Case management tool boosters seeking pilot

Big search engine trolls internet for goods

For years a state TB controller and a Los Alamos computer whiz in the far-flung Four Corners region have been telling everyone who will listen about the wonders of a new case management tool.

OpenEMed, as the program is called, is chiefly the creation of Dave Forslund, PhD, a laboratory fellow at the government’s nuclear weapons shop. Its biggest booster, Gary Simpson, MD, PhD, is the state TB controller of New Mexico.

In places like New Mexico — where there are many patients who have multiple providers and who bump up against the health care system in myriad places — OpenEMed is going to be the better mousetrap harried TB controllers have been yearning for, Simpson says. The software ("not just software, but more like a whole new approach to case management," as Simpson puts it) uses a powerful search engine to cruise the Internet, plucking out lab numbers, CT scans, digital chest X-rays, and histories; presto, an electronic patient record is created on the fly.

"Suppose I have a patient who lives with his family in Utah, gets his health care in New Mexico, works in Arizona, and is an Indian Health Services patient," Simpson says by way of illustration. As it stands now, the only way he can keep in touch with all the links in the health care chain is "through endless phone calls and endless faxes," he says. With OpenEMed, he envisions having simply to log on to do consultations or catch-up.

Keeping collaborators in touch

Whether in a rural setting like New Mexico or a crowded urban area, health care providers need to find ways to share information across a variety of systems, says Forslund. "Health care is 20% of the economy," he says. "The biggest single factor in improving health care is better information management."

Because health care systems typically don’t interface well, data often must be entered multiple times, boosting the chance for error with every re-entry. At same time, other data get overlooked or just plain lost. "Why is that?" Forslund asks. "What we’re trying to do here is make the system work more efficiently."

Simpson isn’t OpenEMed’s only fan. His fellow TB controller Charles Wallace, PhD, MPH, head of the Texas program, calls the program "very powerful and very dynamic." The two have already applied to the Centers for Disease Control and Prevention for money for a pilot project in the Paso del Norte region. That’s the sprawling, impoverished border settlement that includes El Paso, TX, Ciudad Juarez, Mexico, and a stretch of southern New Mexico, an area collectively described as the single biggest border community on earth.

The two states "are already working together in the [Paso del Norte] area," notes Wallace. "We think this would be a great chance for the CDC to have a look at how well this thing works, and at the same time for us to get a comprehensive picture of these patients and follow them through their treatment." If the pilot project gets funding and goes well, the plan is to expand the project to other parts of the border, Wallace adds.

The CDC has yet to produce any money for the pilot, but Wallace and Simpson say they’re more determined than ever to put the software to the test. "Whether it’s the CDC or Robert Woods Johnson Foundation, somehow we’re going to do this thing," Simpson says.

Simpson recently showed the software off at the Southwest TB Controllers meeting. In the meantime, the New Mexico Department of Health is going full speed ahead with OpenEMed in another division, using it to put state immunology records online.

Applications in the ER to be tested

The University of New Mexico is also collaborating with Los Alamos to plug the program into the school’s Emergency Medicine Department. Years ago, OpenEMed was used extensively at National Jewish Hospital to monitor the progress of multidrug-resistant patients. Other projects in other states are in the offing as well.

Funding aside, there are lingering issues that need to be ironed out. For example, if physicians practicing in New Mexico do a phone consult on a case in Texas, they’re currently protected from being sued in the event something goes wrong. With OpenEMed, it’s a different situation, because physician comments would go into an electronic patient record. In essence, a New Mexico physician would be practicing medicine in Texas without a Texas license.

That’s not an insurmountable problem, Simpson maintains. This year, he points out, the legislature in New Mexico passed a telemedicine licensure law. The new law permits a physician in New Mexico to use a current license in that state to obtain authorization to practice telemedicine in another state.

In addition to procedural matters, there are start-up expenses associated with a pilot program. For one thing, scanners that are equipped to digitize chest X-rays need to be purchased. For the Paso del Norte pilot, two scanners would be required at about $15,000 apiece. Because radiologic technology is forging ahead on its own, with more hospitals adapting to digital radiographic equipment, scanners may someday be unnecessary, he adds.

Two issues that aren’t expected to cause trouble are security — OpenEMed’s encryption methodology makes it air-tight, Simpson says — and scalability. Because the architecture for OpenEMed is what software jocks call "distributed," patient data won’t reside in one central computer, but in the computer at the clinic. Hence, clinics opting into the system won’t have to run out and buy bigger computers. OpenEMed, according to Forslund, can run on a PC "straight off the shelf from Wal-Mart."

The software can also interface readily with TIMMS, the CDC’s surveillance software for TB. By getting Forslund to build a "plug-and-play" interface, Simpson assures there’ll be no danger of anyone having to double-enter data. Instead, data entered into the case-management end "will automatically be populated into TIMMS," he says, so the CDC gets what it needs.