SIOUX CITY | Sometimes, emergency department physician Joseph Liewer said he can get a patient’s medical records from a hospital outside of CHE Trinity Health System in under an hour but, frequently, he said this vital information is unavailable if the medical records department at that particular hospital is closed or understaffed.
“There isn’t any current electronic health system that sends it to us. If it’s a Mercy hospital, we have that in our own computer because of the shared electronic records, but not across other hospital systems,” he said.
Time is of the essence in the emergency department. Any information Liewer can gather about a patient from visits to other medical facilities is helpful.
Mercy Medical Center and UnityPoint Health — St. Luke’s are less than two miles away, but the hospitals cannot share medical records electronically.
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St. Luke’s implemented Epic in 2013, a multimillion-dollar system that offers a variety of applications including bar coding for medications and access to patient medical records at all UnityPoint Health affiliated clinics and hospitals. Mercy acquired a Cerner electronic medical records system in 2006.
Their situation isn’t unique. It’s a problem hospitals around the country are grappling with.
“While there can be some challenges sharing information between facilities with different EMR systems, facilities like St. Luke’s and Mercy Medical Center have found solutions, whether through courier service or fax,” said Michael Kafka, St. Luke’s quality and patient safety physician lead.
Electronic medical records systems still have a ways to go before doctors around the country can seamlessly share information. In the meantime, the state is giving physicians, who don’t have dual privileges at competing hospitals, some relief with the creation of the Iowa Health Information Network (IHIN).
Participating in IHIN, which serves as a hub that facilitates the secure sharing of electronic patient health information between authorized users, is voluntary, but both Mercy and St. Luke’s have become subscribers.
St. Luke’s went live with IHIN on Nov. 4, while Mercy is in the process of training staff to access IHIN records. When Mercy goes live in a couple of months, the two hospitals will be able to share critical information electronically such as medication history, physician’s notes and lab and radiology test results.
“It just allows us access to more information to provide safer care for our patients and also to control costs,” said Debra Molstad, director of informatics at St. Luke’s. “If we can pull a record on a patient from another facility, the provider may see that the patient had some tests done. That eliminates the possibility of running those tests again and causing more costs for the health system.”
INFORMATION HUB
The government touted the conversion from paper files to electronic data banks as a way to reduce administrative burdens and cut costs while reducing medical errors and improving the quality of care. Health care providers who failed to move to electronic medical records are facing cuts in Medicare and Medicaid reimbursements in 2015.
Seven years after its initial analysis of electronic medical records, the Rand Corporation says health care spending has actually grown by $800 billion annually. A 2013 study by the non-profit policy think tank found the systems were neither interconnected nor easy to use.
Since he couldn’t access their medical records, Mercy emergency department physician Thomas Benzoni said he unknowingly repeated tests patients had at other hospitals. He calls this practice a “senseless expense” for patients that adds no value.
“I can’t think of anybody in 30 years who hasn’t wanted me to have their records, but I can’t get them,” he said. “Somebody in medical records at St. Luke’s has to print them off, put them in a fax machine and, using 1970s technology, send me a picture of your records. That’s silly.”
Iowa e-Health executive director Kim Norby said IHIN has been available since 2012, but he said its use has substantially increased over the past six months as more providers log on to the network. Ninety percent of the hospitals in Iowa are IHIN subscribers, according to Norby.
He said every state now has one or more health information exchanges like IHIN so they can demonstrate meaningful use under the Medicare and Medicaid incentive program.
“I just think that people should be asking for this from their providers,” he said.
MEETING MEANINGFUL USE STANDARDS
Developing IHIN and getting it up and running was a challenging process that took two years.
Electronic medical records system vendors, Norby said, have added a lot of “functionality” to their systems to be able to exchange records and meet meaningful use standards.
“Most of them are there now, but it has taken them a long time to get the development moved forward where it’s capable of it,” he said.
IHIN allows physicians with clinic/hospital privileges to use the “query” feature to learn about patient medications, current diagnosis or allergies. The hub also offers direct secure messaging that is similar to email.
“It allows them to send records back and forth easily as well without having to have the same (electronic medical records system),” Norby said. “We are connected to all the states around us for the direct messaging. You could send records to somebody in South Dakota, Nebraska, Illinois and Missouri.”
John Hendricks, UnityPoint Health’s chief technology officer, said connecting with IHIN wasn’t too complex. Testing the hub and introducing it to emergency department staff, he explained, was more time-consuming. He describes the information shared through IHIN as a “summary” as opposed to the patient’s entire medical chart.
“If a patient presents in the ED, then the ED practitioners need to be aware that (they) can now go look into IHIN to see if that information is available,” he said. “A couple years ago that wasn’t part of the workflow. There’s just a little bit of initial education and training and reinforcement down the road.”
Date: January 2, 2015