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Posts made in October 2011

Health Information Exchange Enables Continuity of Care

George residesin Seattle Washington.  He suffers fromasthma and high blood pressure, but these conditions are usually controlled withmedication prescribed by his primary care physician.  George goes on a business trip across thecountry to Boston, Massachusetts.  Hedevelops a pain in his chest and shows up in the emergency room at one ofBoston’s major medical centers in the middle of the night.  He has never before been hospitalized anddoes not have a personal health record, his health history or a list of hismedications with him.  He does not evenremember the phone number for his PCP. The ER physicians immediately do a cardiogram and see no indication of aheart attack.  They are puzzled and haveno idea how to treat George without access to his medical information,medications, allergies, etc.

With extensivespecialization in medicine, and continual changes in healthcare insurancecoverage, most Americans receive their medical care from a number of differentproviders. In our current healthcare system, these consumers are encouraged toseek the advice of specialists and obtain second opinions. The differentproviders, all keep their own health record. Although those records may bedigital, they typically cannot talk to one another. As a result an individual’shealth information becomes stored in many silos. The solution is to establishnetworks of health information exchanges to enable mobilizationof healthcare informationelectronically across organizations, within a region or community, and ultimatelyacross the country. HIEs aggregate a patient’s record in asingle data file that can be viewed by many primary care physicians,specialists, therapists and staff at diverse doctor’s offices, hospitals,pharmacies and  labs. The advantage tothe patient is that there is continuity of care. The number of redundant testsis reduced, along with opportunities for medical error and misinterpretation ofdata.

Most Health Information Exchanges began asRegional Heath Information Organizations (RHIOs) that received their initialfunding from grants to states. When the funds ran out, many of the RHIOs failed.Now, most RHIOS are being consolidated into state-wide networks. The ultimategoal is to create a national health information network NwHIN.  The technology is available, but funding issues and confidentiality of patient information hamperattempts to get this done.  The NwHINrepresents a giant step forward in insuring that patient data is available atthe point of care.  It also makes itpossible to aggregate data to improve population health. 

For a more detailed commentary on health information exchange, see therecent article posted in the Journal of Participatory Medicine. www.jopm.org/evidence/reviews/2011/health-information-exchange-a-stepping-stone-toward-continuity-of-care-and-participatory-medicine/

Brave New world of iPad Computing

After all of the discussion  and political debate about EHRs; the pros andcons, the deadlines, the training, the difficulty that so many doctors seem tohave adapting their practice to a model that incorporates an electronic healthrecord, and use of the computer during the patient visit, the world has changedonce again. Enter the iPad.

In many physicians’ offices,patients arrive to find an iPad waiting for them where they can fill in currentproblems, allergies, symptoms, and medications with the touch of a finger. Whenthe nurse takes the patient to an examining room to check vitals, thatinformation is also recorded on an iPad. All of this data is instantaneously transferredto the doctor’s iPad and is available during the office visit. When the officevisit is over, the doctor dictates notes directly into an iPad. The full set ofpatient data is then automatically stored in the patient’s electronic healthrecord. Annoying issues of eye contact and personal communication with doctorswho use desktop systems that can become a barrier to communication go away. The1.3 pound iPad sits between the provider and the patient, can be seen by bothindividuals and does not become a diversion. 

iPads are also easy to use andmaintain and do not require the learning curve or the overhead of largercomputer systems that doctors have resisted for so long. Implementing an iPad-basedelectronic health record qualifies doctors for the stimulus money allocated bythe 2009 Stimulus Package as long as they adhere to the meaningful use definitions. The Electronic Health Record softwarefor the iPad is supplied by the familiar players:  Allscripts, Prima, Meditouch and Eclipse andother vendors who have been developing EHR software for years and havehopefully worked the bugs out of their systems.

In the brave new world of usingIPads, physicians and hospitalists also take them right to the patient’sbedside where they can view the patient’s chart together and determine nextsteps. Doctors who make house calls to home-bound patients are using iPadsloaded up with the patients’ electronic health records, x-rays, lab tests, andprocedures, that they can share and discuss. IPads are even used today inemergency departments to track movement of patients and staff and record orders.

There is a downside to using aniPad that contains extensive patient data and can be carried in a pocket. Privacyof health information is serious. It is important that the data is encrypted,and that iPad users are diligent about insuring that their iPad is with them atall times, so it cannot be stolen. 

Did Steve Jobs ever envision thatthe iPad would become an important device in the delivery of healthcare? Onecan only wonder.