Emergency Rooms Get New Data Source To Reduce Medical Errors

Emergency rooms in several Massachusetts hospitals are using a new electronic tool to access patients' prescription information from insurance claims to improve safety and quality of care.
Emergency-room doctors in several Massachusetts hospitals are beginning to use a new electronic tool to access patients' prescription information from insurance claims before treating them in an effort to improve safety and quality of care.

A new tool called MedsInfo-ED is being piloted over the next year by three Boston-area hospitals with the goal of eventually expanding the program to other emergency rooms and for use by other types of doctors, says Elliot Stone, CEO of Massachusetts Health Data Consortium, a nonprofit coalition of private and public health-care organizations in the state.

MedsInfo-ED allows ER doctors to electronically access the prescription data of patients who have had prescriptions filled and paid for by a number of the region's largest health insurers and health plans, including Blue Cross Blue Shield of Massachusetts, Harvard-Pilgrim, Tufts, the state's Medicaid program, and the state's employee and retirement health insurer, Group Insurance Commission. "This is a collaboration that allows ER doctors to access prescription claim information," says Dr. Robert Mandel, VP of eHealth at Blue Cross Blue Shield of Massachusetts. That's important in the medical treatment of patients who in many cases may not be able to communicate with ER nurses and doctors because of their injury or illness, and whose family members may not have that information or be available.

The prescription claim information used by MedsInfo-ED doesn't reside in a central database, but rather the tool provides electronic access to multiple claims data sources that are part of the data exchange. The three hospitals participating in the pilot are Emerson Hospital in Concord, Mass., which recently went live with MedsInfo-ED; Beth Israel Deaconess Medical Center, which will go live with MedsInfo-ED in November; and Boston Medical Center, which also will begin using it soon. Combined, the three hospitals treat about 14,000 ER patients monthly.

In an E-mail interview with InformationWeek, John Halamka, CIO at CareGroup Health System, which operates Beth Israel Deaconess Medical Center, said that his hospital "integrated the medication information from MedsInfo into our ED Dashboard, so emergency clinicians, with your consent, can view a list of medications you've been prescribed." CareGroup hopes to include others of its four hospitals in the next phase of the rollout.

But MedsInfo-ED can't provide all possible patient prescription information.

For one, Blue Cross Blue Shield's Mandel says some state patient-privacy regulations are "stricter than (federal) HIPAA" rules. For instance, in Massachusetts, health-care companies can't disclose information pertaining to drug treatments for HIV or psychiatric disorders without permission from patients. That means that information won't be accessible to ER doctors checking for drug allergies or other potential interactions. Also, since the drug data comes from claims for prescriptions that were filled and paid for by the participating payers, ER doctors wouldn't know what drugs an uninsured patient may be taking that she or he paid for out of pocket.

Still, Massachusetts Health Data Consortium's Stone says the project can serve as a model for a bigger, possibly statewide rollout. "This is a proof of concept; the idea is getting doctors access to prescription information across any of the health plans," Stone says.

Stone says the MedsInfo-ED tool might also eventually be available to health-care providers participating in the new Massachusetts eHealth Collaborative. That's another pilot group of payers and providers working toward the goal of getting doctors and hospitals throughout Massachusetts using interoperable electronic patient-records systems over the next several years. That collaboration is collecting applications from communities in Massachusetts interested in being one of three communities in a pilot slated to kick off sometime next year.

Some of the members in the MedsInfo-ED pilot also are part of the Mass E-Health Collaborative, including Blue Cross Blue Shield of Massachusetts, which is contributing $50 million for the community-based electronic-health-record pilot project.

Blue Cross Blue Shield Massachusetts CIO Carl Ascenzo says the company's senior management places a high value on participating in and investing in collaborative health-industry efforts. For Blue Cross Blue Shield, he says, "taking a leadership role helps enable the community to obtain greater goals that it's trying to realize," like improving patient safety.