A man from Des Moines faints during a Hawkeye football game in Iowa City and is taken to the University of Iowa Hospital and Clinics. He also has heart problems, but the doctor treating him wouldn’t know that — which makes diagnosing and treating him more difficult.
“Unless someone with him is knowledgeable of his medical history, the physician is flying somewhat blind,” said Lee Carmen, associate vice president for information systems at UIHC.
A group of the state’s health professionals are creating a way for medical professionals to easily and safely transfer patients’ medical records electronically — such as those for the hypothetical patient above. This would instantly better prepare the health care professionals treating him.
But as more hospitals and clinics adopt electronic medical records (EMRs) on various systems that may not always communicate with one another, this is a large undertaking.
“It reduces the effort in moving information around,” said Kim Norby, executive director of Iowa e-Health and the state health information technology coordinator. Iowa e-Health is the umbrella organization overseeing the adoption and use of health IT in the state.
The Iowa Health Information Network, the state’s health information exchange, is a collaborative effort between the Iowa Department of Public Health, hospitals, long-term care facilities, clinics, pharmacies, insurers and other health providers that allows these organizations to easily exchange patient data, including medical history and information on allergies, prescribed medications and doses.
The exchange’s main purpose is to work as a connection as more health centers move from paper-based records to EMRs. These records provide a more comprehensive patient history and allow hospitals to track data, better monitor patients and improve quality of care.
As part of the American Recovery and Reinvestment Act of 2009, the federal government has mandated that all hospitals implement electronic records by 2015, and that EMR systems be capable of certain tasks that constitute “meaningful use.”
To ensure that universal adoption throughout the health care industry actually works, the government has set thresholds that hospitals, professionals and critical-access hospitals must meet to prove they are actively using the records. Those that do can apply for financial incentives.
And those hospitals that don’t will face penalties — which includes a decrease in the amount of Medicare reimbursements.
About 80 to 90 percent of the state’s hospitals have adopted EMRs, Norby said. But there’s still work to do with clinics and other aspects of the health care system.
Building the network
The health information exchange allows health facilities to share patient information in two primary ways, Norby said. The first is through a direct exchange of information, which gives a doctor or health care profession the ability to send and receive information securely and electronically, almost like email.
This method was adopted in July 2012.
“It’s more elegant that the ‘mule model,’ where a patient has to bring reams of papers with them,” Carmen said.
The second is a query-based exchange that allows providers to find or request patient information. This is used more for treatment purposes, Norby said, explaining that it can help a physician in an emergency room situation get demographic information of a patient.
Each state was tasked to build its own health information exchange, and federal funding was doled out in 2010. The Iowa Department of Public Health got an $8.375 million federal grant to develop its information exchange and used about $7.2 million, Norby said.
Since then the IDPH has worked to get more than 3,000 accounts connected to it, he added. The Iowa Health Information Network also connects with health care groups outside of the state in Illinois, Missouri, South Dakota and Wisconsin and soon will connect to Nebraska and Minnesota.
Along the way, the Iowa e-health executive committee — a group made up of health care professionals representing a wide range of fields — provided the department of public health direction on how to configure the service.
“We designed the rules of the road,” Carmen, a committee member, said.
He pointed toward policies the committee designed regarding security and how the IDPH should deal with a breach in privacy as well as the best way to make the system financially sustainable.
This was important, he said, because the governor and state legislators were nervous to accept the short-term funding because they did not want tax payers to be on the hook for the system in the future.
The committee ultimately decided on a tiered payment system so a two-person practice won’t have to pay the same amount as a large hospital.
“All hospital expenses are covered by the revenue hospitals generate, so the fees to participate in the Iowa Health Information Exchange would be covered by clinical revenue,” Carmen said. “That doesn’t necessarily mean rates to patients will increase, as hospitals may find creative ways to reduce other expenses using this technology.”
Carmen said the group is now advancing beyond hospitals to private practices, nursing homes, dental and pharmacy groups who are interested in joining the network.
“They all have unique needs and it’s important to engage them so they get the return on investment they need,” he said.