Old Fashioned Computer
Photo courtesy: IMLS Digital Collections & Content

Tired of repeating the same history every time you go to a doctor’s office? A group gathered in Greensboro this week looks to make that a thing of the past.

By Rose Hoban

Jane Smith walks into her primary care doctor’s office for her first medical appointment since moving to a new town. The 43-year-old woman has her weight and vital signs taken by a nurse, who enters the information into a computer console next to the blood pressure machine. The nurse says to her, “Your blood pressure is doing really well compared to last year. And congratulations, you’ve lost weight.”
“How do you know?” asks Smith.
“Oh, we can see the records from your last doctor out in Haywood county,” the nurse responds.

For decades pundits, policy makers and health care researchers have been expounding on the benefits information technology will bring to the health care system – better coordination of care, efficiency and reduced cost.

Old Fashioned Computer
NCHICA members hope to bring health informatics in North Carolina into the 21st century. Photo courtesy: IMLS Digital Collections & Content

North Carolina has been slowly making progress on reaching the goals of computerizing health information and making that information accessible across the health care system. But realizing those promises is still a long way off.

Getting closer to that goal is the purpose behind a two-day conference on health information technology in Greensboro that started Monday. Several hundred state and hospital officials, academics, technology experts and engineers attended.

“We’re trying to create a decision support system in healthcare so that a doctor will be able to see a patient’s complete history, their family history, their genetic markers for disease, even at the first visit,” said Holt Anderson, executive director of the North Carolina Healthcare Information and Communications Alliance (NCHICA), that’s sponsoring the meeting.

The organization has been setting the groundwork for health information technology adoption in North Carolina since it started in 1994, Anderson’s been with the organization almost as long.

“All this isn’t going to happen overnight,” he said.

But with the passage of several federal bills and some state legislation, the process of networking health information across the state is finally picking up speed.

Part of what’s been accelerating progress on networking health information has been incentives written into several federal laws, including the Affordable Care Act, and the Health Information Technology for Economic and Clinical Health Act, known as HITECH.

“First, doctors need to adopt a certified electronic health record system,” said Steve Cline, Assistant Secretary for Health Information Technology at NC Department of Health and Human Services. Cline said that North Carolina has received more than $60 million in federal grants to help 3,900 medical practices across the state get set up with electronic health records.

A recent survey found more than two-thirds of doctors use mobile devices during patient visits. Photo by daninofal, courtesy flickr Creative Commons. Credit: Dani Nofal, courtesy Flickr Creative Commons.

“The bar goes up every year for using the electronic medical records,” Cline said. “If you meet the bar for each of four years, each eligible provider will get about $63,000.”

Cline said about 70 percent of that 3,900 are already wired up and ready to go, the rest will be ready by the end of 2013.

Another $15 million federal grant helped to get 600 primary care doctors, free clinics and community health centers equipped with electronic medical records. And Cline said more than 90 percent of the state’s doctors now use e-prescribing instead of writing on a prescription pad.

When Smith’s doctor walks into the examination room, she introduces herself, pulls up her stool and swings around a small desk with a computer screen on it next to her.
“So, it says here you were diagnosed with diabetes last year… have you been checking your blood sugar?” the doctor asks.

One of the goals of health information technology has been to make it easier for doctors to treat new patients and have a complete history at their fingertips, no matter where that patient is being seen.

To that end, North Carolina has been working on a communication network that will allow doctors and healthcare organizations to securely share information about patients, said Linda Attarian, an official with the NC Health Information Exchange. Attarian said a doctor would be able to see a summary of a new patient in his or her office.

“It’s designed to have a longitudinal record of your lab tests, of your diagnoses, who you’ve seen, medications you were prescribed,” Attarian said. “It’s only really relevant data that can help a provider at the point of care, to have some background information.”

Paper Medical Records
The goal of the health information exchange is to make paper medical records a thing of the past.

But for all the planning and progress, North Carolina is only in the middle of the pack when compared to other states.

Cline said none of the large hospital systems in the state have thrown their weight behind the statewide network yet, even though all of the big systems have electronic health records within their own walls. And he said the plan for maintaining the system will depend on fees from providers, large and small.

“It’s disappointing,” said Cline, who noted that hospitals have been busy with fiercely competing for patients and to acquire physician practices over the past few years.

“They were at the table when we were designing what we serve North Carolina best, but I think hospitals are finding out that they’ve got a lot of work to do within their own systems.”

Smith’s new doctor starts discussing medications with her.
“I see that you’ve been taking Medication A for your blood pressure,” she says. “But we’re able to look at data from a lot of other women your age who take blood pressure pills in the state and Medication B seems to work better for many of them.”

The above scenario isn’t fiction. The Veterans Administration has been able to do that kind of data analysis for years using it’s in-house electronic health record system. Other private health care systems, like Kaiser Permanente are doing it too.

Attarian said one of the goals of the NC health information exchange is similar – not only will it allow doctors to see patient histories and old records, but it will also enable doctors and researchers to aggregate data to figure out the best treatment for a patient.

Patient information will be stripped of any information that could be used to finger a particular patient, according to Attarian, and the collected data could be used to identify trends or more effective treatments regimens.

She said the state’s Medicaid program, Community Care of North Carolina, has been doing something similar for close to a decade, The program saved the state more than a billion dollars over the last five years according to an independent report published this past winter.

“That is one of the real values of the HIE,” Attarian said. “We’ll be able to de-identify information, and use aggregated data from all providers across NC.”

As her visit with the doctor wraps up, Smith says, “It’s pretty cool that you know all this stuff from my old doctor… but it’s a little scary too. How do I know that no one else is seeing my medical records?”

Federal laws around medical information privacy have teeth said Susan McAndrew from the US Department of Health and Human Services Office of Civil Rights.

She said that in the decade since the first big medical privacy law (known as HIPAA) went into effect, her office has investigated about 75,000 complaints of privacy breaches. About a third of those resulted in some action or penalty, especially if problems in an organization are systemic.

“We can threaten to impose a civil money penalty for violations,” Mc Andrew said. “And since HITECH Act, the amounts can be substantial.”

Attarian argued in some ways, electronic medical records will be more secure than paper ones.

“With a paper record, someone can look at that record and no one will ever know it, because it’s not tracked,” she said. “But with the electronic health records and with the North Caroline Health Information Exchange, every time information is accessed, downloaded or viewed, there’s a record of that.”

And Attarian said patients will be able get a log of who has looked at their patient record if they request it.

She also said patients will be able to opt out of being part of the exchange.

“If they make that choice, it doesn’t mean they won’t get treatment, or there’ll be some price to pay,” Attarian said. “But once patients stop having to be asked every time they go to the doctor when was the last time they had a tetanus shot, or what are you allergic to, that kind of thing, I think that’s going to start making a difference.”

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Rose Hoban is the founder and editor of NC Health News, as well as being the state government reporter. Hoban has been a registered nurse since 1992, but transitioned to journalism after earning degrees...

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