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Thursday, April 18, 2013

Boston Marathon case shows health IT gaps to be fixed in next phase of Massachusetts’ HIE

The pair of explosions near the finish line at yesterday’s Boston Marathon sent more than 100 patients – several of them in serious or critical condition – to unexpecting area hospitals. 

The way those patients were dispersed among the hospitals shows good coordination and planning on the part of the city and emergency responders, said David Delano, a project director at Massachusetts eHealth Collaborative. Similarly, John Halamka told FierceHealthIT that the technological infrastructure at Beth Israel Deaconess Medical Center, where he’s CIO, held up and served the hospital well during yesterday’s events. 

But one area where there’s room for improvement in the process of emergency response is the way information about those patients is, or in this case isn’t, available to the medical personnel who treat the injured. Delano observed that yesterday’s events provided an exact example of a circumstance that phase two of Massachusetts’ health information exchange initiative, Mass HIway, is targeting. 

In the first phase, Mass HIway focused on enabling the secure exchange of electronic medical records between participating providers. That’s helpful when providers know which patient they’re expecting and can request medical records ahead of time. 

It’s not so helpful, though, in situations like yesterday, where there’s no time to request patient records ahead of time. “You had multiple people from different parts of the state, maybe even different parts of the country, showing up in hospitals where they’ve likely never been seen before,” he said. Without having information about a patient’s medical history, current medications, allergies, etc., which all affect how a patient is treated, physicians are left to do their best piecing together what they can about a patient. That may mean rifling through their clothes or belongings and ordering lab tests, which take time and cost money. 

The second phase of MassHIway will create a query capability for providers that participate in the network, so that if a patient has a medical record that exists in a different participating facility’s system, and if that patient had consented to having it shared, the system will be able to find and retrieve it without any delay. 

With HIEs that have this capability, emergency department personnel can search for a patient’s record immediately upon his arrival or even as he’s being transported to the hospital. In hospitals connected to the Indiana Health Information Exchange (IHIE), for example, the system searches for a patient’s record automatically when he’s registered to the ED. “Before the triage nurse even knew that patient was on the premises, they would have access to a patient summary and the option to visit a web portal where they could get more detailed information,” said John Kansky, vice president of strategy and planning for IHIE. 

Being able to run that kind of query in a situation like the one that played out in Boston yesterday is the holy grail of the HIE network, Delano said. But for now, at least in Massachusetts, the gap is still there. 

MAeHC is working with the Executive Office of Health and Human Services and the Massachusetts eHealth Institute to oversee the governance and implementation of Mass HIway. Delano chairs the technology committee workgroup and is spearheading efforts to design this statewide patient index and record locator service. 

He said he hopes to have that piece up and running by the fall. “The way that Mass HIway is coming together is in a series of available services for facilities to utilize,” he said. “It’s not like we’re going to turn on a light switch and all the lights are going to come on. They’re infrastructure services that facilities can use in a variety of ways.” 

All work won’t be done, though, when that piece rolls out. There are plenty of other opportunities to continue innovating what HIEs can do. For example, Delano noted it would be helpful for medical data to be transferred electronically between a hospital and an ambulance. “Most of those services rely on cellular communication [...] but in situations like yesterday, the cellular networks were jammed,” Delano said. 

Then there’s the idyllic idea of connecting various state’s HIEs to form a national network where EMRs can be exchanged. But make no mistake, we’re a long ways away from that. 

“Market by market, the HIE functionality is still all over the board, and it’s going to take a lot more years and a lot more dollars to get to the point where (a patient’s) record is available in an emergency department, period,” Kansky said. “That functionality goes far beyond the current Meaningful Use pattern that they’re on. Meaningful Use 2 or 3 is not an endpoint.”
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