In response to the conundrum raised by Dr. Joel Saland in the Business Outlook Executive’s Desk published March 10, “Electronic health records rife with flaws,” it is important to note the ongoing development of New Mexico Health Information Exchange (NMHIC), the state-designated health information exchange (HIE).
LCF Research is currently in the process of developing a robust HIE that physicians and other health-care providers could use in an efficient and effective manner to share health information, which can assist in managing their patients despite having disparate electronic health records (EHRs). With the appropriate secure interfaces, NMHIC allows exchange of protected health information between different electronic health records.
The HIE can consolidate a patient’s health information from a variety of different EHRs, allowing the health-care provider to view that patient’s diagnosis, medications, immunizations, allergies, procedures, lab, X-ray and even specialty consultations, derived from each health-care organization even when they have different EHR systems.
For example, using the NMHIC HIE, a physician can view the health information that was derived when a patient was seen at the University of New Mexico Hospital, Presbyterian, Lovelace Health System and Albuquerque Health Partners, as well as a vast variety of other health-care provider organizations in Albuquerque and across the state.
In order to accomplish this sharing and consolidation of health information, interfaces with each health-care provider’s EHR must be established. With the appropriate platform, access to the HIE potentially can be embedded in the provider’s EHR so that the physician does not have to use different “portals” to obtain the health information, such as lab or X-ray data, and even view trends in changes in those results independent of the source of that information. For example, laboratory results may come from different laboratories, including organizations such as Tricore or Quest Diagnostics, as well as individual hospitals, clinics or practices.
Many health-care organizations and practices have made significant investments in these different EHR platforms. The use of the HIE can create interfaces with those systems and thus not require the development of one single EHR in this country or in New Mexico.
This allows the sharing of patient information securely between the larger health-care provider organizations and private community, and when patients are out of town and see another doctor who needs their records.
In New Mexico, in order for a provider to view a patient’s information in the HIE, it is required that either the patient give consent or there is a life-threatening situation. Only authorized users can view patient information in the HIE and be able to demonstrate the need to view a given patient’s health information. Patients also can “opt out” of having their health information viewed, in which case, no provider can see their health information in the HIE under any circumstances.
The benefits of the HIE have been demonstrated in pilot use of NMHIC. Those pilots showed a decrease in unnecessary duplication of tests and procedures since those prior results could be viewed in the HIE.
Furthermore, the HIE improved effectiveness in reaching a diagnosis and formulating a treatment plan, building upon prior evaluations and consultations done in different health-care provider settings.
The patient doesn’t have to keep repeating or recall all of his or her health history. It is often difficult for patients to remember all of their diagnoses, medications or other procedures, whereas the HIE will have that information for the providers to view and allow them to delve further with the patients into their health history.
The use of the HIE and EHR need not preclude the important aspect of the doctor/patient interaction, but rather enhance the appropriate patient’s health assessment and care with more complete and accurate health information from all systems in which the patient has received care.
Again, with the appropriate interfaces, even consolidated immunization information can become available, so the doctor with greater confidence can determine whether the patient’s required immunizations are complete. Eventually, the NMHIC HIE can provide a patient portal so individuals can view all of their health information derived from different EHRs and laboratories, creating a “one-stop shop” for patients or, as needed, their families and other caregivers.
Physicians also can design their face-to-face patient interaction so they share what is on the computer and still pay attention to the patient’s description of his or her health problem and still “look them in the eye” in a manner that fits into the workflow of their practice.
The HIE can be customized for individual providers so they are not burdened or distracted by “data overload,” but instead have access to a sufficient amount of a patient’s health information to support his or her evaluation and care management. An EHR combined with the HIE need not deter from the doctor/patient relationship, but rather enhance that relationship and effectiveness of care.
Although the NMHIC HIE is still a work in progress, it has the potential of improving patient care and supporting the patient’s providers independent of the EHR system being used. In order to be effective and useful, each health-care organization in New Mexico and its associated providers need to participate and allow an interface between their individual EHR and the HIE.
When health-information technologies, such as an EHR combined with an HIE, are used appropriately and in a meaningful way, patient care coordination and continuity can be enhanced that results in the ultimate goal of better health outcomes for each patient, providing the right information, at the right place, and right time at the point of care.
For more information about the NMHIC HIE see the LCF Research website, www.lcfresearch.org.