Only a fraction of regional hospitals regularly share information with one another, putting that at the top of health care executives' priority list in 2017. (Healthcare IT News. Jan. 3, 2017; http://bit.ly/2ouDz6c.) This exchange of health care information is essential to treating patients efficiently and safely.
We all know those patients who have been treated at another hospital system, but for one reason or another landed in your emergency department looking for answers to their health problems. Motivators range from inability to obtain appointments at the previous facility, proximity, dissatisfaction, and desire for reassurance or a second opinion.
We can't stop patients from going to different EDs, but we can at least get their health information from whichever hospital or clinic they regularly use. Think of how many times have you heard a patient say, “Well, all my health information is in the computer.” Yet, as you check the EMR, there is literally no information on this patient. Even if your hospital is loosely affiliated with a larger hospital system, the two electronic health care record systems often don't have the ability to talk to each other.
Sure, we can go back to prehistoric times, to the era of faxes, and manually request a medical records associate from an outside hospital to fax patient information to your emergency department. These faxes often get lost, incomplete information is sent, or the wrong information gets transmitted. One time, the wrong patient's information was sent to my department, extending the emergency department visit by hours.
Consider the financial industry. If, for example, I want to buy a car in Tulsa, OK, away from my home in Cleveland, I can do it because all my financial information is stored in a repository (my credit score and history). I can buy pretty much anything else on credit on the spot. An emergency physician, however, doesn't have the same access to consumer information as the financial industry. There are a number of reasons.
Hospital executives love to cite HIPAA, the federal privacy law that is so restrictive that it prevents hospitals from talking to one another. That just doesn't wash because federal laws also protect financial privacy. Competing hospitals in the same market don't necessarily want to share information that easily because it gives competing institutions a unique advantage if they can't keep patients in their system.
The bottom line is that patients and physicians are consumers of health information, and that information at the right time, at the right place, with the right people using it under privacy guidelines and laws is essential. Thankfully, there is hope on the horizon. A nonprofit trade association of electronic health record vendors called the CommonWell Health Alliance was formed in 2013 to help competing vendors readily share health care information through a vendor-neutral platform. No faxes, no paper, all electronic. To date, more than 60 EMR vendors have committed to this union. This alliance was formed out of a federal directive from the National Coordinator for Health Information Technology to promote interoperability. That is, providers should be able to share information with one another no matter what hospital system or EMR a hospital or clinic is using.
I have personally seen CommonWell in action, and I'm definitely encouraged by what I saw. Hospital discharge summaries, allergies, medications, echocardiograms, ECGs, and more can be readily shared. Sharing information is especially important in emergency medicine, quite literally a matter of life or death. I would encourage emergency physicians to approach their hospitals about sharing information with the competing hospital down the street, the high-volume family practitioner in the community, and even the urgent care centers around town.
Having this information at your fingertips will reduce wait times, improve safety, increase patient satisfaction, and also boost physician job satisfaction. The cost to share is nominal and usually free in most cases. It's just a matter of turning on the functionality at the sharing institutions and getting the buy-in from sharing institutions.
Disclosure: Dr. Salgia's employer, Cerner Corporation, is a founding member of the CommonWell Health Alliance.