Doctors Get New Data Source To Improve Care

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

Over the next year, three Boston-area hospitals will test MedsInfo-ED with the goal of eventually expanding the program to additional emergency-room and other types of doctors. "This is a proof of concept," 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 emergency-room staff to access electronically prescription data of patients who have had prescriptions filled and paid for by a number of the region's largest health insurers and plans, including Blue Cross Blue Shield of Massachusetts, Harvard-Pilgrim, Tufts, Massachusetts' Medicaid program, and the state's employee and retirement health insurer, Group Insurance Commission. Giving emergency-room nurses and doctors access to prescription-claim information is important, because patients' injuries and illnesses in many cases can prevent them from communicating with emergency-room nurses and doctors, and family members may not have health information or be available to provide it, says Dr. Robert Mandel, VP of eHealth at Blue Cross Blue Shield of Massachusetts.

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, which is live with MedsInfo-ED; Beth Israel Deaconess Medical Center in Boston, which will go live this month; and Boston Medical Center, which plans to begin using it soon. Combined, the three hospitals treat about 14,000 emergency-room patients monthly.

Beth Israel Deaconess Medical Center "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," says CareGroup Health Systems CIO John Halamka, in an E-mail interview. CareGroup hopes to include other hospitals from the four in its system in the next phase of the rollout.

But MedsInfo-ED can't provide all possible patient prescription information. Some state pa- tient-privacy regulations are "stricter than [federal] HIPAA" rules, says Blue Cross Blue Shield's Mandel. 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 emergency-room doctors checking for drug allergies or other potential interactions. Also, since the drug data comes from insurance claims for prescriptions, doctors won't know what drugs an uninsured patient takes.

The MedsInfo-ED tool might be available eventually to health-care providers participating in the new Mass E-Health Collaborative, Stone says. That's another group of payers and providers planning a test--beginning sometime next year--to try to get every person in three communities on electronic patient-record systems. Its goal is to get doctors and hospitals throughout Massachusetts using interoperable electronic-records systems over the next several years.