Kristin Powers was recently speaking with her colleagues at St. Charles Health System about the recent discovery that a Central Oregon man had received 16 CT scans in six months.
The case hasn’t been confirmed, but Powers, St. Charles’ manager for health integration, used it to illustrate why hospitals should share their patient records. Among the benefits would be providers’ ability to access records of recent screenings that patients received, removing the chance of unnecessary radiation exposure and expensive tests.
A coalition of Oregon health care organizations has a goal of getting software implemented in every hospital and health system in the state by Nov. 1 that will allow them to share their emergency room records with one another. The software, called the Emergency Department Information Exchange, is designed to alert emergency room providers, ideally within minutes of checking in the patient, if he or she has visited an ER at least five times in the past 12 months.
In the case of the patient who had received too many CT scans — a Medicaid patient who had received the scans from St. Charles and a number of other local clinics — EDIE might have notified the ER providers that saw him of the previous tests, Powers said.
“His provider was really upset because he feels like it definitely increases that patient’s risk,” she said, referring to the increased cancer risk associated with radiation exposure from imaging tests.
The idea behind using EDIE is to weed out patients who visit ERs regularly. Such behavior happens for a variety of reasons. Sometimes patients are addicted to prescription pain medication and hop from ER to ER for new prescriptions. Others have complex health issues that aren’t getting properly resolved. Sometimes the issue is simply a lack of education about the proper ways to seek health care.
Once the frequent fliers are identified, providers then work with them to figure out the underlying reasons and redirect them to more appropriate care settings.
Every hospital and health system in Oregon has agreed to use the software, a level of buy-in the project’s leaders — the Oregon Health Leadership Council, the Oregon Health Authority and the Oregon Chapter of the American College of Emergency Physicians — didn’t expect this early on.
“The more in the community that are engaged, the more powerful the tool becomes,” said Greg Van Pelt, president of the Oregon Health Leadership Council.
The council expects maintaining the EDIE software will cost $750,000 annually, with half of that covered by participating hospitals and half by insurance companies and Oregon’s coordinated care organizations, the groups that allocate funding from the state’s Medicaid program, known as the Oregon Health Plan. The roughly $450,000 it cost to implement the program was split among the council, hospitals, the Oregon Health Authority and insurers.
St. Charles, like many hospitals, already has a system of identifying frequent ER users, connecting them with so-called community health workers and creating care plans for them, but the information has, until EDIE, only included records from St. Charles’ own emergency rooms. EDIE will eventually allow Central Oregon’s emergency providers to almost instantly see what other ERs the patients have been to across Oregon and Washington, what medications they were prescribed and what tests they received.
“You can actually track a patient from, say, Bellevue, Washington, all the way down to Klamath Falls,” Powers said.
Timing is everything
St. Charles has been using EDIE since July, adding its own patient data to the system and using it to gather patient data from other hospitals. Since July 1, the software has identified 105 high-frequency ER patients.
St. Charles also added to EDIE records from another 145 patients who it had already identified by the health system as high-frequency users before EDIE was implemented.
Of the 250 total St. Charles patients in the system, the health system has care plans with 111 of them, Powers said. A care plan — specific to each patient and developed by his or her primary care provider — includes instruction for future emergency providers (including whether the patient’s issues are chronic or acute), which medications are most appropriate and which should be avoided.
St. Charles establishes care plans with patients who have had six or more ER visits in a six-month period, Powers said.
At St. Charles, EDIE notifications are delivered by fax when patients sign in at the ER, Powers said.
“They register, you hit ‘enter’ and all of a sudden, no joke, almost a minute later, a piece of paper will print out to a designated printer that says, ‘This patient has been identified as a high utilizer,’” she said, adding that it also attaches a care plan, if the patient has one. “So the providers are being given those at the time they’re seeing the patients.”
Most of the hospitals in Oregon have EDIE configured so that an alert pops up on a computer screen — the most efficient way to use the software — but many, St. Charles included, still have the software’s manager, Salt Lake City-based Collective Medical Technologies, send a fax or call the hospital, Van Pelt said.
Eventually, Van Pelt said, more hospitals will likely move toward the automatic notification.
Dr. Bill Reed, an emergency room physician at St. Charles Bend, said the key to making a program like EDIE work is making it easily accessible and, most importantly, fast for providers like him, who are often crunched for time. Now, for example, he sometimes looks up patients in the Oregon Prescription Drug Monitoring Program, a database that tracks controlled substances dispensed at Oregon pharmacies. But even that can take between 90 seconds and 2 minutes — which is a lot of time in his world.
“Where we work, that’s 90 seconds of incredibly valuable time,” he said. “We don’t stop for lunch; we just keep cranking. You’ve got to definitely have the time to do that.”
For many hospitals, St. Charles included, the information EDIE provides right now is limited to which ERs they visited and when. It does not yet disclose what medications they received, what diagnoses they were given or what diagnostic tests they underwent. Van Pelt said that information will be rolled out in the project’s next phase, which he said will be completed by the end of 2015.
A more distant phase will be to incorporate data from primary care visits and hospital discharges into EDIE, Van Pelt said. Conversations to gauge hospitals’ interest in that will take place this fall, he said.
Results in Washington
Washington state saw noteworthy results in its first year of using EDIE.
There, 98 hospitals have been using the software to share emergency department information as part of a broader effort to cut down on unnecessary emergency visits by Medicaid patients.
In a March report summarizing the program’s first year, the state’s Health Care Authority said ER visits among Medicaid patients had dropped by nearly 10 percent, the rate of frequent Medicaid visitors — defined as five or more visits annually — had dropped by 10.7 percent and the rate of visits resulting in prescriptions for controlled substances fell by 24 percent. The report also found that the rate of visits from Medicaid patients for minor issues that likely did not require emergency care decreased by 14.2 percent.
Overall, Washington state met its goal of saving its Medicaid program $33.6 million in emergency costs in the first year of its efforts to reduce unnecessary ER visits.
The Oregon Health Leadership Council predicts using EDIE will save the Oregon Health Plan $76 million through fewer unnecessary visits and services by the end of 2016, Van Pelt said.
Potential privacy concerns
Anticipating potential privacy complaints from patients who don’t want their medical records shared with other hospitals, an attorney representing CMT President Adam Green explored the legality of using EDIE. The attorney, John Christiansen, of Seattle, wrote in a letter obtained by The Bulletin that using EDIE is lawful both under the federal Health Insurance Portability and Accountability Act and under Oregon’s law governing health records, provided the hospitals have agreements with CMT allowing the company to disclose their information to other providers.
Van Pelt said he hopes people’s privacy concerns are outweighed by the potential benefits of sharing information through EDIE.
“The concern we hear many times is, ‘I just had this test done at this emergency department,’ or, ‘Why didn’t you know that I had a heart attack three weeks ago?’” he said. “I think right now we are relying on that being a more important push than the concern over patient privacy.”
At a time when health care is constantly scrutinized for being too expensive and competitive, Van Pelt said this kind of collaboration is something to be proud of.
“I think in the state of Oregon, a project like this demonstrates we really are trying to work together to bring greater value to the communities we serve,” he said. “That’s the thing that, in so many words, gets me up every morning, that all of our colleagues really want this to work.”
— Reporter: 541-383-0304,