By Tara Bannow • The Bulletin

Imagine traveling and not being able to use ATMs linked to your bank account. Sounds crazy, right? Welcome to the world of medical records.

“Today I can walk across the street from St. Charles to (Central Oregon Pediatric Associates) or Mosaic and my records don’t follow me without a fair amount of manual work,” said Brian Wetter, vice president of infrastructure and analytics for PacificSource Health Plans.

These days, the vast majority of patients’ medical information is stored in doctors’ electronic health records systems. It’s a huge improvement from the paper records that used to crowd filing cabinets, but it doesn’t solve the significant problem of easily sharing that information between providers, short of using a fax machine or having patients bring their folders with them.

Health care leaders in Central Oregon have for seven years been trying to launch what’s called a health information exchange, a portal that allows patients’ medical records — their lab tests, imaging, previous procedures, medications, allergies and other information — to be shared seamlessly across providers. In the health care world, they call that interoperability.

There have been setbacks along the way.

“It still feels like even after many years, we’re very early in the process,” said Dr. Mary Dallas, chief medical information officer for St. Charles Health System, which has been front and center in the region’s quest toward interoperability. “It’s just hard.”

Now, the dream appears to finally be coming to fruition. A number of Central Oregon health care providers, including St. Charles, Mosaic Medical, High Lakes Health Care, Central Oregon Pediatric Associates, Advantage Dental and Deschutes County Health Services, are linking up to a Medford-based health information exchange called Reliance eHealth Collaborative.

Within two months, the goal is to have them all sharing patient information and referring patients to other providers using the exchange. No fax machines or manila envelopes necessary.

More than 200 clinics and hospitals were using Reliance as of the beginning of April, most of them in Jackson, Josephine, Klamath, Hood River and Wasco counties. That bodes well for Central Oregon, where providers often see patients from across the state.

Easier record sharing

A major barrier to doing this in the past is that it costs money. Without having a solid plan in place, it was hard to get providers to cash in, said PacificSource’s Wetter, who heads the group of providers working to establish a health information exchange.

The Central Oregon Health Council, the governing board that oversees care provided to the region’s Medicaid population, is contributing $2 million to the project. The health information exchange will encompass patients covered under all types of insurance, including private policies and Medicare, as well as those without insurance.

The focal point, at least at first, will be giving providers access to a shared information portal. The portal will even include lab results and imaging, such as CT scans or X-rays, once Reliance gets the necessary laboratories and radiology providers on board.

In some cases, providers have been able to integrate the Reliance exchange into their electronic health records system, which means lab results and scans are automatically uploaded into patients’ files, said Erick Maddox, Reliance’s executive director.

Many providers in Jackson County even use Reliance to order labs or scans, he said.

Sharing patient records with providers who have different electronic health records systems can be particularly difficult. That’s especially true in Southern Oregon, where there are 26 different electronic health records systems in use, said Dr. Lee Milligan, vice president of medical informatics for Asante.

Using Reliance has helped Asante’s three hospitals and 10 outpatient clinics communicate with providers that don’t use Epic, the electronic health records platform Asante uses.

On the heels of being able to share health information, Maddox said Central Oregon providers will also be able to refer patients to other providers using Reliance, which triggers a notification to both parties.

The referring provider is notified when the referral is accepted or rejected.

“There are opportunities for that ball to be dropped and the patient doesn’t get the care they need,” he said. “This allows the care providers to close that loop.”

When a patient is referred, all of their records come with them through Reliance.

Better, safer care

At the end of the day, though, all of the effort is about the patients. Their records will follow them from clinic to clinic, hopefully reducing the number of unnecessary tests performed on them, the number of medication errors and even the number of times they have to visit the doctor.

Wetter, of PacificSource, gave the example of a family member with Alzheimer’s disease who was having trouble breathing. His primary care provider performed a chest X-ray, did lab work, prescribed medications and sent him back to his care facility. The patient woke up in the middle of the night with significant breathing difficulty. At the hospital, doctors didn’t have his medical records, so they spent hours trying to figure out what was wrong, even performing a second chest X-ray and more labs.

“That’s just one really simple example that I think highlights one of the thousands of cases of how this improves the patient experience, reduces cost, reduces waste and improves a provider’s ability to do their jobs,” he said.

One of the top priorities of running a health information exchange is making sure the data that’s shared is protected from people who shouldn’t be seeing it, Maddox said. The information is encrypted both in the server and as it’s transmitted across providers, he said.

Reliance also performs regular audits on who is using the data and how. Doctors can’t use the system until they prove they’re actively seeing a patient.

“It’s not just the world opens up to that particular provider,” Maddox said.

If patients are still uncomfortable with the format, they can opt out. Several people interviewed said that’s very rare. Patients can’t log into their own information on the exchange, although that’s a capability Reliance is evaluating, Maddox said.

Dr. Andrew Neeb, a urologist with Urology Specialists of Oregon in Bend, said having an easier way to get information about his patients will make their care more efficient and safer.

Right now, he said there is little connection between the records systems of St. Charles, BMC and other provider groups in town.

Oftentimes, Neeb learns of referrals via faxes that come into his office. After that, there’s the phone tag to schedule an appointment. Patients must sign a release so he can get their records, which are then faxed to him.

“So many people have to touch the information to get it around the horn, if you will,” he said. “It becomes really difficult.”

— Reporter: 541-383-0304,

tbannow@bendbulletin.com

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