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May 28, 2012
An interview with Dr. Joe Davison, chair of the Kansas Health Information Exchange board and a Wichita family physician. Davison provides some background and insight on the health information exchange set to go live in July in Kansas. This audio interview and the transcript that follow are the edited highlights.
KHI News Service: You’re a practicing physician in Wichita?
Dr. Davison: I am. Family physician.
So tell us a little bit about your practice.
Yeah, family physician, I see all ages. I come from a practice that has 24 physicians all in one building, so we have a pretty robust, integrated group. We try to take care of patients from the very beginning to the very end.
Were you an innovative doctor when it came to electronic medical records?
Well, actually not so much. There were physicians and offices that actually got started before we did. Though we could see the value in what health information records would do, particularly when you’re talking about EMRs, you’re talking about the medical record that is in your office. That’s the organizational component of what we do – be able to get to the lab, get to the X-ray, get to the lab note – that was a key for us because you can imagine paper in a physician office is an expensive proposition, so we saw some real benefit in the EMR. What we’re talking about now is different. It’s the health information exchange, so it’s moving that information from the silo in my office to another spot. And that’s the key. That’s where the real value of health information exchange comes in.
This summer we’re flipping the switch of a network that allows electronic medical records to be exchanged relatively widely among practitioners, physicians, providers, that kind of thing.
I dislike the word ‘widely.’ That makes people nervous. We are going to be very careful about where that information goes. But you’re correct; once we flip the switch on this, we are going to begin a process of exchanging health data in a very secure fashion so that patients can see some real benefits in their health care, and everyone will know immediately that this is occurring, because like their demographic information – where they live, why they’re in another doctor’s office doing a referral – they don’t have to repeat that information. It will be there waiting for them to come into the door.
That is one of the basic questions, because everyone has a horror story where they go to the doctor’s office and they’re asked all these basic questions about their care, basic biographical information, they give it and they can go back to another physician a week later and have to repeat all of that. So this process, in part, is intended to reduce all that duplication?
Exactly. And of course that’s the public side of what we’re trying to do, but behind the scenes of what happens if pertinent health information doesn’t get to the doctor you’re seeing and they miss a vital piece of information? So it’s the health information that’s key, but what patients will see is the streamlining of the office procedures.
So it’s convenience on the patient’s end, but on the doctor’s end, it’s information that could be vital to that person’s care, to make sure there aren’t drug issues and to make sure that you’re not doing a lot of repetitive testing?
That’s right. And the other side of this is, we’ll be able to create personal health records, patient portals, so that patients can actually look at their information also. They’ll be able to see a list of the medicines that the doctor thinks they’re on. Maybe they’re not on them, but at least there will be some ability to correct those lists; what their allergies are, what their diagnoses are, what their lab values are. Of course that will all be secure. But think about the increase in communication, how much that can really help the patient in the health care process. If you’re all rowing the boat in the same direction, you’re liable to get there faster.
What has been happening behind the scenes for months is that this statewide entity, KHIE, the Kansas Health Information Exchange, has been busy setting rules and deciding what kind of network to have and certifying the networks that will be participating. Could you describe that process to me?
We use the comical term ‘building the plane as we are flying it’ and that’s just not true with Kansas, it’s true of all the states in this country. The issue that is in front of us is that we do this in a way that agrees with the psyche of Kansas citizens, of the Kansas patient. We don’t want to overstretch our boundaries, we don’t want to do a project that is so lightweight that it doesn’t fulfill the promises that we made, so we’re trying to strike that balance for the citizens. Of course, important to all of that is the creation of policy and regulations, and what we do with that information, and who is responsible for putting certain pieces of information into the record, and what can be done with that information, and does that cost? And so we’re wrestling with a lot of very important issues.
In June, people may start getting notices from their physician that essentially inform them that they are a part of this network and may be exchanging information so the patient will know. What is the patient supposed to do with that information?
We want patients to be a partner. It is their health information, so they have a right to control that information. And part of that control that they have is the ability to say that that information can be exchanged or it cannot be exchanged. We would like that communication to be full so that the patient is making very educated decisions in that regard. And there’s going to be pros and cons for both. So before we start exchanging information, we’re going to begin that educational process.
So they can have a conversation with somebody in their physician’s office about what all this means and then they’ll be asked to sign a document. What happens if they choose not to?
If they choose not to sign the document, that means that their information is going to go immediately into the exchange because Kansas has decided to be an opt-out state, which means that your information will be in the exchange unless you opt out. We hope that that conversation will actually occur on many levels. We hope that the front office of the physician’s office will be talking to the patients. We hope the patients will ask their physicians. We hope that patients will be talking to patients. And we hope that the media will pick it up. And we hope that through this process of getting the information out that people will be making correct decisions for themselves. They are the one who gets to choose.
You’re going to have many physicians and clinics and practices and hospitals and providers signed into these networks so that you’ll have a meaningful exchange of information, or at least the capacity to do that right off the bat?
We will. We’re not going to put historical data in. We’re going to start new and begin to build the database. But what we have seen is that a lot of providers – doctors, optometrists, ophthalmologists – are beginning to build the infrastructure of health information technology in their particular practice locales. Some of that technology is not even ready yet, so I think what we’re going to see is this will come in spurts where a large provider, say a large hospital, will suddenly dump all their data in. Maybe a large physician group will do likewise. But then you’ll have individual doctors who routinely, gradually, progressively start using the exchange. Obviously the more providers who are hooked up to the exchange, the more useful it becomes. We expect it to grow over time.
Let’s say you have electronic medical records in your practice and you are a participant in one of these networks. So if I’m a patient of yours, will my medical history automatically be a part of that network, or will it only be exchanged when there’s a need to exchange it?
That is a great question because there are several different models across the country. The concept of databanking, storing that data, is a very viable process in some states. Our information actually will be stored, but it will be sequestered off in large databanks somewhere else, unable to be obtained by just anyone off the street. There has to be authorizations, there has to be the proper safeguards to protect that information.
In other words, if information is exchanged, it will need to be at the request of a treating physician someplace, and then another physician or provider will have to actively release that information. There will have to be a transaction?
Yes. It’s called push-pull. If you as a patient give a secondary physician permission to get your information, that doctor can pull that information down to his office and use that information.
Right now, medical records are exchanged among providers, but they’re not electronic and probably not as safe because they’re faxed and that really isn’t a very secure way to exchange information.
No, it is not. But as you might imagine, when records are on paper, if there are breaches, if there are lost records, they tend to be small losses. A few records here, a few records there, not large losses. Unfortunately, what health information technology will allow is huge amounts of data lost. That’s why we have to be so very careful.
Lost or perhaps gets put into the wrong hands and confidentiality issues that arise.
And that is the purpose for all of these policies and all these regulations and all of this encrypting of information. We’re trying as hard as we possibly can to keep this information secure and safe, and we think we can. We in this country have had a pretty good record of keeping other big data systems safe, such as financial data, but even that, we have seen some breaches. So this is one of those cost-benefit analyses that I think everyone needs to make. I know the health care industry is trying to make it, some physicians are trying to make it for themselves. And certainly we’re inviting patients to make that decision for themselves. But I think overall, if you add up all the x’s and o’s and all the factors, I think you’re going to find the benefits far outweigh the negatives.
Let’s say I am your patient and I get this notice in the mail and I come to talk to you about it. Your advice to me would be what?
I think you should put your information in the exchange. And I think that information in the exchange should be used as robustly as it possibly can, because along with this data is not just being able to treat you one-on-one – one doctor, one patient – but it’s also going to go into a data field, which we hope will be able to improve the quality of care. And the whole purpose of health information exchange is that not only do we improve the quality of care, but we will also improve the value of care – which means that we somehow, some way, can cut down on some of the duplicate costs we have. Our society needs a way to control our health care costs, and this seems like a very legitimate and powerful way to do that.
Do you expect a fair number of Kansans to be suspicious of it?
I think so. I would also say there’s going to be some physicians who will be suspicious. I think that’s part of the challenge, but it’s also part of our opportunity. The challenge is to show that what we’re doing is of great value, and we need to show that not only to patients but to physicians.
We really are at the starting point. Doctors have been adopting electronic medical systems within their clinics. Really, this is the beginning point at which those physicians and clinics and hospitals are going to be able to meaningfully exchange information.
Correct. And if you think about how we exchange information now, it’s a manila folder tucked under your arm as you go from one doctor to another, or it goes through a fax machine. Certainly that is, by today’s standards, that’s almost archaic. The chances for me to improve care in that old system are almost none. But in the new system where we can collate and do analytics on this kind of data, it is really quite amazing, and I am very excited about population health. Of course, we have, as one of our partners in this process, the health department and public health departments all across the state. And the things that they can do for population medicine are really exciting.
And population health, can you explain that while we’re at it? Health is the health of the individual, but population health is just as it sounds – the health of the population as a whole.
That’s exactly right, and it’s a wide definition. But think if there’s an epidemic in Western Kansas. How many years ago did we have this fear of a Hantavirus epidemic coming through our state, or the bird flu, or any of those? Well that information, correct information, can be transmitted almost virally, if you want to use that term, to the rest of the providers. And then what if in using this data that you are able to survey populations of patients, and you find out that there is a certain ZIP code with a large number of mothers who are giving birth to premature babies – a very expensive proposition. And maybe one of the major reasons is that these mothers may not have a doctor. We have an opportunity then to interject the health care system for tremendous savings just by having these young babies not go to the neonatal units.
The point of bringing that up is, for obvious reasons, if my health care information can be exchanged among treating physicians, it could very well improve my individual care and help the doctors treat me better. But it could also reveal patterns, disease patterns and other things that allow you to intervene in the system and not just individual patient care.
Correct. We’re looking for big gains, and our health care system needs that. If we are able to show that we can better manage information, we think that will allow us to manage patients better, lower costs and improve quality. The other nice thing about having this kind of data is that we don’t have to just guess anymore because we’ll be able to do the metrics. We’ll be able to give performance report cards to the physicians or to the hospitals. Now, they may not like that, but I think that they will learn to like it because it represents better care.
→ Related story: Kansas breaks ground on statewide digital health network
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