Electronic Health Records

Adoption & Implementation News

Will health information exchange repair care coordination?

By Kyle Murphy, PhD

- At Baylor College of Medicine, the progress of health information exchange (HIE) over the past year proceeded quickly. It first began along with other area hospitals using an Epic EHR and is about to widen its reach by signing on with the Greater Houston Healthconnect HIE.

While the progress is certainly positive, Baylor College of Medicine’s CMIO reveals that it is a long time coming. According to Jeffrey Steinbauer, MD, several factors have caused care coordination among providers to break down, but fortunately the exchange of health information via HIEs and the use of standardized electronic formats have the potential to remedy the situation.

In this one-on-one interview, the CMIO and family physician explains how HIE use is changing the way providers deliver care and the long-term benefits of increased HIE adoption to healthcare as a whole.

What motivated the decision to sign on with Greater Houston Healthconnect?

Given the incentive programs such as meaningful use have a trajectory from encouraging basic installation and operation of electronic records to sharing of information and quality improvement, we have seen an enormous growth in the use of electronic records and the ability to share electronic data throughout the country. Our practice is largely specialist and the majority of our patients in the Baylor clinic come to us as patients referred by other providers or patients who have challenging, unusual, or esoteric types of problems.

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The ability to gather information that has already been performed on the patient and/or to share that information back with the community where they will go for their continuity of care is very important for us. We see a terrific opportunity to both increase the quality of care through better coordination and communication among providers and potentially reduce the cost of care if we are able to access all the tests and evaluation done on the patients prior to the time they come to see us.

How has coordination of care changed over the years? What has contributed to the difficulties of communicating between physicians?

I’m a primary care physician, a family doctor, and I have been in practice for about 35 years. I have seen this come a long way and one of the things I have noticed over those years of practice is that the coordination of care between specialists and generalists or between specialists and specialists has eroded.

There are a number of reasons why this has occurred: the explosion in the number of specialists who are available; the patient’s ability to pick and choose which providers to see and those providers may be in very different geographic locations (certainly not within the same clinic); and lastly but not unimportantly the effects of insurance panels and the patient being driven to one provider or another based on who their insurance has approved for them.

Why is HIE important to you as a primary care physician?

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For me as a primary care clinician, if I am seeing 25 to 30 patients per day, the amount of effort it would take to get on the phone and call all the different providers involved in the patient’s care becomes unmanageable. The opportunity for us to share electronically, for me to have a direct address to share information securely or to pull information from a patient’s previous physician, would be invaluable.

A not uncommon vignette in our very large market would be for a patient to come and see me for a “post-hospital visit” and it may be a patient whom I know very well who was admitted to a hospital somewhere in the city and the first time I knew the patient was in the hospital was in that visit. Not only do I not know the reasons for being admitted but I also don’t know what was done. The patient’s ability to give the history accurately in understandably not as good as we would like and the reason for that is that there are so many tests done and they may not be told what all the results are. If we are able to share information through the transitions of care document which can now be shared electronically, we have that information immediately available.

Where does Baylor currently stand with HIE adoption?

Our institution has just signed a contract with Greater Houston Healthconnect and that organization has a contract with Medicity as a HISP. Shortly, we will be receiving transitions of care documents on our patients regardless of where they have been admitted and regardless of which electronic health record that institution is using.

At the present time, if you’re a patient in another hospital that uses Epic, our ability to pull information from that hospital on your hospital stay is pretty good from Epic to Epic but it is not good from Epic to Cerner, Epic to McKesson, or Epic to any other EMR. Through the national program of Direct Trust, the health information service providers have been standardized in a way now that if you sign on with one that is Direct Trust-approved, you have access to all the others which opens huge pathways for information exchange.

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What will HIE use at Baylor look like in the months ahead?

Right now we’re seeing that exchange of information occur in a way that it did not occur 12 months ago — it didn’t happen at all. Now the Epic-to-Epic transfer of information is happening with some frequency and in 12 more months we expect the Epic-to-non-Epic transfer to be happening with great regularity and to see a logarithmic in that kind of data exchange. The impact of this on patient care, continuity, quality, cost reduction, and so on is anticipated. I hope we see it happen and quite convinced that it will.

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