Seamless exchange of clinical data will help eliminate the need for doctors and hospitals to hunt down records from multiple providers, order repeat tests or manually send documents.
When dancer Melissa McKenna moved to New York City from Chicago three years ago, she brought along her clothes, her tap shoes and 25 years of medical history going back to when she was a baby.
Finding a doctor was simple; recounting even her most recent medical history on new patient forms was not. When was the last time she had a tetanus shot? What was the name of the antibiotic that made her sick last year? Is her blood type O-positive or O-negative?
“I did my best to answer my new doctor’s questions,” she says. “But honestly I could not remember a lot of that information, and I didn’t think to ask for all my records before I moved.”
A more reliable and efficient way to carry her recent medical history forward would have been for the doctor’s office in New York to have had digital access to her medical records from Chicago — with all relevant data included — instead of counting on the memory of a young adult trying to schedule dance auditions, start a job and find her way around a new city.
Enter stage left clinical data exchange, which is the broad term for the secure electronic movement of data among disparate points in the health care system — doctors, nurses, pharmacists and health insurance companies. It is nothing short of a revolution in patient care, helping to eliminate the need for physician offices to hunt down records from multiple providers, order repeat tests, or manually send documents. It also can be used to alert providers to a patient’s drug allergies, previous illnesses and any conditions requiring special care.
The ability to exchange this information is an essential part of the move toward value-based care, which ties provider payment to care quality rather than the volume of visits and treatments — quality over quantity. Online access to a patient’s medical history at the site of care offers providers the opportunity to make smarter treatment decisions. They can see what care is still needed, and avoid unnecessary treatment.
Eventually, the person who’s going to deliver care is going to know all about the patient before the exam even begins.
Insurers can also use clinical data exchange to identify if a patient has had duplicate tests, unnecessary imaging or was readmitted for the same issue — all measures of care quality and efficiency. It also helps provide an updated snapshot of the member’s health, which may enable the insurer’s case management team to intervene more quickly if appropriate.
Ultimately, when all the pieces are in place, clinical data exchange has the potential to improve the speed, quality, safety and cost of patient care.
“The primary goal of clinical data exchange is to create a clinical picture for those who deliver care and those who measure care quality and efficiency,” says Dr. Joseph Cunningham, divisional senior vice president of health care delivery and chief medical officer at Blue Cross and Blue Shield of Oklahoma. “Eventually, the person who’s going to deliver care is going to know all about the patient before the exam even begins.”
The first step in the journey is trying to grasp the massive amount of health care data available. Take every office appointment, emergency department visit, hospital stay, prescription, lab test and image one person may have and multiply it by hundreds of thousands per day — and that still doesn’t come close.
A 2014 report in Health Information Science and Systems predicted the amount of health care data would soon reach the zettabyte and eventually the yottabyte level, which is roughly equal to 1 trillion terabytes (a single terabyte is usually the amount of storage on a desktop computer or external hard drive). The numbers are too much for the human brain to comprehend.
What is clear is that the information within each of those bytes – every MRI, every lab test, every X-ray — is a valuable piece of a person’s health record. The challenge is to open the pipelines flowing to and from these vast repositories of data, ensuring it can go anywhere it’s needed. It’s complicated even more by a complex system of multiple insurers, hospital systems, outpatient centers, retail clinics, pharmacies, labs and the mobile lifestyle of consumers.
Despite these potential roadblocks, the prospects are better now than ever.
“The health care ecosystem is environmentally more ready to share data, and many insurance carriers, providers and technology firms are positioned to support the vision of connected, patient-centric capabilities among all stakeholders,” says Hayes Abrams, executive director of network strategy and implementation for the Blue Cross and Blue Shield Plans of Illinois, Montana, New Mexico, Oklahoma and Texas.
“The ultimate goal is to empower clinicians and consumers with tools and information to manage care by leveraging clinical data capabilities,” Abrams says. “We are implementing many of these capabilities now. It has been a journey, and it is not all here, yet. And the upcoming years will be pivotal and exciting for the industry with the changing health care delivery models and technology the clinical data exchange capabilities can provide.”
Because achieving this ambitious vision relies on cooperation among many independent players, some are joining networks that facilitate data-sharing, typically within a particular region or community. These are often referred to as health information exchanges, or HIEs. One example is the MyHealth Access Network in Oklahoma.
MyHealth, created in 2009, is a nonprofit coalition of more than 400 health-related organizations that make patient records securely available whenever and wherever they are needed.
By late 2017, there were records for 3.5 million people in the MyHealth database, which represents more than 90 percent of Oklahoma’s population, says Dr. David Kendrick, CEO of MyHealth and chair of the Department of Medical Informatics at the University of Oklahoma’s School of Community Medicine. Thanks to a federal grant, it will soon be expanded to include data from more than 200 additional health care and social service organizations in the MyHealth database.
“If you are in an accident or have another issue that sends you to the ER, the provider there can pull up your full health record from all other places where you’ve received care,” Kendrick says. “They can provide you with personalized care because they will have the full story.”
MyHealth is especially useful in preventing errors related to medications. Kendrick says there are about 25,000 adverse drug events each year in Oklahoma, and the leading causes are duplicate and non-complementary treatments that are prescribed by doctors without knowing every medication a patient is taking as well as their drug allergies.
MyHealth has multiple layers of security built in to protect patient data. Providers who subscribe to MyHealth log into the web-based portal and search for a patient using multiple identifiers. Only patients who have consented to have their information in a clinical data exchange are accessible. If the patient is found in the database, the physician must attest that he or she is caring for that person. At that time, the patient’s clinical data in the exchange – including all prescribed medication and known allergies – becomes available. There are multiple levels of access, depending on how it is to be used. So a doctor would have full access, while a billing clerk would have a very limited, if any, view.
Cunningham says MyHealth also plays an important role for insurers, particularly in being able to predict which patients are the most likely to have future problems. With that information, an insurer’s care coordinators can offer interventions to the patient that may prevent more serious and costly problems later.
“We have more than 500,000 members’ fresh medical claims data and pharmacy data in MyHealth,” he says. “We will be able to do predictive modeling with not just claims data, but with clinical data and claims data together. We can see who’s next to have a catastrophic illness. If you can identify the next heart attack, you can intervene before it happens. When you use old data to predict the future, it’s like painting the front window of your car black and using your rear view mirror to figure out where the next curve is.”
Dr. Tobie Bresloff has experienced the benefits of an HIE as both an endocrinologist and as the medical director for the St. John Health System accountable care organization (ACO). A good health information exchange is essential for ACOs because the organizations’ value-based care compensation agreement is tied to the quality and efficiency of care provided to patients. Those metrics are easy to track within an HIE.
“As an endocrinologist, patients often were referred to me by another office,” Bresloff says. “Before MyHealth, the records sometimes came with them and sometimes what came wasn’t what I needed. The only alternative was to wait until my medical assistants got on the phone and had them faxed over. In MyHealth, it is a whole lot easier to pull it up ourselves. I could see if they’d been in the hospital, and what was done and the discharge instructions. Patients often forget or don’t know the details of the care they received.”
In her role as a medical director for the Tulsa hospital system, she says MyHealth helps doctors identify gaps in patient care that can hurt the quality of data used for payment. “We don’t want to repeat a test, but we also want to make sure it was done and it had adequate results.”
She cautions that the system doesn’t have complete information on every patient just yet; there are still some gaps because not all doctors and hospitals participate and exchange their data. Still, she says, Oklahoma’s program is a model for how to use HIE for patient care.
“I think more patients than not have something in there,” she says. “When I go in to look, there isn’t always something helpful. When there is, it’s like finding gold.”