Health Care and Technology

Electronic network prepares to branch out: More hospital systems, doctors in line for speedy test results through Indiana Health Information Exchange

August 8, 2005

The Indiana Health Information Exchange starts a busy fall next month with plans to add two more hospital systems to a cutting-edge electronic network designed to improve patient care in central Indiana.

The expansion is helping keep Indiana ahead of other states exploring this new branch of medical technology, experts say. The state also is home to the Indianapolis Network for Patient Care, a system that started in the mid-1990s as a way for hospital emergency rooms to share patient data.

Indiana has "one of the most advanced-stage health information exchanges in the country," said Janet Marchibroda, CEO of eHealth Initiative, a Washington, D.C.-based not-for-profit that supports electronic health information exchanges. "Clearly, Indiana is leading the way."

The Indiana Health Information Exchange allows doctors to receive test results and other data through a secure computer network instead of by fax or courier. It started last year with St. Vincent Health and Community Health Network. It plans to add St. Francis Hospital and Health Centers and possibly Clarian Health Partners in September, according to Tom Penno, IHIE's chief operating officer.

By the end of the year, it also might include Wishard Health Services and boost the number of doctors involved to 3,500. Penno said 1,900 doctors in the nine-county, central Indiana region are already connected.

Doctors pay nothing to join the network, but each hospital system chips in a flat fee and a separate fee based on the number of results delivered. The five main Indianapolis hospital systems could wind up paying a total of $1.5 million each year for the network.

Those already involved say the network speeds the flow of information, boosts efficiency and guards against error.

A doctor can log onto the secure network through a hospital's portal, request lab tests and exam results, discharge data or other information, and have it delivered to his account or a practice account.

The request travels through a server at Wishard Memorial Hospital. IHIE standardizes the necessary data and delivers it to the inbox. Results can be delivered within 30 minutes, Penno said.

For instance, a doctor who orders an electrocardiogram at Community would have results sent to his electronic account instead of by fax or courier. The doctor then would forward the information to colleagues in the system.

The quicker information flow helps doctors make faster decisions for patient care, Penno said.

Speedier turnaround also allows doctors to use their time more efficiently. If a patient forgets to get a blood test until a day or two before an appointment, for instance, doctors using the system could still get results back in time to discuss them at the appointment, said Dr. James Ehlich, who has a rheumatology practice on the east side of Indianapolis.

Ehlich joined the IHIE network a few months ago because he heard Community was eliminating its courier service.

Each morning, he logs onto his account and prints out test results for his patients and those of his practice partner. The system also trims the filing workload by cutting down on duplicate printouts of the same results, a frequent problem in medicine.

"We would get as many as three or four copies of every patient's labs," he said, "and when you're a manual file system, the less duplication the better."

The program can warn the sender if no one opens a report within a certain amount of time. This guards against cases where it might be sent to the wrong person, said Dr. Clem McDonald, direc- tor of the Regenstrief Institute, an Indianapolis-based health care research notfor-profit that writes the software that makes both networks run.

A software program designed by Dr. Mike Barnes of Regenstrief and called Docs4Docs allows IHIE to deliver these results to the doctors. Regenstrief also controls the Indianapolis Network for Patient Care.

That network now encompasses five hospital systems and 14 hospitals. Its focus has moved beyond emergency room care, McDonald said.

Regenstrief plans to make INPC available for data on inpatient hospital stays instead of just emergency room visits. It also links to public health agencies and is developing a statewide network to watch for data patterns that might indicate a disease outbreak or bioterrorism attack.

Eventually, McDonald would like IHIE users to be able to access data from the other network. He noted that both networks use the same infrastructure and send data and requests to Regenstrief.

The main obstacle is figuring out how to control broad access to confidential patient records, said McDonald, who added that he has no time frame for this integration.

"It's much more important to make sure we do it right than we do it fast," he said.

All this electronic sharing here has gained national notice. The central Indiana setup was featured in an article on wired hospitals in the Aug. 1 edition of U.S. News and World Report.

The two networks also fared well in a recent survey by eHealth Initiative.

The organization surveyed 107 health information exchange programs across the country and grouped the Indianapolis networks in rare company. It found only about 10 other systems that are fully operational and transfer actual patient information.

McDonald puts Indiana's networks in front of even this exclusive pack.

"This is pioneering activity," he said. "There's no one close, here in the U.S., to what we're doing."
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