Advocates Push Health Care Networks to Provide Wider Access to Patient Records

Advocates for a shared information technology system that would link hospitals, doctors and other providers partnered with Hewlett-Packard Co. this month, with hopes of connecting 90 percent of California by 2014.

Meanwhile, seven of San Diego County’s 19 hospital emergency rooms are gearing up to start their own information exchange system starting June 1.

The issue of leveraging technology to provide wider access to patient medical records has been a long-standing one wrought with concerns for privacy, security, cost, value and ultimately, control.

From a medical perspective, doctors armed with a more complete medical record, including past prescriptions, surgery claims and diagnostic tests, can provide better, more efficient care with reduced risk for medical error, said Dr. Steve Carson, a pediatrician and chief medical officer of the San Diego County Medical Society Foundation.

From a business standpoint, that same doctor can avoid ordering costly duplicate tests and spend less on staff needed to hunt down a patient’s medical history, he said.

Some support local efforts to link providers, while others, such as the California Regional Health Information Organization, believe a state system is best.

“Even when you’re dealing with information technology professionals who really know what they’re doing on a micro level, you still end up with systems that are really complex,” said Dr. Don Holmquest, CalRHIO’s president and chief executive officer.

To simplify the process, CalRHIO seeks to serve as a public utility, providing a beacon for local entities to follow.

Holmquest said his 2-year-old San Francisco-based nonprofit can’t afford to help hospitals, physician practices, laboratories, insurers and other providers buy computer equipment, but it can facilitate statewide standards.

“If we just stand around and wait for the regional organizations to stand up and get all their issues worked out I’m afraid we might very well be waiting till 2050 to be getting started,” said Holmquest, who said he does not discourage local efforts, nor does he want to compete with them.

That would include Carson’s effort to launch a pilot program funded with a $320,000 grant awarded last year by Blue Shield of California Foundation.

Local Approach

“My very strong opinion is if you don’t hook up your community the value of hooking up statewide or nationally is really useless,” Carson said.

Unlike CalRHIO, which seeks to create a database accessible by many, the program to be launched in San Diego County involves patient information being logged into a computer program where it is then passed electronically along to other parties’ systems.

The program will focus on uninsured visitors to the seven participating emergency rooms at Scripps Mercy Hospital, Scripps Chula Vista, Rady Children’s Hospital San Diego, Kaiser Permanente, UC San Diego Medical Center, Tri-City Hospital and, tentatively, Paradise Valley Hospital. Upon arrival, each patient will be asked if they want to join the program.

If patients agree, the record from the visit will be passed along and someone from the program will give them a follow-up call.

During that call, the individual will get asked a series of questions to determine eligibility and help them fill out applications for various free or discounted health plans.

Later, they will be referred to one of 16 participating clinics in the program, so that next time they need to see a doctor and it’s not an emergency, they will know which clinic to go to and how they will pay for the visit.

Carson said he hopes the program will save 10 percent of the $40 million written off in bad debt each year by area hospitals, largely because of uninsured ER visits, as well as related tests and overnight stays.

It’ll cost about $1 million a year to run the program in San Diego County, said Carson. At 10 percent of $40 million, the net savings could be as much as $3 million a year, he said.

“Once you’ve shown it’s working, people will pay for it because the end result, the gain is too compelling to ignore,” Carson said.

Lobbying For Change

Holmquest and other CalRHIO executives are eager to prove that a shared system would save participants money, too.

Currently, the group’s focus is to put together a business plan, which Holmquest said he would like to have done by year-end.

“We’re not dealing with just paper records out there, we’re dealing with fragmented systems that have been messed up for years,” said Holmquest, noting that California spends $192 billion a year on health care.

If CalRHIO can help save just 5 percent of that, the savings would be $9 billion.

Harry Kim, director of Health and Life Sciences for Hewlett-Packard Co., said his Palo Alto-based computer maker has servers in 96 percent of all U.S. hospitals, but has never officially worked on an RHIO before.

He said it will take time to develop a statewide system with this much anxiety behind it.

“This at its core is not a technical issue, at its core it’s a technology adaptation issue,” Kim said.

Privacy and security will be a foremost issue.

“You have to hit privacy and security at multiple layers,” Kim said. “If anyone was to say there was a silver bullet, they would have it wrong.”

Tough Crowd

Sharp HealthCare operates seven hospitals in the county but none are in the local ER pilot program, nor is the system looking to join CalRHIO’s efforts.

Chief Information Officer Bill Spooner estimates that Sharp has spent $85 million over five years upgrading its information technology. And he said it will continue to concentrate efforts on internal improvements where Sharp sees the greater value.

“My conclusion is that there’s really not one answer for the whole county,” Spooner said, referring to a handful of other states where systems serving large parts, if not all of the state, have shown positive results.

He said he respects what Carson is attempting and he is watching with interest, but he doesn’t believe San Diego is well-suited for any sort of shared information technology system.

San Diego is home to too many tightly organized providers who won’t be interested in trading notes, he said.

“In San Diego, I have to say today, I’m skeptical,” Spooner said.