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Medical data made whole Health exchanges hope to offer all patient records in one place

Victoria Colliver, Chronicle Staff Writer vcolliver@sfchronicle.com

Tuesday, March 8, 2005

One of the main stumbling blocks in the American health care system, many experts say, is the inefficient use of computer technology to manage medical records.

Now, in Santa Barbara County, a network of hospitals, laboratories, pharmacies and doctors is pioneering new technology that will allow medical professionals with different computer systems to share clinical information. The initiative may well be a first step toward the creation of a national patient-care data bank.

It's an effort to save money as well as lives. Some experts believe that information-sharing initiatives like the one in Santa Barbara are key to controlling runaway health care costs.

Five hospitals, more than 800 physicians, as well as regional laboratories and pharmacies in Santa Barbara are testing a digital infrastructure that will allow the secure exchange of sensitive medical data. Developed by a group of stakeholders including local hospital executives, doctors and county health officials, the system is expected to be running by this summer.

The Santa Barbara project is one of hundreds of grassroots efforts nationwide carried out by regional health consortiums. Groups in Tennessee, New York, Colorado, Massachusetts, Rhode Island and Indiana have made strong headway in establishing these networks. Within California, initiatives are under way in Silicon Valley, Los Angeles and San Diego. Santa Barbara's will be one of the first projects to begin functioning.

"There's a movement that's starting, and it really started in Santa Barbara. It started with the idea that a community could build a secure way to share health care information across all the health care institutions in that community," said Sam Karp, chief program officer at the California HealthCare Foundation, an Oakland health philanthropy that contributed $10 million to the project.

"We believe we are pioneering the development of a workable model for the rest of the country," he added.

The promise is the creation of a system that will link local networks to create large regional networks that will better track patient care as well as reduce redundant tests and unnecessary paperwork that result from incompatible data systems and lack of communication. Eventually, the regional networks will talk with one another, in effect creating a true nationwide medical data repository.

Dr. Molly Joel Coye, founder of the Health Technology Center in San Francisco, compares these data exchanges to the early days of the telephone.

"The national idea is you'll have many of these local exchanges and they'll all be connected like telephone exchanges were," Coye said.

Most health experts agree that digitalizing and sharing health information could lower costs, something that is urgently needed in an age of skyrocketing health costs and soaring insurance premiums.

Currently, there are no common standards. Large, closed health systems such as Kaiser Permanente and the Department of Veterans Affairs have computerized systems that are interconnected. But many insurers, hospitals and physicians have systems that are incompatible with one another. Many health practitioners rely on primitive digital record-keeping systems and, in some cases, aren't even computerized at all, keeping patient information in paper files.

The U.S. Department of Health and Human Services estimated last year that improved health information technology could trim $140 billion a year from the total U.S. health tab, which reached $1.7 trillion in 2003.

President Bush last year called for electronic medical records to be in place for most Americans in 10 years. He appointed Dr. David Brailer of San Francisco as the nation's first health information technology coordinator, charging him with standardizing regional efforts.

Not quite 15 percent of hospitals and less than 7 percent doctors have an electronic medical record system in place, according to health experts. Part of the reluctance, especially among solo practitioners, is due to the cost. Computerized health systems can cost doctors as much $20,000 to install and about $5,000 a year to operate.

Data-sharing systems like Santa Barbara County's are designed to break down these technological silos.

While efforts vary, the general concept of the exchanges -- dubbed "regional health information organizations" -- is to share information in real time using peer-to-peer file-sharing technology, popularized in the music world through such companies as Napster Inc.

These initiatives will be a major topic of discussion at a health care summit, Health Information Technology Summit West, which ends today in San Francisco.

Experts say exchanging health information is far more complicated than sharing MP3 music files. It involves creating an infrastructure that allows the exchange of varied and complex data including radiological images, physician notes, lab results and pharmacy information.

"We built a system that accommodates all these different types of systems, " Karp explained. "Hopefully, others will be able to do it even faster and cheaper and better."

The Santa Barbara Exchange, which started development in 1999, has been anything but fast and cheap. In addition to the $10 million in grant money from the California HealthCare Foundation, Santa Barbara officials managed to secure $400,000 from the federal government, one of nine "e-health initiative" grants offered.

Since grant money will not be available for many other exchanges, funding sources must be developed, said Jeffrey Rose, chief executive officer of HealthAlliant, a consulting firm based in Piedmont.

Since insurers glean most of the savings from reducing clinical and administrative redundancies, Rose said they should help finance some of the costs. He suggested that insurers, along with employers, hospital networks, pharmacies and government sources, pay into a pool to help subsidize these efforts for physicians and cash-strapped hospitals.

Security is also a major concern. In Santa Barbara, patients must agree to be included in the network, said Phillip Greene, chairman of the data exchange's board. In addition, sensitive diagnoses, such as mental health and HIV status, have special confidentiality guidelines. Information about such conditions will not be accessible through the Santa Barbara exchange.

Meanwhile, some health economists caution that technology may not be a panacea for all health care cost woes.

While data exchanges may reduce some unnecessary spending, they do not address the primary drivers of health costs, said Laurence Baker, associate professor of health research and policy at Stanford University. Cost pressures from expensive new drugs and medical technologies, for example, will not be controlled by data exchanges, he said.

"There are redundancies and inefficiencies in the system and there are advantages to doing this, but the question is how they weigh against the costs, " Baker said.

While these systems may cut health spending, emergency department physicians like Owen Stormo care less about financial efficiencies than about patient care.

"Someone comes in with a heart attack or is unconscious and I literally have no information on them other than their name -- nothing about their medications, prior surgeries," said Stormo, who works in hospitals in Santa Barbara County. "This could be potentially lifesaving."

What they are: Regional health information organizations are consortiums of hospitals, doctors and others developing digital medical data systems to ease the flow of information among practitioners. They represent a first step toward a true nationwide system for sharing medical information.

How they work: The organizations create a computer network that allows the exchange in real time of varied and complex digital files, including radiological images such as CT scans, physicians' notes, lab results and pharmacy information.

Why they matter: The lack of a nationwide computer system for sharing medical data creates costly inefficiencies and redundancies. The federal government estimates that effective digital record keeping would save $140 billion in health care costs annually.

E-mail Victoria Colliver at vcolliver@sfchronicle.com

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