In a world in which financial transactions whiz around the globe in milliseconds, do you ever wonder why it can take weeks to get your medical records to a doctor across town? Soon, your wait may be over.
Central Illinois’ efforts to modernize healthcare communication began in earnest in mid-2009. Led by Quality Quest for Health of Illinois, a Peoria-based nonprofit healthcare collaborative, a kick-off retreat introduced the region to the concept of the “health information exchange.” Attendees represented every aspect of the healthcare system—large, multi-site medical centers; small, critical-access hospitals; public health departments; independent physician offices; long-term care centers; behavioral health providers; physical rehab centers; employers; insurance companies; and patients.
The work that day began with a simple exercise. Every person was asked to tell a story about his or her personal experience, as a patient, in getting medical records from one place to another. In an instant, it was as if the organizational nametags had disappeared. Every person had a story to tell—and few positive things to say about how well healthcare providers are able to communicate with each other.
Among the experiences shared:
- One woman had recently spent several days driving around to various physician offices to get copies of medical records so that she could transfer an ailing parent into a nursing home.
- One man was required to have all of his childhood immunizations over again because there was no record that he had ever had them.
- A mother who had spent weeks helping her child get through inpatient substance abuse treatment was mystified by a physician’s lack of knowledge about the situation when they went for a follow-up visit.
- Another shared that she carries her husband’s medical record around with her in a large binder so that she knows that she will have the latest information to provide to various specialists.
With more than 75 people in the room, the same themes were recurring—procedures unnecessarily repeated, medication mix-ups, decisions delayed, time wasted. In that moment, agreement was reached that there must be a better way.
The National Story
At the federal level, efforts to modernize healthcare technology are spearheaded by the Office of National Coordinator for Health Information Technology (ONC). “ONC is the principal federal entity charged with coordination of nationwide efforts to implement and use the most advanced health information technology and the electronic exchange of health information” (healthit.hhs.gov).
Several years ago, under the Bush administration, a goal was established to ensure that every American would have an electronic health record (EHR) by 2014. The big-picture vision is that a patient can walk into any physician’s office and, with that patient’s permission, all the information that is needed to provide high-quality, cost-effective care would be available. This vision is far removed from the current experience, in which a patient’s health history is predominantly documented on paper, sprinkled across every healthcare provider who has ever served them.
The desire to go electronic didn’t gain serious traction until the American Recovery and Reinvestment Act (ARRA) passed last year, earmarking unprecedented funds to healthcare information technology. Under ARRA, stimulus dollars are made available to healthcare providers that adopt electronic health record software. The available funds are substantial—up to $44,000 per physician (or other eligible professional) through Medicare and up to $63,750 through Medicaid.
The catch? Offices have to make the up-front investment in equipment and software first. They also have to show that they are using the software in a way that the federal government has deemed as “meaningful.” No meaningful use, no stimulus funds.
Change is Hard
Like any company that has ever endured a major technology implementation, physician practices have hurdles to overcome. Providing healthcare is a paper-intensive process, generated by a steady stream of patients in and out the doors. Changing fundamental workflows and conducting complete staff retraining is challenging enough. Doing it while still being available and responsive to the daily deluge of patient appointments, phone calls, lab results and required referrals can feel almost insurmountable.
Yet, for those forward-thinking practices that have already taken the plunge into electronic software, most say that the pain is temporary. Strong leadership, a willingness to change and maintaining a spirit of flexibility (if not a sense of humor) through the process can make a difference.
One resource that is currently available to help is the grant-funded Health IT Extension Center. Illinois is home to two such centers—CHITREC, which serves the core Chicago area, and IL-HITREC which serves the rest of the state.
Quality Quest for Health of Illinois serves as the Central Region office for IL-HITREC. The Regional Extension Center team housed there helps physician practices in 38 counties stretching across the middle of the state. From readiness assessments and vendor selection to project planning and change management assistance, the team works to ease the transition for offices that choose to move forward with EHR.
Currently, grant-subsidized assistance is only available to primary care practices (family practice, internal medicine, pediatrics, obstetrics/gynecology and geriatrics). The team serves specialty practices at negotiated rates.
The Next Step: Health Information Exchange
Nationally, it is estimated that fewer than 10 percent of physicians are using electronic medical records. Central Illinois fares better, with more than 50 percent using electronic records, but this higher number is likely inflated due to the presence of large hospital networks in our area. For small, independent practices, our status mirrors the national picture.
Of course, getting your health record into an electronic format is only half the solution to modernizing healthcare communication. Providers also have to work together to create a way for that information to be shared—securely and privately—across traditional organizational boundaries.
That brings us full circle back to the retreat discussed at the beginning of this article—a dedicated group of committed stakeholders planning for a better way to get medical records from one provider to another.
Following the retreat, more than 200 people from healthcare organizations across central Illinois participated in a 12-month planning process to lay the groundwork for what is now known as the Central Illinois Health Information Exchange (CIHIE). At one time, it was estimated that those involved were devoting a combined total of 664 hours to various advisory councils and workgroups associated with the HIE every single month.
The planned HIE will be available to all of the healthcare providers in 20 counties across central Illinois, including the metropolitan areas of Peoria, Bloomington, Champaign and Decatur. The paperwork to establish the HIE as a nonprofit subsidiary, under the auspices of Quality Quest, is being prepared, and formal setup of the seedling nonprofit is expected in early 2011.
A number of organizations have stepped forward to provide the HIE with start-up capital, in exchange for charter memberships which allow them to hold initial board of director seats and to be among the first organizations to be connected to the Exchange. As of January, charter members included Methodist Medical Center of Illinois, OSF Saint Francis Medical Center, University of Illinois College of Medicine at Peoria, Human Service Center, Easter Seals, Advocate BroMenn Medical Center in Normal, Decatur Memorial Hospital and St. Mary’s Hospital in Streator.
A limited number of charter memberships will provide half a million dollars in start-up capital, enough to move forward confidently with vendor selection and negotiations. Future capital will be raised through the services that the HIE will offer to healthcare providers once it is operational. It is expected that the exchange could be operational as early as late 2011.
What Does Going Electronic Mean for All of Us?
Increasingly, as physicians, hospitals and other healthcare settings adopt electronic records, patients will reap the benefits. Physicians will be better able to utilize the information in the patient’s record in their decision-making, taking advantage of automatic alerts and reporting features to know when an important test is missing or when there’s a medication conflict. With connection to the HIE, physicians will have faster and more complete access to activity that has happened outside the walls of his or her office.
Plus, as more patient records are transitioned over to electronic format, physicians are able to analyze practice data across the entire population of patients served, an exercise that often leads to streamlined procedures and quality care improvements that make a big difference in patient experience.
2011 is going to be a truly exciting year as we watch this transition happen across our community and beyond. iBi
Joy Duling currently serves as project director for the Illinois Health Information Technology Regional Extension Center (IL-HITREC) office, which is housed at Quality Quest for Health of Illinois in Peoria.