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11/10/2009
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Information Exchanges Let Doctors Share Patient Data Efficiently

Several new networks are being launched across the country, and while they vary in size, scope, and clientele, the goals and challenges are similar.

Maine has had a decade of experience of consolidating healthcare data, because insurance claims data from healthcare providers and insurers gets submitted to a centralized repository, Culver said. HealthInfoNet is similar to that effort but focused on continuity-of-care records, including information on patients' lab and radiology results, prescription drugs, diagnoses, and allergies.

Healthcare providers access the exchange using a Web browser, making for a simpler workflow. If a doctor is looking at the EMR records of patient Jones while he's at the office, the physician can open the exchange using a browser to check that patient's other data.

Once a clinician enters data into the system, it's immediately available to other healthcare providers on the exchange. HealthInfoNet is currently is getting data from about 42% of all ambulatory care visits, 50% of emergency room visits, and 52% of hospital discharges that take place in the state, Culver said.

Access to patient data via the exchange is providing clinicians with more complete information on patients to help improve decision-making and avoid unnecessary duplication of tests. One cancer center has found the exchange provides information about lab results for diagnostic tests done at other facilities that, in the past, it wouldn't have known about, Culver said.

Western Washington Network

Smaller regional networks are taking similar approaches to Maine's statewide exchange, using centralized repositories to collect key patient data.

Western Washington Rural Health Care Collaborative, a non-profit rural health network, also went live this summer with a Web-based exchange to facilitate electronic information sharing among three small, rural hospitals and HarborView Medical Center, a level I trauma center in Seattle.

The WWRHCC exchange, which is financed by government funding and grants, will be expanded to six additional rural hospitals. All facilities in the network are close to the Canadian and Oregon borders and serve a total of about 150,000 patients, said WWRHCC executive director Elizabeth Floersheim.

The exchange will initially provide the smaller hospitals, some of which have fewer than 25 beds and are located 35 or more miles from other healthcare providers, with telepharmacy services. Patient data, such as allergies, medications, lab results, and demographic information, is collected in a central repository, and pharmacists at one of the facilities can remotely provide assistance to other hospitals.

The exchange is expected to reduce costs by eliminating duplicate lab work, as well as provide doctors with fast access to data on patients who are rushed from the regional hospitals to the trauma center. Orion Health is providing most of the technology for the exchange, including its portal, central repository, integration engine, and patient identifier system.

Big City Exchange

In places where populations are larger, federated, peer-to-peer approaches to health information exchanges are favored. In New York City, there are already four such regional health information exchanges, said Dr. Amanda Parsons, acting assistant commissioner of the NYC Primary Care Information Project.

The Primary Care Information Project is providing primary care doctors, who care for underserved patients in the south Bronx, Harlem, and south-central Brooklyn, with free eClinicalWorks e-medical record software and services. The project is separate from the city's four regional exchanges and funded with $30 million from the city's public health department. It's aimed at providing preventative services and improving quality of care for low-income patients, especially those who have chronic illnesses such as diabetes and high blood pressure, Parsons said.

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