Legislators, Hospitals Split Over How To Share Records [Courant]

Hartford Courant
Hartford HealthCare announced this week that it was overhauling its IT systems to allow its patients’ electronic medical records to be viewed by authorized clinicians at other hospitals in the state, and vice versa, including Yale-New Haven Health System, St. Francis Care and Connecticut Children’s Medical Center.

Those hospital systems all use Epic software, allowing doctors and other clinicians to retrieve a patient’s medical records from any other hospital that uses the same system, with the patient’s permission.

But the three-year, $200 million investment by Hartford Hospital’s parent company is not enough to convince some legislators that Connecticut will have a universal IT system to share patients’ electronic medical records among health systems.

A legislative bill wending through the system would establish a State Health Information Exchange. The bill, Senate Bill 811, directs the state Department of Social Services to issue a request for proposals to manage an IT exchange of patient records among doctors and hospitals. It has the endorsement of Senate President Pro Tem Martin M. Looney, D-New Haven, and Senate Minority Leader Len Fasano, R-North Haven.

Looney and Fasano wrote in an op-ed piece that the federal government has invested more than $26 billion, including more than $300 million in Connecticut, to help hospitals and doctors adopt electronic medical records. The idea was to save money and improve the quality of care by reducing duplicative testing and medical errors and to create a system that allows health information to follow a consumer from one office to another, Fasano and Looney wrote in the op-ed.

Despite the fact that Connecticut’s largest health systems use the same software, not all hospitals use the same IT vendors. Fasano and Looney wrote that the Office of the National Coordinator for Health Information Technology published a report detailing why hospitals and doctor offices don’t yet have a fluid method for sharing patients’ records.

The report found that IT developers use licensing and pricing schemes designed to deter connectivity with competitors, Fasano and Looney wrote.

“Examples of anti-competitive information blocking include hospitals refusing to use their IT systems to refer patients or transmit information to unaffiliated providers, or an IT vendor that charges $100,000 to allow its system to communicate with another vendor’s system,” Looney and Fasano wrote.

They added, “Only a statewide publicly accountable neutral system will ensure that we (1) empower patients to make informed decisions, (2) improve the efficiency of our delivery system, and (3) promote public health through timely disease monitoring and response.”

Hospitals contend, however, that a public Health Information Exchange will duplicate what they have already done.

“As we move to integrated electronic health records, I think the good news is you’ve got four Connecticut health systems with a lot of physicians that have made decisions with the same vendor, and that vendor, Epic, provides as part of the product, its own internal health information exchange,” said Dr. Rocco Orlando, chief medical officer for Hartford HealthCare.

Yale-New Haven Health System’s Chief Information Officer, Daniel Barchi, said that Yale-New Haven has had the ability for a while to share electronic medical records with other hospitals throughout the nation through Epic.

“Epic has had this ability for many years, and it’s really just a question of when health systems decide to turn on the functionality,” Barchi said. “We turned on the functionality more than two years ago, and, as a result, have been able to share patient records when necessary for their care between Yale-New Haven Health System and, say, NYU or Cleveland Clinic or UCLA for quite some time now.”

Yale-New Haven started implementing Epic software in 2011 and finished in 2013. Hartford HealthCare will have its primary care doctors on the Epic system by August and all of its affiliated hospitals will join at different times throughout 2016.

The Hartford HealthCare chief medical officer, Orlando, said a State Health Information Exchange might not be necessary.

“There are all kinds of health information exchanges,” Orlando said. “Some of them — not terribly functional, not user-friendly. Some of them — quite helpful, in that they interact with the electronic health records. So, the selection and implementation, number one, is costly. And you can spend a lot of money and not get much value.”

Some states have health information exchanges that require a clinician to log into a system separate from the one typically used by hospitals, Orlando said. Finding a patient’s medical records is akin to looking for a needle in a haystack, he said.

Ideally, a state exchange would work with Epic software that Yale-New Haven, St. Francis, Hartford HealthCare and CCMC are already using so that a clinician doesn’t have to go back and forth between different operating systems, Orlando said.

Fasano said it’s absolutely false that a State Health Information Exchange would duplicate what hospitals are already doing privately.

“We know in New Haven private practices cannot upload and download to the Epic system,” Fasano said.

Fasano said it strikes him that several major hospital systems in Connecticut are only now announcing that they will use the same software system to share medical records.

“If you’re all on the same system, and you’re telling me that Harford can lock out Yale can lock out St. Francis, then it automatically tells me … that prior to this arrangement, Hartford locked out Yale, Yale locked out Hartford, both of them locked out St. Francis. Which means there’s a key for which you could turn off the information and turn the information on.”

Fasano said that the information should be shared regardless of whether a health system uses the Epic software or any other.

Orlando, the Hartford HealthCare chief medical officer, said he was appalled that someone would suggest that Hartford HealthCare would use its software system to lock out information needed in caring for patients.

“Given the current reality, we interact, we have collegial relationships with our colleagues at organizations that we compete with,” Orlando said. “We share information routinely. We simply do it through the clunky means of telephone calls and faxes. We’re committed to serving our patients. … The data belongs to our patients. We’re holding that information on their behalf and have to use it wisely on their behalf, and the technology will enhance that.”

Morphing Legislation

Originally, a different legislative bill was drafted to establish a State Health Information Exchange. It was Senate Bill 812.

The bill drew criticism from trade groups for doctors, health insurers and hospitals, along with the Connecticut Business and Industry Association. SB 812 didn’t make it out of the committee phase of this session’s legislative proceedings.

Another bill, however, has been working its way through the system. Senate Bill 811, which was originally intended to address parity in how the state regulates hospital sales, was amended on May 21 to establish a Statewide Health Information Exchange.

The goal of the SB 811 amendment is to “empower consumers to make effective health care decisions, promote patient-centered care, improve the quality, safety and value of health care, reduce waste and duplication of services, support clinical decision-making, keep confidential health information secure and make progress toward the state’s public health goals,” according to the bill.

Aides for Looney and Fasano point to key differences between the original bill and the one that has gained traction in the legislature.

The amended bill requires hospitals to use the functions and software available within their existing systems to facilitate the exchange of patient records. It does not require hospitals to spend additional money on new equipment.

Although the original bill would have immediately authorized $50 million in general obligation bonds to develop a statewide health information exchange, the amended bill establishes a committee to work with the Department of Social Services to develop a plan for establishing an information exchange.

A fiscal analysis of the original bill said that the total debt service on $50 million in bonds would cost taxpayers about $76.4 million. Separately, the original bill required hospitals to maintain a certified electronic health record system. To buy one for John Dempsey Hospital at UConn Health in Farmington would cost an estimated $85 million, a legislative report said.

A fiscal analysis of the amended bill doesn’t offer a clear cost of the State Health Information Exchange. However, advocates of the state information exchange say it will result in health care savings. One state estimate is that an information exchange would save $50 million in health care expenses annually by reducing duplicated medical services, for example.

Early Failure

This isn’t the state’s first attempt at creating a health information exchange.

The state has tried since June 2010 to establish a Health Information Technology Exchange as a quasi-public agency for health information technology as well as a health information exchange.

The Department of Public Health received $7.29 million in federal funding in March 2010 to promote health information technology. In June 2010, the state created the Health Information Technology Exchange of Connecticut, or HITE-CT, a nonprofit quasi-public entity to share, develop and implement a secure statewide system for sharing health care information.

The public health department signed an agreement with the new exchange and transferred $4.34 million to set up a system for sharing electronic medical records. The state issued a request for proposals on April 2011 from vendors to build a data-sharing system.

In September 2011, HITE-CT entered into a 36-month contract to pay $6.24 million to Axway Inc. to license, maintain and support the health information exchange.

On Nov. 12, 2014, state auditors said that HITE-CT “was unable to meet its strategic and operational schedule primarily due to its inability to adapt quickly to changing market conditions. The exchange’s board of directors recognized that the terms in the original contract with its vendor required significant modification to reflect the evolving market place for an integrated statewide electronic health information infrastructure.”

The exchange ceased to exist on July 1, 2014.

Fasano said that the earlier attempt to create an information exchange failed for “a bunch of different reasons.”

People were more concerned years ago about adapting to the Affordable Care Act, often called Obamacare, and setting up the state’s health insurance exchange, Access Health CT, Fasano said. People weren’t paying attention to a system of sharing electronic medical records and the state was doing the whole process from scratch.

The current bill is different because it calls for a committee and DSS to look at existing state health information exchanges, like one in Rhode Island, Fasano said.

“We know what we need, and we know that it’s out there,” Fasano said. “It’s just a question: Who is going to come to us with the best price? Now, I don’t know what the price is going to be, but I think the price, if I had to guess, [would be] $5 million, $10 million a year.”