[Ed. This is the first of a two part series]
In October, the Journal of the American Medical Informatics Association (JAMIA) published a study by led by Mark Frisse, MD demonstrating significant cost savings when emergency departments (ED) have access to patients’ data via health information exchange (HIE).
The study showed a total net savings after costs over $1.07 million over a 13 month period and was associated with a decrease in hospital admissions and statistically significant decreases in head CT use, body CT use, and laboratory test ordering.
This was an important milestone in the ongoing national effort to build health data “highways” and helped to validate the presumption that health information technology can reduce unnecessary testing and costs.
Dr. Frisse is a physician and professor of bioinformatics at Vanderbilt University. He also directs the executive-level Masters of Management in Health Care program at the Vanderbilt Owen Graduate School of Management. I had a chance to speak with Dr Frisse about his experiences with the alliance that manages a network of HIEs in Tennessee. He shared several insights that I found to be especially interesting and worth highlighting. These included the important role of political leadership, patients’ willingness to allow their data to be shared digitally and differences innovating in affluent versus less affluent regions.
Since 2005 the non-profit MidSouth eHealth Alliance has governed and managed HIE services among sixteen major health care provider organizations in the Memphis, Tennessee metropolitan area. All twelve major hospitals provided hospital discharge summary notes, laboratory data, pathology reports, radiographic reports, other transcribed notes, and a range of other clinical and administrative documents.
All participating clinics provided demographic information, registration information, and a limited number of clinical data types. HIE is defined as a set of services that support access among parties who are motivated by common interest and governed to ensure that the rights of patients and participants are protected.
Eleven of the twelve participating direct access hospital EDs accessed HIE data only through a separate, secure web portal designed specifically for this purpose. The twelfth site is a mixed access site and employees printed encounter forms. The study measured nine separate outcome variables: hospital admissions from the ED, head CT scans, body CT scans, chest radiographs, echocardiogram, outpatient surgery, number of patients receiving one or more laboratory tests, admissions for observation, and ankle radiographs.
First, there can be no understating the importance of competent political leadership when establishing complex, multi-stakeholder health information exchange organizations to attain the level of success realized by the Memphis HIE. Were it not for the supportive vision of former Tennessee Governor Phil Bredeson, it seems unlikely the Frisse and his team would have achieved so much so quickly.
Secondly, the Memphis experience shows the overwhelming willingness of patients to consent to have their personal health data made generally available through information exchange when given the option (95%+), thus, once such systems can be standardized and more widely adopted it is reasonable to assume nearly ubiquitous consumer participation. It doesn’t take much to see the tremendous business opportunity inherent in developing platforms for creating, managing, securing and facilitating the sharing of the health data while maintaining secure data liquidity amongst all participating stakeholders.
The study cautions that data was not widely accessible or desirable to HIE data (6.8%) because data were not integrated into and presented through the many EHR systems used within the region, though, it was accessed some 20,000 times across the 16 participating clinics during the 13 months of the study. It concludes with the following statement of confidence about the potential impact of digital technologies on the future of health care delivery:
“Our study demonstrates a positive financial impact on communities, but we believe these savings will be only a fraction of the economic benefit that will be realized as our connected digital healthcare system evolves.”
See the transcript of my interview with Dr Frisse on the next page and continue the discussion in the iMedicalApps Forum.