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 the country."
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 backlash.”
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 Coumadin.
“The system itself can recognize when there’s something that needs the physician’s attention,” said Liss, “and then draw his attention to that.” Â