By Stephen Berberich
Electronic sharing of patient records in state health information exchanges is readily available to many physicians.
Yet, in a 2013 survey, the most recent by management consultant company Accenture LLP, many U.S. doctors said they see limited positive effects of the new health information exchanges on treatment decisions, medical errors, and health outcomes
Interviews with physicians from across health care disciplines paint a many-colored portrait of why many doctors don’t embrace health information exchanges.
When the exchanges were created, the goal was to allow “information to follow a patient where and when it is needed, across organizational, vendor, and geographic boundaries,” notes the Office of the National Coordinator for Health Information Technology, or ONC, a federal agency that supports states with grants, awards and guidelines.
However, Paul Kempen, an anesthesiologist at the Weirton Medical Center in West Virginia, doesn’t see it happening that way. One of his big complaints is that various state systems don’t “talk to each other.”
For instance, Kempen’s pain clinic is within a 10-mile wide point of the state’s panhandle, near Ohio and 23 miles from Pittsburgh, Pennsylvania.
“A third of my patients come from each of the three states,” he said. “Every time we administer pain therapy, we look up the patient in three databases. Maybe he’s doctor-shopping, with prescriptions from multiple physicians. It is time-consuming.”
At the University of Maryland School of Nursing, Ronald J. Piscotty Jr., assistant professor of informatics, agreed. Preventing “polypharmacy” between the primary care provider and specialists is costly and often unnecessary, said Piscotty. “If a patient had a normal complete blood count two days ago, there is no need to repeat it,” he said.
No long-term strategies
In March 2010, ONC announced that 56 states and territories qualified for federal awards to build health information exchanges. The agency gave an additional $16 million to states to create and implement up-to-date privacy and security requirements for the exchanges, to coordinate with Medicaid and state programs, and to set strategies to meet gaps in the exchanges’ capabilities.
However, only a handful of states, such as Delaware, have been able to develop a financial strategy to maintain their health information exchanges after the federal money is exhausted, said Mansur Habib, cybersecurity technology program chair at the University of Maryland University College.
“While the federal government gave states the money to build [health information exchanges], states needed to develop a financial strategy to keep these exchanges running,” Habib said.
(For information regarding Minnesota’s health information exchange, visit www.health.state.mn.us/e-health/hie.)
In theory, a health information exchange allows a physician to look into a patient’s record, review lab tests, radiology, medications, surgical procedures and then assess whether a test is needed or new therapies should be prescribed.
In Accenture’s survey of 601 physicians across a wide range of disciplines averaging 16 years in practice, 74 percent said they access patient clinical data from different organizations, such as a laboratories, hospitals or other physicians’ practices. Yet, of those, only 51 percent said they routinely access patient data from a different health organization, 19 percent sometimes, and 4 percent rarely. The survey also found that 79 percent said they were more proficient using electronic health records than two years earlier.
Cyber-savvy younger clinicians may be a defining factor. Corrine Russo, physician’s assistant at Anne Arundel Medical Center in Annapolis, Maryland, said, “With anything like that, the younger doctors would tend to use [health information exchanges] more than older ones.”
For a doctor to participate in health information exchanges, his or her state must have an exchange, Habib said. “Unfortunately, the implementation of these exchanges became politicized and several states shunned the federal money to build these exchanges,” Habib said.
The Connecticut State Medical Society is creating its own health information exchange after a frustrating decade of waiting for state action, according to Matthew Katz, the society’s vice president. He said he hopes the CTHealthLink will be operational before clinicians miss Medicare and Medicaid incentives.
Still, many physicians said they find the exchanges of limited value, and some said they worry about treading on patient confidentiality.
“The [health information exchanges] depend on this wasteful, dysfunctional electronic system few of us trust and few of us care to waste our time on because it takes away from patient care, is about as secure as Equifax and about as useful spoiled milk,” said Thomas W. LaGrelius, a geriatric and family doctor in Torrance, California.
LaGrelius said he uses electronic medical data “when forced to” at his hospital but not in his private practice.
Curtis Caine, a retired Mississippi anesthesiologist, said most patients do not fully understand what they are signing when entering a physician’s office as “a multitude of forms are shoved in front of them” to sign with a consent to share their medical history in the exchange.
Caine maintained that the patient should own the record. “No one should have access to it without his permission,” he said, especially when they are “not feeling their best and don’t read every word. People have been indoctrinated to be ‘sheeple.’”