In both cases, I had to fill out paper forms asking for the usual name/address/emergency contact/insurance provider information. One physician required me to fill out two forms in advance, then three more in his waiting room — all asking for the same basic information, all formatted differently. Once the forms were complete, of course, the physician's staff had to either file them or re-enter the data into a computer.
Neither provider offered me a way to go online and provide basic information about myself in a format that could then be imported into whatever forms I might need to sign. Neither provider had a computer terminal in the waiting room where I could type in such basic information. Neither provider had a system that would allow them to share information or test results electronically with my general practitioner.
By the time the doctor came into the exam room, I was all but gagging on irony. Before me was a 21st century, technologically sophisticated medical professional who could test my blood for all manner of microscopic substances and snake a camera into me to take pictures inside my vital organs. But when it came to storing and sharing information in a way that is in my — his patient's — best interests, he wasn't much beyond clay tablets. Some Florida providers like Moffitt and Mayo are further along and effectively use sophisticated electronic records within their walls. But their patients start back at square one if they need care at a different institution, even if it's an emergency room a block away, since the other institution can't access the electronic records.
There are two main issues in moving health records into this century. One is simply getting doctors and hospitals to use electronic records, a conversion that requires considerable effort and expense. The federal government has created big incentives, with about $1 billion available for providers in Florida to help offset the cost of going electronic.
The adoption of electronic records by physicians and hospitals isn't the only piece of the puzzle, however. Just as important is building a "health information exchange" network to electronically link all those individual providers.
The state of Florida has fumbled the ball in helping to create such a link. Beginning in 2005, the state encouraged, via about $6 million in grants, the formation of public-private partnerships called Regional Health Information Organizations. Members of RHIOs include doctors, hospital representatives, officials from social service agencies, consumers and others involved in a community's health. The RHIOs — there are now 10 — were meant as a way for local communities to explore the issues associated with creating health information exchanges, with an eye toward eventually building a statewide network from the ground up.
Many of the RHIOs haven't gotten very far, either for lack of funding, leadership or both. But at least four — in the Orlando, Jacksonville, Pensacola and Tallahassee areas — have made solid progress. The Pensacola-based Northwest Florida RHIO, for example, now links data on poor and uninsured patients served by 18 community providers in a two-county area. The Tallahassee-based Big Bend RHIO, meanwhile, actually succeeded at creating a working electronic records system that encompasses patients and physicians throughout most of the region.
Dr. Lonnie Draper, an associate professor at the FSU College of Medicine and a member of the IT committee of the Florida Medical Association, says the Big Bend RHIO now includes the health records of more than 500,000 patients, shared electronically among more than 500 providers. "About 60-70% of all physicians" in the area are represented along with both hospitals, Draper says. Usage has skyrocketed since July 2008, rising to about 40,000 "lookups" a month. "It's pretty significant."
Under the administration of former Gov. Charlie Crist, however, the state Agency for Health Care Administration began ignoring the RHIOs — particularly once some money for information networks began trickling down from the federal government. Notably, AHCA even tried to create a top-down plan for a statewide network that didn't even mention the RHIOs.
That draft plan was changed, and although the state's approach to building a statewide health information exchange is still too top-down, the future isn't entirely bleak. In December, the state signed a $19-million contract with Harris Corp. to develop a platform for a statewide health information exchange. It likely could have gotten more bang if it had spent even half those bucks on building infrastructure at the local level, but Harris is a hugely competent company and will most likely deliver a good product — if it listens to the RHIOs and local healthcare providers and builds the network with the needs of the actual users in mind.
A big wild card in how this plays out, of course, will be where new Gov. Rick Scott places AHCA in his organizational structure and whether the agency's managers decide to be responsive — or dictatorial.
The success of health information exchanges is important to Florida, which had staked out a leadership position when it created the RHIOs. Efficiencies from managing and sharing data electronically will be an essential part of controlling costs both among Florida's Medicaid population and among the privately insured.
Having health information readily available is also vital, in this age of specialization, to better outcomes for the patient. Until patients' records from all their providers are linked, doctors simply can't make the best decisions.
Draper remains hopeful that the capacity to link health records around Florida could exist within two years. Meanwhile, have a seat in the waiting room. Here's a sheaf of forms and a pencil.
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