Analytics. Maimonides won a New York state grant in 2006, which sparked the formation of the now-independent BHIX. It has a joint governing model, representing three home care agencies and four nursing homes. The data exchange will enable the sharing of both discrete electronic data and scanned images, such as advance directives. Data sharing is expected to begin later this year.
Partners Community Healthcare faced a common problem with its physician members. Beyond the members of Partners' academic medical center group practice, adoption of EMR technology was low. The AMC members used the Boston-based healthcare organization's own homegrown system, but primary care physicians lagged in technology adoption throughout the vast community setting Partners encompasses.
Yet, through a combination of carrots and sticks, Partners is on course for 100 percent EMR adoption by its 6,000 affiliated physicians by the end of 2009. Partners CIO Cynthia Bero told hundreds of participants at the HIMSS conference that although physicians understand the benefits of clinical automation, giving them an option about which software to use was a major boost to the effort.
To facilitate physician participation, Partners negotiated pay-for-performance incentives from three managed care plans. The payers agreed to pool money from one year to the next, in the event a practice took longer than anticipated to implement. Partners also provided a "total cost of ownership" analysis to its community physicians. The fiscal analysis was tailored to individual practices. By demonstrating the long-term ROI of an IT investment, the organization helped allay physician fears, Bero observed. Leaning on local and regional physician leaders also helped.
In 2007, Partners added a stick to the various payer carrots it had dangled. It mandated EMR use by any new physician group joining its network, and later expanded the mandate to include all physicians. But physician acceptance has played out better than expected. Only 16 physicians out of some 1,100 primary care physicians opted to leave the network.
Bero's presentation was part of the 2008 HIMSS conference, which is taking place in Orlando this week.
Northrop Grumman Corp. has formed a partnership with the Defense Department and Pennsylvania-based Conemaugh Health System to build a prototype system to move health records between military and civilian medical facilities. Members of the military and their dependents could use the system throughout their lifetime if the experimental electronic transfer system becomes a reality.
Sixty physicians at multiple locations near the city of Barrie, Ontario will upgrade to an electronic medical record and practice management system. The Barrie and Community Family Health Team intends to implement the integrated Clinical Management Solution from CLINICARE Corporation.
The US Department of Agriculture is calling on companies from the food and electronic industries to join the MyPyramid program which aims to provide science-based information about healthy food choices. The MyPyramid program proposes a number of hi-tech initiatives to promote healthy eating, such as video games for kids, podcasts of good nutritional messages or free CD-Roms given away with food products.