It’s full steam ahead for medical data highway

(June 3, 2012) – Health care is and will be changing in Delaware regardless of what the U.S. Supreme Court decides on the Affordable Care Act later this month.

Delaware physicians started changing paper-based patient records to electronic ones back in 2006 as part of a Centers for Medicare and Medicaid Services technology initative. Since then, Quality Insights of Delaware, as part of the American Recovery and Reinvestment Act, is assisting even more physicians to not just buy an electronic records system they can just plug in, but to use electronic records to improve patient care and achieve “meaningful use,” a set of quality measures each practice has to attain. To date more, than 1,400 Delaware physicians have sought that assistance. But why is all this necessary?

When I first went into practice as a family physician, I would care for my patients in the office, admit them to the hospital when necessary and then follow them through the hospital stay, to an extended care facility if that was required, and then back to their home with even a home visit now and then. Over the years, with increasing pressures and demands on my professional time, I, like many other primary care physicians, became essentially office-based, transferring patient care to collaborating colleagues. However, with the increasing complexity of medical care, it has become increasingly difficult to maintain the necessary detailed follow up which today’s sophisticated medicine requires. In medical parlance, we are moving patients from silo to silo, often without the critical information their health care professionals need to optimize their care.

To counteract this downward spiral, across the country, new systems of caring are starting up. Within primary care practices the Patient Centered Medical Home (PCMH) is the most basic. Under it a practice changes its internal workflow so that instead of just the physician, a care team is created which takes responsibility for the patient’s health care, monitoring each of the patients to make sure preventive care is done, that patients make their specialty consultation, that patients return to their PCP for follow up of important health issues. Here in Delaware, there are several PCMH initiatives under way, with the Medical Society of Delaware’s Patient First being the largest effort to date.

Accountable Care Organizations will be the next step in Delaware, as health care groups band together to take responsibility for patients within a geographical area, usually under contract with one or more insurance plans, such as Medicare.

All of this may seem to be overwhelming complex. Obviously, it cannot function within a paper-based system. Therefore, electronic health records are a baseline necessity for any place a patient goes, so that their data, whether at the office, hospital, extended care facility, home health, or outpatient radiology and laboratory, can move with them and in anticipation of future need. But to do that, all of these silos need to be interconnected, so information can be transferred between the silos, so care can be coordinated.

In Delaware, the Delaware Health Information Network is the connection. This “health information exchange” is growing in membership and complexity. Eventually it will allow patient information to flow securely between all of the silos in real time, making patient’s information available regardless of where the patient goes within the state. In a far future development, this information will be available nationwide so that travel beyond our state borders will not limit care.

What does all this mean to the patient?

While a lot of new words and abbreviations are being tossed about that patients need to understand, we can acknowledge that the health care system is not anywhere near perfect or mature.

While we are bulldozing a lot of interconnecting paths within the medical community and some actually have asphalt, we have a long way to go before we get anywhere close to a mature and sophisticated informational medical superhighway. In the interval, which will take years to complete, as we are moving from silos of care to patient focused care, each patient needs to take responsibility for knowing about their own health status and working to make sure their basic, as well as critical health information, moves with them at all steps in the process.

Edward R. Sobel, DO, is the medical director for Quality Insights of Delaware.

(Reprinted from The News Journal, June 3, 2012, https://www.delawareonline.com/article/20120604/OPINION07/306040025/It-s-full-steam-ahead-medical-data-highway?odyssey=mod|newswell|text|Opinion|p)