Partnership Tests Value of EMRs

Many Americans are nervous about the security of their personal health information in a digital interoperable healthcare system—and for good reason. It seems like there is a new headline every week about a data breach involving personally identifiable patient information. Healthcare isn't exactly known for being the most advanced when it comes to data security. The industry still has a long way to go when it comes to securing electronic data. Unlike a paper-based health system, criminals don't need to break-in to a physical location to gain access to personal health information in a digital world.

So it's understandable that some people are a bit anxious about allowing their personal health information to be stored and shared in electronic health records and health information exchanges. But it is important for the health industry to demonstrate the value of electronic health records, build trust, and encourage the community-at-large to opt in and allow their information to be exchanged, because managing populations of patients is a key factor to realizing the value of electronic medical records (see "Unlock Value," October 2009).

Managing populations of patients with chronic illnesses, using de-identified data for genomics research, and tracking disease outbreaks are just a few examples of how providers will be able to use information stored in EHRs to control costs and improve quality of care in the future.

If people can see the value of capturing digital health information, they are more likely to take some risk and allow providers access to their personal medical information—especially if the data is de-identified and proper security precautions are taken.

The Centers for Disease Control and Prevention and GE Healthcare's recent announcement that they are partnering to monitor H1N1 and seasonal influenza activity may be just the opportunity needed to generate widespread support of EHRs from the public. Under the agreement, GE Healthcare will submit real-time information on the status of influenza activity from its Medical Quality Improvement Consortium, an electronic health record repository that uses de-identified data and meets HIPAA guidelines.

Participating physicians contribute patient data to the MQIC each day through the normal use of GE's Centricity electronic medical record. Information collected during the patient visit is fed to a data repository where the information is de-identified while still onsite at the provider location. After the data is de-identified, it is automatically transferred to GE's MQIC database every 24 hours.

The MQIC, which includes nearly 14 million patient records, enables the CDC to track clinical symptoms, such as fever, nausea, and chills, as well as variables like pregnancy and patient age, within 24 hours of being documented.

"The speed of which we are doing this can't happen in a paper world," says Mark Dente, MD, chief medical informatics officer for GE Healthcare. Traditionally, the CDC would rely on insurance claims data, which has a much longer lag time, to track diseases.

Dente says three benefits of the system are:

1. Speed. Data are collected on a 24-hour cycle that can be used to monitor events like H1N1 or a salmonella outbreak.
2. Standardization. Researchers can query a condition like hypertension and the database will include all variations of that nomenclature like HTN or high blood pressure in the results.
3. Analytics team. To help identify unique occurrences, GE has a team of statisticians and epidemiologists helping identify any thing unusual so that the CDC can get a baseline as quickly as possible—within hours versus weeks.

The health industry is already treating high volumes of patients who are flooding into doctor offices and emergency departments concerned about H1N1 and the health of their children and loved ones. If this partnership and its use of EMR data to track outbreaks of H1N1 can better prepare regions to treat the needs of its community, it stands to reason that people who have reservations about having their personal health information online may change their view. Of course if the EMR data doesn't really change the response time to an outbreak or prove to be more effective than traditional avenues, the opposite may hold true.

"There isn't a better use case out there, but I'm not sure if we're using it the right way," Dente admits. "We are not best at marketing sometimes."

The intent of the program is more about alerting providers earlier in the process that there is a spike of H1N1 in their region so they have more time to prepare rather than communicating outbreaks to the public, explains Dente. "Do we have enough beds available? Do we need to get more resources in the area?"

Getting the general public on board with having their personal health information collected digitally and used for population-based studies is something that should probably be focused on a bit more, Dente says. "People may not understand the nuance in de-identified aggregated clinical information and that is something that we need to make folks aware of." When monitoring an outbreak, 36-hours could make a significant difference, he says.

"Here is a perfect example of how truly de-identified data can be used from a public health perspective and show how quickly information can be shared rather than the traditional methods that would take weeks," says Dente. "It is just intuitive that someone could see the value in it."