Medical data is starting to be exchanged electronically in New Jersey via "health information exchanges" whose members are hospitals, doctors, and other healthcare providers working in the same region of the state. Often, these providers treat the same patients; the goal is to improve outcomes by giving them access to information on all the care these patients receive. Ultimately, the state plans to link these regional information exchanges into a statewide digital health information network, so one day the medical records of a Sparta resident who winds up in the emergency room while on vacation at the Jersey shore will be available to the local medical team, just as they are to the individual's family physician at home.
One of the regional exchanges, Health-e-cITi-NJ, on Tuesday held a conference to demonstrate how the eight hospitals in the network will exchange records with one another and with ambulance services, physician practices, and visiting nurses. In the next few weeks the exchange will go live. "Doctors will understand their patients' allergies, immunizations, advance directives, test results, and medical histories, easily and immediately," said Tom Gregorio, chairman of Health-e-cITi-NJ and chief executive officer of Meadowlands Hospital Medical Center in Secaucus, which hosted the conference.
Patient privacy and data security are built into the system, according to attorney Alexandra Garcia, who said patients will be able to opt out of having their digital medical records become part of the exchange. But patients who do give the green light will get online access to their own medical records, just as they now go online to see their bank balance and their credit card statements. The system will maintain a log of any provider or individual who looks at the records.
Health-e-cITi-NJ is one of several regional health information exchanges in various stages of implementation across the state.
The Camden Health Exchange went live in October 2010, according to Dr. Jeffrey Brenner of Cooper University Hospital, who founded the Camden Coalition of Health Care Providers nine years ago to address the excessive hospitalization of Camden residents for chronic ailments like diabetes.
Brenner said the city's hospital ERs and primary care physicians log into the system to check on patients. "One clinic cares for homeless people, and you can imagine the complexity and the difficulty of getting good information," on that population, Brenner said. "Now the doctor can pull the information up right in the office at any computer connected to the internet. Sick people are getting better care. You don't have to repeat tests that have already been done, and you can make quicker decisions because you know what has happened recently, especially with patients who can't articulate the care they have gotten."
Every day the system generates a list of patients who've gone to a hospital, identifying their primary care doctor. "Believe it or not, the primary care doctor often has no idea which patients have gone to the ER," Brenner said. "Every time a patient goes to the ER or is admitted to the hospital, we want the doctors to know about it so they can respond and make sure the patient is getting the care they need."
Other regional exchanges are being developed in Trenton, and in northern and central New Jersey.
Benjamin Bordonaro is acting chief information officer of Hackensack University Medical Center, one of 18 hospitals in the Jersey Health Connect exchange, which he said is going live in stages. Beginning in January, several of the hospitals will start feeding patient data into the system; by the second quarter hospitals will use the system to communicate with one another. Besides working out the IT issues, Jersey Health Connect is putting patient education resources in place to ensure "that the patient has the right to opt out of the health information exchange; this has to be totally under their control," he said.
Bordonaro said electronic records "have huge implications for continuity of care. If a patient receives care at any one of the hospitals or providers, we will all be able to see the records electronically." If a patient is treated in the Holy Name Hospital ER and then comes to Hackensack "I can see that the patient went to the ER and was given medication. This is very important to know, for patient safety and continuity of care."
Joe Carr, chief information officer of the New Jersey Hospital Association, is part of the effort to create a statewide electronic health information exchange, a project being directed by Colleen Woods, New Jersey Health Information Technology Coordinator. Carr chairs a data standards and technology committee that he said is "figuring out how to make sure the security of this whole operation is rock solid." He said the New Jersey Health Information Network should be launched by the end of next year and will be the hub through which the regional health information exchanges share data. Trenton's health information exchange is an initiative of the Trenton Health Team, chaired by Christy Stephenson, who said when the exchange goes live in the first quarter of 2012, a major goal will be more efficient use of medical resources in Trenton.
She said the state's Medicaid program recently shared data with Trenton on how medical services are being used, which she said revealed a high multiple use of hospitals and medical facilities. About 70 percent of the high utilizers of the medical system are frequent visitors to the ER. "What that means is that there is a real duplication of services for these individuals, a lot of unnecessary diagnostic testing, and doctors who do not have access to that information right at their fingertips."
Dr. Kemi Alli, vice chair of the Trenton Health Team, is a pediatrician at the Harry J. Austin Health Center, a federally funded clinic in Trenton. Alli said making better use of Trenton's medical providers is a key reason for going digital. "We did a general survey of our nurses, and they are spending 25 percent to 50 percent of their day just looking for information. Nursing is a valuable resource that should be doing something else, like providing preventive care outreach to our patients."