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Medical Group Takes Big Step to Share Patient Data

Posted on: Monday, 3 April 2006, 03:03 CDT

By Weeks, Katie

Despite little support from local hospitals, the San Diego County Medical Society Foundation has licensed software to share patient information among medical professionals.

Santa Clara-based Sun Microsystems, Inc. is licensing software to the foundation on a "pay as you go" basis as the foundation works to gain the favor of more hospitals.

The systems, nationally known as Regional Health Information Organizations, or RHIOs, allow linkage of health records among medical professionals, such as pharmacists, physicians' offices and hospitals to improve patient safety and access to health care and to eliminate duplicated efforts, proponents say. Critics of RHIOs say they jeopardize patient privacy.

The foundation had asked area hospitals to help raise $1.2 million for the network, but when hospitals missed the mid-December deadline, the foundation decided to look elsewhere for the funds and move ahead anyway. In addition, Sun withdrew an "open-ended" licensing offer to weave together all hospitals in the area for a flat $1.2 million. Sun said it would still offer a discount because it wants San Diego to be its "flagship RHIO," but it is unclear exactly how much the project will cost hospitals now.

Dr. Stephen Carson, a pediatrician and the chief medical officer of the foundation, said the first phase of the project will cost $350,000. The foundation plans to use recent donations - $315,000 from the Blue Shield of California Foundation and $50,000 from Long Beachbased Molina Healthcare - to pay for phase one.

"The first building block involves finding medical homes for those ER visitors for which hospitals receive no reimbursement," Carson said.

He said the project will reduce the number of patients mostly uninsured - who are using emergency rooms for primary care in San Diego County by 10 percent to 20 percent this year, saving hospitals some $5 million to $6 million collectively a year.

The foundation has paid Sun $100,000 from its own coffers to begin a licensing agreement that will require a monthly fee from hospitals who sign on. The fee will depend upon the complexity of the hospital's needs, Carson said.

Money from Blue Shield and Molina will pay for the first year of salaries for four new full-time "certified assistors" who will work out of the offices of San Diegobased La Maestra Community Health Center to find a "medical home" for those using the emergency room for primary care. In years following, Carson said hospitals are expected to pick up the tab for the four employees.

"We anticipate that as hospitals realize how much they'll save as a result of the program, it will be a relatively easy decision for them," he said.

Seeking Help From Business

Carson said the foundation is also turning to local employers for funds, emphasizing that improved access to health care is advantageous to companies' bottom lines.

He said Children's Hospital and Scripps Mercy, which sees 1,500 uninsured patients in the emergency room each month - one of the highest in the county - will likely be the first hospitals to participate in the project's initial phase.

Scripps Chief Executive Officer Chris Van Gorder said the health system has not committed to the effort, citing unanswered questions about ongoing costs. Children's Hospital press office did not return a phone call.

San Diego County hospital finance executives have said unpaid emergency room bills increase health care costs for those who do pay because officials make up for the loss by raising the cost of medical services.

Still, busy hospital executives with varying information technology priorities have meant difficulty in coordinating leaders to get the network, dubbed the San Diego Medical Information Network Exchange, or SDMine, off the ground.

"It has not been an easy task here in San Diego," Carson said.

Growing Popularity

RHIOs have been adopted in more than 200 communities across the country, according to a University of Maryland survey.

Sun announced last week that it is providing components for a RHIO that will initially connect three hospitals in Pennsylvania, adding up to eight more health systems during the next three years.

Steven Escoboza, the CEO of the Hospital Association of San Diego and Imperial Counties, said local hospitals support the concept of a RHIO, but apparently need more time and information.

"We were trying to get all the hospitals to join in at once," Escoboza said. "Sometimes the incremental approach is a good place to start."

Carson said the first phase will mean that doctors in some emergency rooms will send secure electronic lists of patient names with demographic information - with patients' consent - to the certified assistors, who will then help the patients make follow-up appointments or select primary care physicians at one of San Diego's 70plus nonprofit community clinics or other doctor's office. Patients' health records would not be released until the person consents at the follow-up visit.

By law, anyone who arrives at an emergency room must be offered health care, even illegal immigrants.

"Hospitals are not trying to avoid their obligations," Carson said. "That's not it."

Concerns Over Standards

Some hospital officials in San Diego have said they worry about investing money to adopt health information technology systems until the government passes standards. No hospitals have pledged money to the SDMine project.

"I have great concern about spending a lot of money only to find out we have to chuck our system," Scripps' Van Gorder said. "We need national standards first."

At this year's Healthcare Information and Management Systems Society annual conference, held last week in San Diego, RHIOs were among the most talked-about health care trends. RHIOs are seen in the industry as building blocks for a nationwide health information network, which the federal government is pushing, though not immediately standardizing.

David Brailer, the national health information technology coordinator, spoke to a standing-room only crowd at the San Diego Convention Center, saying: "The government won't build, operate or own the infrastructure for a unified health information technology system. A market-based program is in everyone's best interest."

It's not technical disagreement that slows down RHIOs, said Sharon Canner, the vice president of government affairs at eHealth Initiative, a Washington, D.C.-based nonprofit aimed at helping communities collaborate on health information technology efforts.

"It's the political and social issues, and getting the doctors and hospitals to sit down together and agree they are going to stop duplicating each other," Canner said.

Wayne Owens, the vice president of health care integration platforms at Sun Microsystems, said the group still intends to offer much of the typically $2 million to $3 million RHIO project at a discount to San Diego. The entire project would cost about $1 million a year to maintain, according to the foundation.

"Carson was calling the hospital CEOs on a daily basis back in November and December," Owens said. "And at the last minute, they just said, 'Gee, we ran out of time.' They don't know how it will work."

Copyright San Diego Business Journal Feb 20, 2006

Source: San Diego Business Journal

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