Saturday, November 17, 2007

Will we get a health information exchange?

On Monday Community General Hospital, along with other Syracuse hospitals,[1] will be part of a grant application that asks New York State for several million dollars to start a health information exchange (HIE) in Onondaga County. This will be our third such state application in as many years – and so far, our success rate is 0-2.

The HIE application will be submitted by the Health Advancement Collaborative of Central New York (HACCNY)[2] in cooperation with the Southern Tier Health Link, an organization that did receive a grant from the state under an earlier application process. Its success rate is 1-1.

An HIE would make patient data available via the Internet, no matter which doctor, hospital, or testing center holds a patient’s past test results. That means, any physician could, with a few keystrokes, locate an individual patient’s recent (or past) x-ray and lab results, as well as prescription lists, no matter what time of day or night…even on weekends. That could improve care, it could reduce waiting times, and it could save money by avoiding duplicate tests.

Some people assume that such ready access to patient data already exists, and they can’t believe that all the computers in the health care world don’t really talk to one another. But health care is filled with stand-alone systems for radiology, lab results, and medications. Even when the systems are linked, they typically do not communicate beyond the walls of a doctor’s office or hospital.

The advantages of health information exchange are self-evident. Bill Gates writes:
For the last thirty years computers and software have helped industry after industry eliminate errors and inefficiencies and achieve new levels of productivity and success. Many of the same concepts and approaches…can be adapted to the particular requirements of health care.
Dr. David Brailer, the former National Coordinator for Health Information Technology for the Bush Administration, said recently that the problem of linking patient data in a system wide exchange
is numbingly complex, and simplistic solutions won’t work. In an ideal world, we would not have to create intermediate infrastructure like [the exchange that HACCNY is trying to build] but in an ideal world HIT (health information technology) would already be in use.
Besides computer systems that don’t communicate with one another, there are other obstacles to developing an HIE, including paying for it. In the health care world, the sector that pays for an HIE investment doesn’t necessarily realize the benefits of such investment.

A 2006 a HACCNY study[3] demonstrated that potentially significant savings could be achieved by a Central New York HIE if it is structured to eliminate duplicative and unnecessary tests, reduce medication errors, and increase generic prescriptions. But that same study showed virtually all the savings from an HIE would accrue to insurance companies and the third parties that administer employer self-insured claims, not to doctors and hospitals that would have to pay for it or incur costs in implementing it.

In our health care world incentives are often misaligned, even perverse. If one part of the system benefits, another part is often if penalized, even when the overall impact on society is a positive one.

Of a potential $20 million in annual savings for CNY, 94% would go to the insurance side of health care. Other parts of the health care system – namely hospitals and pharmacies – would have negative savings. In other words, the HIE would actually cost hospitals and pharmacies more, not less. This argues for HIE investment by the sectors that realize the return from it, i.e., by insurance companies, by governments, or both.

To its credit, New York State has the HEAL grant program, under which tens of millions of dollars become available for doctors and hospitals to link together their patient data systems. The state realizes such linkage is in the long term interests of patients, and therefore it is in the public interest to capitalize HIEs with public funds.

HACCNY’s first grant application was turned down by New York State on a technicality. HACCNY did not yet have approval from the IRS for its tax-exempt status. This year the state declined to award funds because, after all the applications were submitted, Governor Spitzer’s administration changed the criteria developed by Governor Pataki’s administration. HACCNY’s second HIE application, along with all the others submitted in state, was turned down.

Next week HACCNY makes its third run at HEAL funds, this time in combination with doctors and hospitals from the Southern Tier. Let’s hope the third time is, as they say, the charm.

But even a successful grant award will not assure the start of an HIE in Onondaga County. There’s another obstacle, the lack of sustainability.

If HACCNY is successful in getting the hardware and software grant needed for an HIE, there is as yet no workable financial plan to assure the new system can pay its operating costs year after year. HACCNY wants to develop a sustainability plan, and it intends to accept state funds only when it has a viable financial model in place.

Stay tuned.

[1] Community General Hospital, Crouse Hospital, St. Joseph’s Hospital Health Center, and University Hospital of SUNY Upstate Medical University.

[2] I am the secretary of HACCNY, which is composed of health care, business, and insurance representatives. HACCNY was developed by the efforts of the MDA (Metropolitan Development Association), MACNY (Manufacturer’s Association of CNY), Greater Syracuse Chamber of Commerce, the Hospital Executive Council (HEC), the Onondaga County Medical Society, and Excellus BlueCross BlueShield.

[3] The study, funded by HACCNY and Excellus of CNY, was conducted by Health Alliant.

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