Getting wired can link both care and coverage
Getting wired can link both care and coverage
Network links providers, insurer
Major health systems in Dayton, OH, have given a whole new meaning to the idea of getting wired and they are not talking about drinking too much coffee.
More than 1,000 doctors’ offices in 20 health care facilities (including seven hospitals) and an insurance company are sharing medical records and other information through a community health information network (CHIN) that, in essence, is the Dayton region’s own medical intranet.
The Dayton CHIN consists of two main networks. One is the patient health information network (PHIN), which links the emergency and medical records departments of the seven major hospitals in town. The second is the Greater Dayton Area Health Information Network, also called the integrated health information network (IHIN), which forms a triangular linkage between doctors offices, hospital patient records, and insurance companies.
Before the patient health information network went live in March 1995, emergency department (ED) medical staff had to between 30 minutes and two hours before receiving the paper medical records of a presenting patient, says Lisa Paige, RRA, director of medical information services at Miami Valley Hospital in Dayton. "Now they can access that information in about five minutes," Paige says. "It’s a huge increase in efficiency."
The PHIN was started in the emergency departments of the seven hospitals because caregivers there "have the greatest need for accessing patient information rapidly," Paige says. "[For example], someone comes in unconscious and that person has a drug allergy. Now physicians can find out that information within minutes as opposed to the length of time that it took in the past."
To make the system more useful, project administrators started the process by polling ED physicians to determine exactly what kind of information they needed on presenting patients. Today an emergency department physician who calls up the record of a patient who has been an ED patient at any of the participating hospitals will find demographic information from the fact sheet, the history and physical, lab test results, X-rays, and EKGs.
Improved quality of care
Most hospitals have only the verbal portion of the EKGs, but Miami Valley Hospital also has the waves stored optically, says Paige.
"There’s no doubt that this has increased the quality of care," Paige adds. "If you have to transfer the records across town, it’s easy to see the time saved by electronic transfer. Physicians get the records faster, which allows them to make medical decisions faster, [resulting] in better care for the patient."
While they are part of a network, each hospital maintains its own electronic patient database. When looking for patient information, each hospital then searches the others’ files. This system eliminates the need for one central repository, an option that raised questions as to who would own the repository, maintain it, and control access, Paige says.
Dayton’s CHIN started in 1995 as part of a beta site demonstration project sponsored by IBM and Ameritech, a Chicago-based vendor. IBM provided the hardware and software, and Ameritech provided the fiber optics to link the sites. Because it was a beta site, the hardware and software were free, but each hospital contributed $50,000 to pay for outside consultants to troubleshoot problems and help each site get the most out of the hookup, Paige adds.
But the new system has been implemented without any additional full-time staffing in her department, says Paige. Now that employees have had two years to become familiar with the system, the organizational changes have been minimal.
One problem area is the 150 EKGs that have to be scanned in each day, she adds. "That can get backlogged because we didn’t add any new staff. It’s a catch-as-catch-can situation. But that seems to be one of the most important pieces of information doctors use, so we make it a point to get it in there."
Previously, only the dictated reports and lab records were available in the EDs, but not the handwritten materials such as notes. But as of May 1, this was added. "Those will be scanned in for all [ED] patients about 70,000 a year," she says.
While pleased with the progress, Paige admits that medical record nirvana a total electronic patient record is still off in the future.
"There has been talk of putting more of the inpatient record on optical, but it is very labor intensive. We can scan about 140 pages a minute, and my average chart size is about 150 pages. If only 40% of that is electronically generated, that means I’ve got 60% of 140 pages I have to hand scan on 33,000 discharges a year. You can do the math on that."
Her advice to other health information managers who find themselves involved in a CHIN is to be assertive. "Typically what I’ve seen in other CHINS is that HIM people are not involved. You end up with a lot of technical people making patient care decisions in terms of dissemination of information, and it’s really our job to know the rules and the laws. The security issue is also something health information managers really need to get their hands around. So even if you’re not being included, I say get in there and force yourself on them."
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