Hospital health exchange goes live

Doctors regionwide begin sharing data

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A few months ago, Butler Memorial Hospital's Thomas McGill might not have sniffed out the ruse -- the new hepatitis C patient complaining of back pain was trying to get her hands on narcotics from any doctor who would oblige.

But now, he was quickly onto her. A few clicks on his computer, and he could see that the young woman had tried the same thing with other doctors -- in a separate hospital system.

He was able to do so because physicians from the Butler Health System can view patient records from the UPMC network and Heritage Valley Health System via a new health information exchange that went live last month.

"I went into ClinicalConnect, and I could see that she'd seen a number of physicians in the UPMC system, with a lot of notes about asking for narcotics," Dr. McGill said. And he could also see that the woman ultimately had been referred to a pain clinic, with her own physician responsible for prescribing the painkillers.

Before ClinicalConnect, Dr. McGill might have asked the woman if she had a pain doctor -- and she might have lied or dodged the question. "And then I'm in the dark," he said. "How can I check?"

ClinicalConnect is the new health information exchange -- called an HIE, for short -- that eventually will connect physicians and patient data from UPMC, Heritage Valley, Butler Health, Kittanning's ACMH hospital, Westmoreland County's Excela Health, St. Clair Hospital, The Washington Hospital, Jefferson Regional and Altoona Regional.

"That's who we look like today," said Laura A. Mosesso, client services manager at ClinicalConnect, though the exchange could recruit new providers in the future.

For now, only UPMC and Heritage Valley are populating the system with a patient's clinical data, and only Butler and Heritage Valley can actually view the information. But by the first quarter of 2013, all of the participating health networks should be fully online, barring any unforeseen vendor-related technological delays.

Butler, ACMH and Washington are now supplying demographic data to the exchange -- that is, a patient's name, date of birth and so on, mainly for the purposes of verifying a patient's identity -- and Washington will likely be the next to push clinical care documents to the exchange.

ClinicalConnect, UPMC and Butler's Dr. McGill -- who is also the leader of ClinicalConnect's quality committee -- offered a demonstration of the system this week. It works like this:

A physician would view a patient's electronic record on an in-house computer system. Each system is different -- Dr. McGill, for example, uses an electronic records system designed by Massachusetts-based Meditech -- but somewhere on the patient's computerized record will appear an icon that links that in-house record to the ClinicalConnect exchange.

Click on that link, and a summary page notifies the physician about a patient's recent problems, recent "encounters" (doctor or hospital visits), allergies, medications and lab tests.

Select any of those tabs and a physician can drill down further to see the results of the lab tests, for example, or to learn the maker and batch number of a particular vaccine that the patient received.

The system, built by local health IT vendor dbMotion, also allows a physician to get a better chronological sense of events -- was that abdominal fluid detected before the splenectomy, or did it appear after?

Lots of patients with complex medical histories, especially "people who are older, they can't remember all of the details," said Dr. McGill. "And, of course, getting all of the details right is one of the key features of good medicine."

Good medicine is the long-term goal of the billions being spent to install health information exchanges, the systems that allow a patient's continuity of care document to flow from one hospital, or physician, to another more or less instantly. Without these types of systems in place, hospitals or physicians must first obtain a patient's consent to seek the records from those other providers, a process that can often take hours, or even days.

Advocates say the systems will allow physicians to make better and more timely decisions, and will help to cut back on redundant tests and evaluations because the doctors will have patient data going back years; critics worry about the security of the systems, and say they are expensive and unproven, possibly to the detriment of patient care outcomes.

Most of the data that's available on these systems will be text-based written reports. Via ClinicalConnect, said Christian Carmody, UPMC's vice president of IT outreach services, a physician can view a written report on the ankle X-ray or the chest MRI, but not the radiology images themselves, at least not yet.

"That's something we're going to have to figure out," he said. "The size of those files are pretty large. And for those to move about [the network] consumes bandwidth, takes up storage."

Hospital systems and physicians clinics are being pushed to build, or subscribe to, such systems by the federal Affordable Care Act and by the American Recovery and Reinvestment Act, which tied more than $25.8 billion in health IT funding, as well as future Medicare funding levels, to a variety of deadlines and usability benchmarks.

In Pennsylvania, at least six separate HIEs are now being built by hospital network coalitions, health insurers and private tech companies. Within a year or two, all of those exchanges should be able to communicate to one another, allowing physicians participating in, say, the ClinicalConnect HIE to pull patient records from the Geisinger-led Keystone Health Information Exchange, operating out of Pennsylvania's midstate and northeastern counties.

The HIE-to-HIE, hospital-to-hospital communication and clinical sharing is the key to the statewide system.

"Pretty much all hospitals have this sort of thing locally," Dr. McGill said, meaning that a Butler Health System physician could view all of a patient's interactions and records within that health system.

"But people go back and forth between institutions all the time," he said. About 62 percent of Heritage Valley patients, for example, also have crossover treatment with UPMC facilities or doctors.

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Bill Toland: or 412-263-2625.


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