Aspirin is often the first drug physicians turn to when a patient
arrives at the emergency room showing symptoms of heart failure. “But
if the doctor prescribes an aspirin and the patient has a history of
taking Coumadin” â€“ a blood thinner used to treat blood clots associated
with many chronic diseases â€“ “that could be a real problem,” explained
David Liss of Columbia Presbyterian Medical Center.
Unfortunately, doctors at Columbia Presbyterian don’t always know
whether their patients are taking Coumadin. In fact, they often know
little about their patients’ medical histories because they rely on
phone calls, faxes, or even the mail to get information from other
health providers. Clearly, this can be dangerous for those being
treated. Such communication barriers are also expensive, since the only
choice is often to repeat tests.
So when Liss began meeting with his counterparts from other hospitals
in northern Manhattan about collaborating to serve their patients
better, they quickly agreed to focus on improving communications. The
result is the Upper Manhattan Health Information Initiative, a program
they are developing to help hospitals use advanced technology to share
data on patients more easily.
New York Takes the Lead
Both the potential savings and the up-front costs of implementing
health information exchanges are enormous, according to Jan Walker,
executive director of the Center for Information Technology Leadership
at Partners HealthCare System.
In a recent study, Walker’s organization found it would cost $28.5
billion to establish a way to exchange “encoded, standardized
electronic transactions” for the New York State’s entire health care
system. Once in place the system would cost another $1.75 billion
annually to maintain. But it also found that the benefits would more
than offset the costs. Walker estimates that after the program was
established the state would save $4.54 billion a year, and health care
providers would save $1.8 billion annually.
This is exactly the kind of savings that candidates for public office often advocate as part of the solution to the ever-mounting cost of health care. Improving technology has
been cited in particular as a way to reduce the expense of the state’s $44
billion Medicaid program.
Northern Manhattan, of course, is not the only place whose hospitals
face serious communications problems. Studies show that between eight
and twenty percent of laboratory tests and x-rays across the country
are carried out simply because doctors cannot find results of tests
that have already been conducted. Nor is New York the only place where
so-called health information exchanges are being considered. Health
care providers nationwide are looking into such programs in varying
forms, and the federal government provides grants to do so.
But experts say that New York is positioning itself as a national
leader in the field by preparing for such an investment.
“Everyone says that it's a good idea to bring [information technology]
into health care,” said Jon White of the federal Agency for Healthcare
Research and Quality, which funds health information exchanges. “One of
the big issues is how do we pay for it, and New York is well ahead of
In its most recent budget, Albany set aside $1 billion over four years
for improving technology and restructuring the health care industry.
The state also hopes to get federal funding.
Questions of Confidentiality
But it’s not just about money. There is some concern that even if it is
financially responsible, converting to computerized communications in
health care could compromise confidentiality by increasing the
likelihood of accidental leaks or deliberate attacks from hackers.
These questions have to be fully addressed in order to move forward,
said James Tallon of the United Hospital Fund.
“Where are the patients, where is the consumer in this conversation?”
he asked. “They are clearly out there ready to be part of a privacy
Those working to develop health information exchanges are still looking
for the correct balance. One group of New York health providers and
insurance companies working on a health information exchange has ruled
out establishing a common database, or even a system where members
would be able to access one another’s files automatically after
deciding that privacy couldn’t be guaranteed in such systems.
Instead, participants would have to request tests and records from one
another, just as they do now, said Kenneth Ong of St. Vincents Catholic
Medical Center, one of the participants in the project. The only
difference would be how the records are sent once they are located.
“The patient [will have] already consented by the time we move
forward,” he said.
Nor are the benefits only financial. For his part, Liss focuses on the
active improvements to care that information technology can bring.
The Upper Manhattan Health Information Initiative will do more than get
patients’ histories into doctors’ hands more quickly, he said,
describing an electronic system to help diabetics. Currently, such
patients keep daily blood sugar and blood pressure diaries, showing the
results to a doctor about once a month. Instead, he says, patients
could have a machine at home that would record the levels and
automatically enter them into the system’s database.
Such a database may also be programmed to let a doctor know immediately
if there is anything important in the medical history of a patient
showing up in the emergency room like, for example, whether she is on
“The system itself can recognize when there’s something that needs the
physician’s attention,” said Liss, “and then draw his attention to
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