Cincinnati's HealthBridge: Bringing Results From Multiple Service Locations to One Record

Abstract

Medical practice in the twenty-first century could easily be consumed by records management. Patients have opportunities (and reasons) to receive both inpatient and ambulatory care, literally, all over town. Quality care requires that a treating physician have knowledge of what happened in all of these venues, both to incorporate the observations into their assessment and care and to avoid duplication and repetition. As a patient's history becomes more complicated, the process of record retrieval becomes concurrently more difficult yet more important. Because of an unusually successful regional health information clearing-house known as HealthBridge, the 2.2 million people living in greater Cincinnati, Ohio, and their 4,800 physicians have the records management problem better solved than many other populations. Funded primarily by local hospital systems, this data distribution network provides local physicians with one interface for accessing results from virtually every local provider. In its doing so, providers save money and remain compliant with Health Insurance Portability and Accountability Act (HIPAA) standards, while providing greater efficiency in physicians' offices. Just 10 years ago, if physicians in Cincinnati wanted clinical test results from a hospital system in which they worked, all they had to do was ask, and the hospital was happy to equip that physician's office with a dedicated terminal connected to their information network. However, if they wanted results from another hospital, they needed another terminal. Similarly, national clinical laboratories, which wanted to compete with the hospital systems to provide outpatient laboratory testing, would put their system into place. At Oncology Hematology Care (OHC), a medical, radiation, gynecologic, and neuro-oncology practice currently with 41 physicians in 15 offices in three states, it was not uncommon for between three and five such connections to be installed in a particular office. Even worse, at sites without dedicated terminals, results would drift in by courier, mail, fax, or be hand carried by doctors from their hospital mailboxes. Some results would arrive with multiple copies. Others arrived only when someone remembered that they were needed (usually because the patient was waiting to be seen in the office), prompting harried and impolite phone calls and impatient toe tapping at the fax machine. We are most familiar with the benefits HealthBridge provides to our oncology practice, OHC, and will use our test and patient visit volumes for illustration. In 2005, OHC's 29 medical oncologists saw approximately 95,000 office visits and 40,000 hospital visits, caring for 23,000 unique patients. In the same year, OHC received 600,000 results electronically through HealthBridge, indicating an average of 2,300 separate messages each weekday, and either 25 results per patient or four results per patient encounter. Across the community, HealthBridge delivered 1.4 million results in January 2006, including laboratory results, radiology reports, and transcriptions. Inpatient, outpatient, emergency department, and hospital preadmission results are all sent through this system. To accomplish these kinds of volume deliveries, HealthBridge pushes results to all physicians of record (e.g., admitting, attending, referring, primary care physicians) who are associated with a particular patient. Whenever a result for that patient is posted, results are sent by mail, by fax, or electronically. Within the system, each patient has a unique identifier by which authorized physicians are able to query and locate patient records. All results sent electronically (currently 89%) are stored in physician group databases, with the group controlling all secondary access to their data, such as forwarding for referral or analyzing patterns of care. There is no attempt to create a community-wide repository organized around the patient. Results are available and organized around physicians or physician practices. The function of HealthBridge is to bridge the flow of data between laboratory and hospital systems, and to maintain the barrier that allows only those physicians (and their designated nursing and clerical agents) caring for a particular patient, access to their records.