Online conversation: Computerizing medical records

Physician Elliot Menschik graduated from medical school, but instead of helping patients, he's trying to cure the whole health system.

His prescription? Shared health information.

In 2000, Menschik, 35, founded Hx Technologies, a Center City-based company that works to contain costs and improve the quality of patient care through a health information exchange.

Hx just finished a 20-month experiment analyzing medical imaging done at Thomas Jefferson University Hospital and hospitals in the University of Pennsylvania Health System.

The study discovered that about 20,000 patients used both systems, generating 125,000 X-rays, CT scans and MRIs.

Of those, 10,000 could have been helpful if their doctors in the other hospitals had known about them. And of the 10,000, 1,520 were straight duplicates that cost $218,000, an expense that could have been avoided.

Now Menschik is working on a larger project to link more area hospitals and hoping that insurers will foot the bill.

"Insurance companies want to to improve the quality of care," he said. "The return on investment is linked on how many dollars they can save."

Today at noon, Menschik explained his project during an online conversation with Inquirer business writer Jane M. Von Bergen.

Here's the transcript:

Jane M. Von Bergen: Elliot, you've been working on connecting electronic health data for a long time. What do you see as the future for this in Philadelphia, working off your current project?

Elliot Menschik: I think the key is to start with what can be accomplished today, with minimal cost and maximal impact. For us, this has been starting with diagnostic imaging (x-rays, CT scans, etc.). These forms of information are already digital and already in widespread use around Philadelphia and most major metropolitan areas

Jane: So, is your next step to link more hospitals or to exchange more types of information?

Elliot: The next step focuses on expanding to more hospitals and imaging centers in the region to make the network as useful as possible to both patients and those who provide their care. At the same time, we have already seen significant interest from those we work with to move to other forms of information as well, such as laboratory results. We are just beginning to explore those avenues.

Jane: How does it actually work? Take me step by step through the process. Let's pretend Joe Patient gets an MRI at the University of Pennsylvania. Then what?

Elliot: Our system has links to the imaging archives at those sites participating in the network, so we are able to index in real-time and know that Joe has had an MRI performed

Jane: Then what?

Elliot: If fictional Joe were to seek care elsewhere across town, he would be asked by his care provider if he is willing to grant permission for his doctor to electronically access his information from other sites on the network

Jane: Why would Joe say yes?

Elliot: The more information Joe's doctor has about his medical history and results, the more informed and accurate his diagnosis and management will be. All too often, the new doctor wouldn't even know the MRI exists, let alone be able to access it electronically. This can lead to delays, additional testing, and even missing a critical diagnosis

Jane: But wouldn't our fictional patient Joe have a legitimate concern about privacy issues? How is Joe supposed to be assured that his information won't get to someone like an employer who may not be willing to hire him if he knew he had a condition that required getting an MRI?

Elliot: Privacy and security of the information is of paramount concern and had driven the design of our system from day one. This is why it is critical that the patient be involved in the consent process - giving specific permission as to who is allowed to see his/her information and for how long. In our system, it would be impossible for an employer to access this information without the patient's consent.

Jane: OK, so Joe gives his permission. Then what happens?

Elliot: With permission granted, the doctor is able to securely look up Joe's history on his web browser and get a complete view of his results drawn from the other medical facilities on the network who are now willing to disclose this information having secured Joe's permission. The doctor can then select the MRI exam and view the images themselves and the radiologist's report online in the web browser

Jane: This morning, I got several emails from readers who expressed a lack of confidence in these kinds of electronic records -- especially when it comes to doctors using them to write orders. The problem is that the doctor or provider may make computing errors or not know how to find the important patient information on the computer. Not everyone is a techno whiz kid.

Elliot: I would answer such concerns by highlighting that the entire point of efforts such as ours is the fill the gaps in the doctor's knowledge that already exist, to enable more accurate and timely intervention. The reality is that patients move among different care providers to a great extent, and accidentally scatter needed information around those offices and hospitals. The information has unfortunately been trapped behind their walls, and at times leads to mistakes and suboptimal care.

Jane: I'm going to send you a paragraph on this topic from one reader.

Elliot: ok

Jane: "Software changes frequently and radically: doctor's office/hospital A may have a much different application than office/hospital B. The patient may not see a health provider frequently enough to keep up with the changes that take place in applications. Power outages are always a possibility. Dips in power can erase data in the process of being saved. The need for several back-ups for each patient and procedure takes space, time and great care. Can that be guaranteed in this greedy system we call healthcare?"

Elliot: Your reader is correct in that software does change frequently and across any given city, there may be hundreds of different applications in use. What is missing is the infrastructure to securely link those sites and applications so that no one hospital or practice needs to be the central repository of all medical information. In fact, it's unlikely that any patient would trust any one organization to hold all their information.

Jane: Good point. Elliot, what is your timetable for all this in Philadelphia?

Elliot: Our work over the last several years has focused on proving that this works technologically, and gaining insight into what the impact will be on patient care were it available widely. We are just now moving into a new phase to make the system more widely available to care providers across Philadelphia.

Jane: So when are you talking? And what?

Elliot: The dates are still in development with our colleagues at the participating medical facilities.

Jane: We have time for one last question. This one comes from Patrick.

Elliot: OK

Jane: "What kind of acceptance or adoption has he seen from doctors regarding EMR? Do they readily accept it or are they hesitant to possibly change their routine of care?"

Elliot: EMR (electronic medical records) are seeing increasing adoption with every passing day - the problem is that the vast majority of medical information remains on paper and needs to get "into" the EMR even once the doctor has one installed. Infrastructure such as the Philadelphia Health Information Exchange will be part of the solution by population the EMR with useful information on-demand and hopefully help drive even more widespread adoption of EMRs.

Elliot: At the same time, there is no reason to wait for widespread EMR adoption - much can be done today based on what information is already digital, and can be leveraged to enhance the safety and quality of care, while managing its cost as well

Jane: That's why you chose the imaging -- x-rays, MRIs -- right?

Elliot: Absolutely

Jane: Elliot, you told me that you graduated from medical school, but you really didn't practice medicine for long. How did you decide to take this path? Maybe you don't look good in a lab coat??!!

Elliot: Prior to medical school, I had a strong background in information technology and software and so throughout my medical training had been looking on how to apply this background to have a significant impact on care. Ultimately, I decided that I could have a far greater impact on a larger number of patients by bringing to the market the technology and services needed to bridge these gaps between facilities and in the knowledge of care providers.

Jane: Well, thanks for your time, Elliot and keep us posted on what happens with your project.

Elliot: Jane - thanks for the opportunity to take part in this chat and I will look forward to keeping you apprised of our continued progress!