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/