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The "wiredness" of Utah's doctors and hospitals may be more of a hindrance than a help to architects of a statewide health data exchange, a conduit that one day will enable a doctor in Moab to push vital patient information to an emergency room in Salt Lake City.
Health information exchanges are in various stages of development in every state, a growing IT infrastructure fueled by billions in federal funding and a belief that data can improve health care and lower costs.
Utah's cHIE, or Clinical Health Information Exchange, has buy-in from all the state's major hospital systems. And the state's doctors are a tech-savvy bunch, which should favor creation of a health exchange. About 60 to 70 percent of them use digital medical records — double the adoption rate of their peers nationally — largely due to e-health investments by the state's hospital giants, Intermountain Healthcare and University of Utah Health Care.
Such an atmosphere should bode well for success of the cHIE.
But it also means many providers are locked into working with e-health vendors with incompatible systems, said Jan Root, president and CEO of the nonprofit that's building the cHIE, the Utah Health Information Network (UHIN).
"Here our vendors are very diversified, whereas elsewhere there's a lot of blue water" open for health IT companies to exploit, Root said.
Competing systems have caused delays in getting major hospital groups wired into the cHIE. HCA MountainStar hospitals are the only chain now contributing data. Intermountain is in test mode.
So are the U.'s hospitals and clinics, which use two separate electronic medical record keeping systems — Cerner for inpatient and Epic for outpatient.
Both are top shelf systems, but they aren't designed to talk to each other, said university spokesman Christopher Nelson, who explained that the university will likely soon migrate to just one system.
In the interim, the U. built a data warehouse to combine its data stores and hook into the cHIE. The fix worked, but the U. recently suspended its data feed pending completion of a security audit.
"We are hypersensitive about patient privacy issues after that data breach," said Nelson, referring to a 2008 theft of a back-up tapes containing records on more than 1.5 million patient records. "This was a pilot to see if the interface worked. Now we're going back to do a security audit before going full bore. We've come a long way but still have quite a ways to go."
IT investments don't come cheap. The U.'s Epic system alone cost more than $20 million. Meanwhile, data standards are evolving, such as the revamp of billing codes that hospitals must now use in order to be paid by Medicare.
"It's hurdle after hurdle, but there's a recognition that it gets us to a much better place," said Nelson, underscoring the U.'s commitment to the cHIE.
Buy-in from providers is the only way to sustain information exchanges since they pay subscription fees. Getting a critical mass is also a must for showing patients the value of consenting to share their information.
UHIN is campaigning to amass patient consents. Root didn't have hard numbers, but she said participating clinics report that more than 90 percent of patients approached sign consent forms.
"This is complex, and people are cautious," said Root. "But we'll get there."