Initiative to Link Doctors For Delivery of Stronger Patient Care

If you are admitted to the hospital over the weekend, chances are your doctor’s office won’t be open to send over your medical files.

Come Monday morning, chances are when they do open, getting those records to the hospital will take phone calls, copy machines, faxes or assorted other time-consuming technologies.

Imagine, instead, that your hospital could instantly access your medical records, regardless of what time or where an emergency happens. Doctors would have at their fingertips recent diagnostic test results and medication information from your primary care physician that could help them make the best treatment decisions.

Imagine, too, that it worked the other way around. After discharge, your primary care doctor and any necessary specialists had at the ready the information they should have about your hospital stay that could help them in developing a longer-term treatment plan.

That day is coming.

Tucson Medical Center’s transition to electronic medical records in 2010 laid the foundation for what’s known in the industry as a “health information exchange,” which will allow authorized health care providers to safely share patient information.

“As more practices move to electronic medical records systems, you would think theoretically that would allow us to exchange information between parties,” noted TMC’s Chief Information Officer Frank Marini.

But what’s so easy in theory is not so easy in practice, Marini said.

Health providers use a plethora of electronic records systems – and those systems don’t readily talk to one another.

Enter the health information exchange, which will provide the infrastructure that will allow the systems to communicate.

TMC is developing that capability on two fronts.

The hospital will be part of a public system being developed at a statewide level by a community-based non-profit known as the Health Information Network of Arizona. That system, which includes hospitals, health plans and other providers who opt in, will likely start small when it goes live later this year and will expand incrementally across the state.

TMC, however, is also building its own information exchange to help serve as a building block for the hospital’s participation in a new health care delivery model called an “accountable care organization,” which was authorized under the 2010 federal health care reform law.

The new model delivered by Arizona Connected Care tries to help patients – and particularly those with chronic ailments – maintain better health and prevent unnecessary episodes in the hospital. Ultimately, that’s going to require stronger coordination between primary care doctors, specialists, therapists and any other provider in the healthcare continuum who might touch that patient.

With more than 200 providers participating, it’s important to connect those practices, Marini said, adding that he hopes the majority will be connected within the next 9 months.

The private system TMC is building will be customized to fit the needs of its participation in Arizona Connected Care and will include some advanced features, Marini said. A basic system will allow a user to access patient information. A more sophisticated system could automatically alert the provider that a patient has received emergency care, for example, instead of requiring a provider to search for that information.

But, Marini said, it remains important to be a part of the public effort as well, since as a practical matter, patients will be getting care from providers who may not be participating in Arizona Connected Care.

Steve Nash, the executive director of the Pima County Medical Society, described health information exchanges as “the wave of the future,” saying any creakiness in the new system will be smoothed out as the technology progresses.

And while he’s heard some privacy concerns from some patients, as well as some confusion from doctors who are learning to navigate this new electronic world, he said there’s no question that people understand the need for it.

“You have a situation now where primary care doctors didn’t even know a patient was in the hospital, and now that patient is in the office for a follow-up,” he said. Patients might have been too sick or too confused to understand the diagnosis or digest the treatment plan and can’t fully report to the doctor.

“This is a way to make sure that continuity of care in our fractured system can be maintained,” Nash said.

Kalyanraman Bharathan, executive director for the public statewide effort, said privacy concerns are taken very seriously.

Like the TMC exchange, patient data is encrypted and will be available only to authorized users. Patients may also opt out of participating in the exchange.

Bharathan predicted the new system will save lives. Medication errors, for example, are more likely to be avoided if doctors know more about the patient in front of them.

“You will be getting better care than if you wind up in the emergency department and nobody knows anything about you,” he said.

“The important thing is to get the right information to the right person at the right time.”

Michael Griffis, the I.T. lead for Arizona Connected Care, said while the effort to integrate disparate systems in individual practices is difficult, it will ultimately make a difference.  “When we make this work, it will be highly relevant and replicable for other communities like ours who face similar challenges,” Griffis said. “We hope that from what we learn here, others can benefit.”


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Tucson Medical Center | 5301 E. Grant Road | Tucson, Arizona 85712 | (520) 327-5461
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