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By Jennifer McAdams On a sweltering day in California's San Diego County, the emergency room at Scripps Mercy Hospital typically fills with uninsured patients, many of them with Type 2 diabetes and suffering from heat stress. They are part of an estimated 45 million people in the county who lack health insurance and often turn to their local ER for routine medical care. To help relieve crowding and provide more appropriate care to ER patients, the hospital recently launched a pilot program to test a secure clinical messaging system that will help find medical facilities that can offer better care to uninsured and especially chronically ill people. The San Diego Medical Information Network Exchange (SD MINE) is designed to link ERs with smaller clinics and public health offices throughout the county. It will start with Scripps Mercy Hospital and La Maestra Community Health Centers. Ultimately, SD MINE aims to provide connectivity between health care facilities and physicians' offices so they can track and share the records of uninsured patients. Eventually, developers hope to incorporate smart cards to expedite medical services, but for now pure connectivity is critical for relieving the burden on local ERs. "We are expecting 500 to 700 leads per month from each hospital in terms of the patients who need follow-up care and case-management services," said Zara Marselian, chief executive officer of the nonprofit La Maestra Community Health Centers, which serve San Diego's immigrant community. Saving by sharing "The medical homes effort stands to deliver a three- to five-times return on investment," said Dr. Stephen Carson, chief medical officer at the San Diego County Medical Society, SD MINE's main sponsor. So far, the society had not asked the county's hospitals for financial contributions to support the new system. Instead, it will initially rely on about $3 million in grant money from the Blue Shield Foundation and Sun Microsystems for the Scripps Mercy/La Maestra pilot project. The funding will allow the society and Sun to create a system that will give physicians and other health professionals a "single composite view of the patient throughout the community at large," said Wayne Owens, Sun's vice president of Healthcare Integration Platforms. A portion of the grant money will allow La Maestra to hire more certified assistors and multilingual workers who can follow up on patients after they are discharged from the ER and help those without insurance establish a permanent medical home at the center. Along with electronically enrolling patients for ongoing care at La Maestra, the assistors will also help uninsured immigrants identify public health programs for which they might qualify. Inside SD MINE The second component is the SOA integration platform, which allows users to pull records from different systems into the common framework via the third component of the system - polling software that will be added to ancillary systems. The polling adapters will glean information from PCs and even fax machines that stream patient information among pharmacies, providers and health plans as standardized Health Level 7 transactions. "These are polling devices that will be placed on existing systems," Owens said. "This way we are not asking physicians to change their behavior, since we will be taking data from current operations." Not asking physicians to change behaviors or hospitals to provide funding are crucial to SD MINE's success, Carson said. "We believe hospitals and other stakeholders will support this effort long-term, because it identifies a business case and proves financial sustainability," he added. "It is really important for us to chip away at this problem any way we can," Marselian said. |
Just don't call it a RHIO
Despite the strain that uninsured patients place on San Diego's emergency rooms, medical officials say area hospitals are reluctant to participate in regional health information organizations (RHIOs), even though many consider record-sharing an important tool in finding more appropriate ways to care for people with long-term diseases. "We've decided purposely not to call what we are doing a RHIO," said Dr. Stephen Carson, chief medical officer at the San Diego County Medical Society. "The main reason is that what we've seen mostly over the last two years around the country are failed, expensive attempts to link communities together. So the minute you talk to hospital [chief information officers] or clinics and use the word 'RHIO,' they turn off to the idea." And when hospital CIOs or major health insurance organizations turn off, interest in funding often shuts down, too. "From a conceptual standpoint, we see the real need and value in these kinds of programs," said William Spooner, senior vice president and CIO at San Diego's Sharp HealthCare. "The other side of this is that we have some real thinking to do in terms of the contribution we can make." Promoted heavily by the Department of Health and Human Services, RHIOs are viewed as ways to store patient data at the local community level while making pertinent information available to all the providers involved in a particular patient's care. So far, however, federal funding for RHIOs has been sparse. "There is general frustration that the government has not delivered on its promise to fund RHIO development," Carson said. Although lackluster government support is one reason medical information technology executives are reluctant to embrace RHIOs, the complexities involved in sharing medical records is another. "The reason we are not jumping into RHIOs or other community efforts as fast as we'd like to is because we are going through huge steps internally just to make information available electronically so routine providers can share it," Spooner said.
- Jennifer McAdams
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