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Data doctor: Andrew Ulrich, an emergency physician at Boston Medical Center, says miscommunication between doctors and patients is commonplace, and patients often don’t remember what medications they’re on. BMC clinicians can now consult detailed patient records linked to primary-care physicians at Boston-area community health centers. Such links can help resolve medical mysteries.

Plausibly, all of this could have been avoided if the doctors been able to find an earlier EKG showing that her cardiac abnormality was preëxisting. In the end, the doctors found nothing wrong. Three days later, Jobson was discharged. Her care probably cost something in the neighborhood of $15,000–surely a piece of the $700 billion in spending that the economist David Cutler was talking about. And doctors at BMC say the story is typical of patients for whom no records can be found. Vague complaints result in a fusillade of defensive and probably needless tests and treatments–a situation that is unlikely to change unless doctors and hospitals all around the country can share and analyze data electronically.

Balkanized Caregiving
What will it take to stitch together all the health-care providers in greater Boston, let alone the entire United States? Linking disparate facilities is technically possible now, but the fact that it took BMC eight years just to make connections with 10 health centers shows how hard the process can be. Hospitals are businesses, after all, and don’t want to lose patients to competitors. Nor do they want to violate patient confidentiality, a risk that can increase as information is shared beyond a hospital’s walls. “What’s in it for the hospital to give up their data? What is the incentive?” says Larry Nathanson, director of emergency-medicine informatics at Beth Israel Deaconess Medical Center in Boston. “Right now, under the current model, there is a lot of risk involved if you are going to share your data. There is considerable risk, and there is little benefit. Except maybe a ‘herd benefit’–if you do it for me, I do it for you.” Beth Israel uses software developed by Nathanson to manage care in its emergency department, but the technology can’t access records at other hospitals in the area.

Massachusetts health-care executives have long discussed wider information sharing among clinical facilities, and they’ve even hammered out the technical prerequisites. But in Boston as elsewhere, medical institutions are still inclined to spend their IT budgets on their individual needs, concedes John Glaser, vice president and CIO of Partners HealthCare. (Glaser is now on loan four days a week to the Office of the National Coördinator of Health IT, where he is a senior advisor to David Blumenthal.) “From a research perspective, there is a lot of collaboration,” he says. “But a patient who moves from BMC to Brigham–does the data move with them? No. That is typical across the country. If you sit at a board meeting, whether at Brigham or Beth Israel Deaconess or BMC, and say, ‘All right, we have $10 million in capital funds and $40 million worth of requests,’ and one is to improve an IT system for nursing care, and another is to connect electronically with the Lahey Clinic, the one for the nurses is going to win every day.”

That should start to change as states begin receiving their share of the $564 million that Blumenthal has designated for jump-starting statewide and regional health-information networks. And the forthcoming “meaningful use” definitions are likely to include additional incentives for networking at the state and, eventually, national levels. Executives from most hospitals in eastern Massachusetts plan to start sharing discharge summaries (as patient records of hospital stays are called), something a few hospitals are already doing. And several pilot projects for data exchange are under way.

A national network of electronic medical records would not just promote greater efficiency and more consistent patient care; it could also give rise to unexpected insights. Consider the case of the onetime blockbuster anti-inflammatory drug Vioxx. It was a 2004 analysis of the electronic medical records of 1.4 million patients in the Kaiser Permanente health-maintenance organization that showed that users of Vioxx–on the market since 1999–were twice as likely to suffer heart attacks or strokes as people who took a rival drug, Celebrex. Later, Glaser says, Partners HealthCare looked at its own network data and found a similar pattern. “When you look at this data, your reaction is ‘Holy shit, we could have seen this in 2001!’” he says. “You can see the signal. The key question is: if we look at more and more of this data, can you see these kinds of signals much earlier?”

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Credits: Guido Vitti, Tommy McCall, Porter Gifford
Video by Conrad Warre, edited by JR Rost

Tagged: Computing, Biomedicine, healthcare, medicine, electronic health records, healthcare IT, hospitals, e-health records

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