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When a patient walks into University Methodist Hospital’s emergency department (ED) complaining of chest pains, Dr. Ray Walther can’t always be sure what types of tests the patient has previously received. But with the new eHealth network, Walther can log on, type in the patient’s information, and gain immediate access to the individual’s medical history.

That ability may wind up saving money — and lives.

The eHealth network, which went live in the fall of 2006, is a data sharing system that enables EDs and health clinics across Shelby County to view the electronic medical records (EMRs) of more than 800,000 patients.

It’s part of the MidSouth eHealth Alliance (MSeHA), which was launched in 2004 in response to Gov. Phil Bredesen’s push for technology readiness among healthcare providers. The governor urgently wants to drive down the state’s spiraling TennCare healthcare costs by making the EMRs more widely available to hospitals statewide. The MSeHA is the first real attempt to create a viable network.

“Tennessee is setting the course for eHealth initiatives,” Bredesen told the Tennessee Tribune during the release of the state’s Technology Readiness study last summer. “As a nation, it’s time we do a better job of leveraging technology to improve the quality of care and hold down costs. This is the real frontier in healthcare. In Tennessee, we are committed to using health information technology to improve the quality of care available to all.”

The alliance was launched with a $4.5 million grant from the federal Agency for Healthcare Research and Quality and a five-year, $7.2 million grant from the state. It was designed to improve communication between hospitals and clinics. The MSeHA , which is based in Memphis, is made up of 14 Memphis-area hospitals, 15 healthcare clinics, a medical group, and a managed care organization.
Alliance members weren’t required to have expensive EMR systems already in place in order to participate. Instead, Vanderbilt’s Center for Better Health was approached to create a system that would allow data to be shared among all alliance members. Now that the system is fully live, users can view everything about a patient’s care: from lab and diagnostic test results to X-rays.

Healthcare professionals know many people use hospital emergency rooms for their primary care, particularly when illness strikes on the weekend and health clinics are closed. But ED physicians often can’t get quick access to medical records, which are typically faxed from one hospital to another, to learn what type of diagnostic tests have been performed on a patient before they are released.

“We can’t call a doctor per their past lab work or radiology results, so then we do more CT scans, and more lab work,” said Marianne Fournie, corporate director for emergency services at Methodist Healthcare Systems, and one of MSeHA’s members.

Now, physicians with access to the system can view patient records through a secure Web-based browser that provides real-time data. The system currently has 2.1 million EMRs representing more than 800,080 patients and continues to add more every day, said MSeHA president Tom Duarte. The aim is to reduce retesting, hospital stays, and ultimately improve patient care.

“On eHealth, we can see how many times one patient has come into the hospital or emergency room within a month and depending upon the patient’s complaint, we can decided whether a test needs to be done. It’s good for the patient because they won’t get repeated radiation or dye, and it’s good for the hospital because it saves time,” noted Fournie. Unnecessary testing and re-diagnosing will also save hospitals millions of dollars. “In the long term, it’s a good, efficient way of providing healthcare,” added Walther, medical director of the emergency department at University Methodist.

Dr. Mark Frisse, director of the Regional Informatics Programs with the Vanderbilt Center for Better Health in Nashville, said part of the reason the information exchange works is the collaborative nature of the project, which has brought together leaders from the public and private sector. The governor’s eHealth Advisory Council, Mayor AC Wharton’s office, hospital administrators, and public health workers have all joined forces to share information and hammer out specifics like how to ensure the network’s security and patient privacy.

Only key personnel, such as physicians, hospitalists and nurse practitioners, are allowed to log onto the network. To gain access, users are issued a user name, a password, an electronic key fob, and an access code. To further ensure system security, no one is allowed to log on from their home computers and an audit trail signals when someone is trying to gain access offsite.

While the eHealth system is doing what was envisioned, it’s still a work-in-progress. Hospitals have experienced problems with transmitting data, some aren’t yet uploading real-time discharge records, and stiff security measures make it less than user-friendly.

“All (participants) have deficiencies in the information sent,” acknowledged Walther. “Anything done to a patient should be put live immediately on the eHealth system, so that any record would be available, but we’re not there yet.”
Walther said he doesn’t use the system for 70 percent of the patients he sees, since he can already access their EMRs within Methodist’s system.

But he’s quick to add, “The kind of information I can get is very useful. It’s invaluable when it comes to caring for patients. It’s hugely beneficial.”

Primary care providers like the Health Loop, the public health clinics operated by the Memphis and Shelby County Health Department, may be the biggest benefactors, as they’re able to follow their patients once discharged from the hospital. Health Loop nurse practitioner Diane Pace said eHealth is particularly useful in managing “frequent fliers,” patients who travel from one hospital ED to the next for their care. “We see a lot of patients after doctor offices close, so we can access records and see previous lab work and EKGs on patients from other hospitals.”

Pace also points out that alliance members worked diligently to insure patient security and privacy. “We’ve been strong patient advocates to make sure patient information is accurate and properly used.” Patients can also opt out and decline to release their information for the network. Pace said it’s up to doctors and nurses to make sure patients understand how their information will be used and the value of making it available to healthcare providers on the network. Frisse said Memphis has reason to feel proud about creating one of the few health information exchanges nationally that’s really working. The question yet to be answered is how the project will evolve once the five-year trial period comes to a close. The state has a vested interested in it, said Duarte, “And we want to make this a viable option. It’s a valuable tool for the medical community and patients.”



July 2008

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