Collaborate and ConquerCollaborate and Conquer

For instance, a doctor treating a pregnant patient might request a summary of all obstetrics testing, which could help alert the doctor to patient conditions that should be investigated further, Overhage says. The fact that the patient's summary indicates that she had a recent EKG alerts the doctor that the patient might have heart problems and therefore shouldn't take certain medications. The summary would also cite the facility where the EKG was conducted, letting the doctor track down the results, if necessary.

Using the medical-record system, Regenstrief is also researching the impact IT can have on improving patient safety through a three-year, $1.5 million grant awarded in November 2001 from the Agency for Healthcare Research and Quality of the Department of Health and Human Services. The project is focused on patients with two prevalent and costly conditions: congestive heart failure and asthma. Overhage and his team are using the medical-records system to identify indicators of potential errors in the care of outpatients and changes in the health-care delivery system that can potentially reduce these errors.

Meanwhile, in New England, work that was done for HIPAA electronic-transaction compliance could provide the framework for sharing clinical information among local health providers, says Dr. John Halamka, senior VP of IS, CIO, and a physician at CareGroup Healthcare System, which operates five Boston-area hospitals. The New England Healthcare EDI Network is a consortium of about 40 regional payers and providers that have designed and implemented a HIPAA-compliant E-commerce platform that reduces administrative costs through electronic payment for health-care services. Work is under way to let doctors use the network's architecture to share clinical information as well. It's likely that medication information will be the first shared, with an initial user focus on emergency-room doctors who need to make quick decisions.

As much as HIPAA compliance has been an extra burden and expense for many health-care companies, the regulations have helped kick-start industry movement toward improved collaboration and integration. "In a positive light, HIPAA is very much about standards. And the one thing you need for collaboration and integration to work are standards," says Ted Dellavecchia, senior VP and CIO of CareFirst BlueCross BlueShield of Maryland.

Sutter Health CIO Hummel says that like the impact of HIPAA's regulations, it will likely take government pressure to get the health industry to share clinical information: "Electronic medical records will eventually come, but it will need to be a government mandate" (see story, "Federal Government Leads By Example").

HIPAA regulations have already raised awareness about a basic but important issue: ensuring the identity of the patient. One of the key challenges in sharing patient information is being able to guarantee that the information a doctor accesses absolutely pertains to the patient at hand, not someone who has the same name or a similar Social Security number. "It's a big inconvenience to have a screwup on your credit report, but having a doctor access wrong medical information about a patient could be life threatening," says Randy Thomas, VP of implementation services at HealthLink Inc., an IT consulting firm focused on services to health-care providers.

The federal government's original HIPAA plans in the late 1990s contained a proposal for national medical IDs for all patients. Although the proposal was eliminated because of privacy concerns, some health-care organizations, including Santa Barbara County, Sutter Health, and Sharp HealthCare, an operator of several hospitals and medical groups in San Diego, are taking steps to ensure the accuracy and integrity of patient data by developing their own internal master patient indexes. "Sharing clinical information nationwide without a national identifier will always be an issue" working against collaboration and integration in health care, says Bill Spooner, senior VP and CIO at Sharp.

Still, it just might be ambitious regional efforts such as those in Santa Barbara County that will convince others to push for national collaborative initiatives. Says California HealthCare Foundation's Karp,"We're in the early stages of community sharing that has great potential."

Illustration by Brian Stauffer