Information, please | Maine's pioneering medical record exchange program promises returns on care and costs
photo/David Rodgers
John Vogt, a pediatrician at Martin's Point Health Care in Portland, examines Caroline Fallona, 4-12
photo/David Rodgers
The state's new HealthInfoNet should help health care facilities provide better care and ultimately trim costs, says Edward Ringel, a critical care physician at MaineGeneral Medical Center in Waterville
This past January, President Obama called for all American health records to be computerized and consolidated within five years to reduce the “preventable medical errors that pervade our health care system,” and by doing so, “save billions of dollars and thousands of jobs.”
Maine appears to be well ahead of the deadline. Earlier this summer, after nearly six years of intensive work, the state’s HealthInfoNet initiative went live. The secure, centralized system through which care providers — city hospitals and rural clinics alike — can share patients’ electronic health records is the largest and most comprehensive clinical health information exchange in America, reported Healthcare IT News, a medical trade publication, and could be a national model.
“The implementation of HealthInfoNet,” says John Vogt, a pediatrician at Martin’s Point Health Care in Portland, “is a first step towards the creation of a single Web-based patient medical record at the national level.”
The state’s four leading health care delivery systems — Central Maine Health Care, Eastern Maine Healthcare Systems, MaineGeneral Medical Centers and MaineHealth, which together comprise some 2,000 physicians statewide — have all signed on to HealthInfoNet, as has Martin’s Point and Franklin Memorial Hospital in Farmington. Maine Center for Disease Control is also joining the demonstration.
HealthInfoNet’s creators, and the caregivers who’ve just started using it, are confident it will save lives. They’re also convinced, at a time when health care costs seem to be rising inexorably, that it will save money.
Initial savings are projected to be between $10.6 million and $12.5 million annually for the first phase of implementation. (See “Projected savings,” below.) It’s hoped that number will increase to $20 million by 2011, and eventually — presuming more providers opt in to HealthInfoNet — grow to as much as $52 million per year as redundant treatments are eliminated, administrative costs are lowered and productivity is increased.
“This is the most attainable strategy to bring down costs that we have on the horizon,” says Wendy Wolf, president and CEO of the Maine Health Access Foundation, which contributed $2 million to help get the program off the ground. “It is the only thing that has been estimated to bend the curve for rising health care costs.”
Why it should work here
“Maine is a terrifically pragmatic state,” says Devore Culver, HealthInfoNet’s executive director. And it’s that common-sense character, he says, that inspired the initiative’s participants — organizations that ordinarily compete against each other — to decide that they’re “not going to compete on patient information anymore.”
Culver’s career in Maine health care goes back more than 25 years, including a stint as CIO of Eastern Maine Medical Center beginning in 1986. Back then, he says, “even the concept of having a chief information officer was pretty odd.” Fast forward 20 years to 2006, when Culver signed on to direct HealthInfoNet, which had begun feasibility studies in 2004.
Overseeing the program is a board of 19 professionals representing all its disparate stakeholders: businesses, consumers, care providers, insurers and the government.
HealthInfoNet is unique in its co-mingling of patient data in one secure system, says Culver, as opposed to a federated model, which uses a locator to track down data in the separate computers systems where they’re stored.
HealthInfoNet collects and shares actual clinical data such as lab tests and radiology studies, as opposed to just demographic information, as other states’ systems do. As it does, says Culver, it allows “consumers to actively engage in the management and the understanding of their information.”
The development and implementation of HealthInfoNet was a huge undertaking due to privacy concerns and the expense and complexity of syncing up disparate information systems. Only about 20% of doctors nationally use electronic records, and many still rely on the fax machine.
Ultimately, Culver says, it was worth the effort and expense.
Patients often see many different doctors, and those doctors don’t always know what blood tests or other lab work their colleagues in other parts of the state may have already ordered. “There are large gaps between points of service,” Culver notes. “And people move between those points.” Studies have shown, he adds, that “between 13% and 20% of all diagnostic testing is redundant.”
“Every time we can avoid duplication of tests, that saves money,” says Rebecca Ryder, president of Franklin Community Health Network and Franklin Memorial Hospital in Farmington. Working at a small hospital in a rural area, she knows the importance of pinching pennies. “If a particular patient gets an X-ray in Lewiston and doesn’t remember it, or doesn’t remember the outcome, that could be an extra few hundred dollars … an MRI or CAT scan could be $800.”
Better care, lower costs
HealthInfoNet’s primary mandate is to improve care and save lives. Edward Ringel, a critical care physician at MaineGeneral Medical Center in Waterville, presents the following scenario:
“It’s 10 o’clock on a Friday night. And the family’s just brought Grandpa into the emergency room. He has a temperature of 104 and is delirious. The family is very well-meaning but, well, all they know is that he was just discharged from Maine Med two days ago after a three-week hospitalization for ‘an operation on his belly that went bad.’ His laboratory tests are all over the map. He’s in really bad shape. It’s obvious that something needs to be done very, very quickly. The poor family even left the discharge instructions at home in their rush to get Grandpa here. I think you can see where I’m going with this: Something like HealthInfoNet can literally be lifesaving.”
“The more we share, the better the care,” says Eric Hartz, chief medical information officer at Eastern Maine Medical Center in Bangor. “Fewer errors will be made — better sharing of patient allergies will prevent administration of a wrong drug; having a complete list or medications will help prevent drug-drug interactions which may harm the patient.”
Electronic systems lower administrative costs, too. “Our staff doesn’t need to spend hours trying to find [information] prior to physician visits,” says Hartz. “It also improves the pace of care: I don’t need to wait for someone to track down a piece of paper and later get back to what I was doing — sometimes days before.”
Best of all, those savings should be contagious. It’s projected that MaineCare, for instance, will save between $900,000 and $1.3 million annually by 2010, a significant improvement for the state-backed health program that Ringel describes as “quite problematic” given its low reimbursement rates.
In coming years, Hartz is also hopeful that “as cost of care goes down, premiums may eventually follow.”
For now, says Wolf, HealthInfoNet’s cost efficiencies are an important step. “If we can’t bring down the cost of health care, we’re going to have a devil of a time trying to get health care coverage and expand access to health care for everyone.”
Can HealthInfoNet stay healthy?
There are potential pitfalls for HealthInfoNet, say program participants. Chief among them is keeping the public-private partnership properly funded beyond its demonstration phase. The network requires substantial communication and security infrastructure, and that costs money — especially if it’s to expand and evolve as its creators hope.
“There are many challenges that are presented by working in a space where there has been no direct economic incentive before,” says Culver. “The very real near-term challenge for HealthInfoNet is to have those who will benefit from the exchange participate in funding it through subscriptions, dues or other types of fees.”
Culver expects the annual operating expenses for HealthInfoNet to be $6 million or so, and says that its current business model plans on care providers contributing a third of that, with the other two thirds coming from government and insurers/businesses.
Maine has included $1.7 million in its 2010-2011 budget to keep HealthInfoNet up and running, and Culver hopes that “we will be able to count on some level of funding from the stimulus bill.” The American Recovery and Reinvestment Act has set aside $20 billion to promote health care information technology.
Ryder says Maine can be proud that “we are on the cutting edge.” It’s unusual that a rural, sparsely populated state leaps to the fore on an expensive and logistically complex issue that’s frustrated providers nationwide for more than a decade.
“Maine is a small, rural state, with a limited number of players where consensus building is part of the culture,” says Vogt. Not insignificantly, he adds, “health care providers in this state have surprisingly well-developed electronic health record systems compared to other states, enabling a statewide system like to this to connect to more providers and offer more value.”
“Moving health care into the electronic information age is something that is going to happen,” says Wolf. “So the question is, are you going to lead how this unfolds and do it in a way that’s right for Maine and maybe serves as a national leader? Or are you going to wait for the federal government to mandate it and then try to fit it into whatever structure they’ve figured out?”
HealthInfoNet allows Maine to “do the right thing based on what Maine needs,” she says, “working with Maine hospitals and Maine doctors and Maine consumers.”
Contributing writer Mike Miliard can be reached at editorial@mainebiz.biz.
Most Recent
Most Recent
Comments