To help transform health care, the state should invest more in electronic infrastructure that supports the automated exchange of electronic medical information, writes Russell Sarbora of Community Health Network of Washington. Increased efficiencies, lower costs and less waste of resources will help improve the health-care system.

By Russell Sarbora Special to The Times

IN Washington, state spending on health care ranks second only to education. The state has consistently asked how we can improve efficiency, reduce costs and focus scarce resources on insuring and caring for more Washingtonians.

The rapid exchange of accurate and timely information is going to transform the delivery of medical care. Infrastructure that supports the automated exchange of electronic medical information is and will continue to be a primary driver for efficient health-care delivery. We need to encourage and realize an efficient infrastructure for interoperability between electronic medical-record systems.

Washington state has at least two key assets already in place that have the potential to support creation of this infrastructure. These are the Washington State Health Care Authority-sponsored Health Information Infrastructure Advisory Board (HIIAB), and the Community Health Network of Washington (CHNW), the nation’s largest system of community health centers.

The 19 community health centers that make up the network are the primary health-care home for more than 600,000 low-income people in Washington state, including one-third of the state’s uninsured adults and one-half of the state’s uninsured children.

At CHNW we are working with HIIAB to achieve its objectives and have already implemented electronic medical-record systems that cover more than 70 percent of our member clinics and more than 85 percent of our patient population.

Business pressures will eventually produce efficient health-data-exchange services for patients served by commercial insurers and providers who rely primarily on commercially insured patients. But who will ensure that similar services are provided to vulnerable populations?

Through continued support for the HIIAB and by strengthening efforts to encourage the interoperability of electronic medical records, Washington state can improve patient health and safety while simultaneously controlling state-funded health-care costs.

Electronic medical records are used in the vast majority of acute-care facilities in Washington state; by all laboratory-service organizations operating in the state; by almost 25 percent of Washington’s primary-care physicians, and by more than 70 percent of CHNW’s member physicians. Yet, there is no statewide or national infrastructure today that supports sharing this information.

This infrastructure needs to be created, and the states that do so will lead the nation in delivery of efficient health care during the next decade. Washington state can and should be a leader in realizing this goal.

To achieve this leadership position, our state must adopt existing data-exchange policies and standards for health-information exchanges between organizations receiving state funding, provide incentives for technology investments required to support health-information exchanges, and financially support pilot programs that enable health-information exchanges.

CHNW is already working with HIIAB to create a Health Record Banking system that supports sharing of health information between patients and their health-care providers. We need to upgrade this existing business process to use current generation technology and thereby overcome existing shortcomings in reliability, efficiency and accuracy.

Interoperability between electronic medical-record systems is the key to achieving widespread sharing of clinical data. Today, these proprietary systems are incented to constrict access to the data they contain and there are numerous unresolved issues regarding access to the data and under what conditions data are shared.

Fortunately, the HIIAB is well-versed in these issues and well-positioned to support their resolution. The HIIAB is already proceeding with the creation of mechanisms to support patient access and control of their health data. However, the single greatest shortfall in the proposed Health Record Bank system is the absence of mechanisms to automatically include physician-created health data in these patient-controlled record systems. Lacking this critical body of data, the value of Health Record Banks will be substantially diminished.

We need to extend the HIIAB charter and role to encourage interoperability between electronic medical-record systems employed in Washington State and to achieve automated exchange of clinical data. The technology to do so already exists. Policy and will are the only hurdles to be overcome.

Russell Sarbora is the chief information officer for Community Health Network of Washington.

Copyright © 2009 The Seattle Times Company

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