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Newsletter Editorial Page – October 23, 2007 Community Health Alliance— by Dr. Ann Lindsay, Public Health Director of Humboldt CountyWhen you check out at the supermarket, an electronic device records your purchase, calculating for the store manager what stock to reorder. The health care field is light years behind technologically. Many if not most medical providers can't tell you how many patients they have, let alone who are the diabetics or who has hypertension. In recent months, the Community Health Alliance Information Technology task force has brought together representatives from all the Humboldt hospitals, the community clinics, medical provider groups, public health, and some of the larger medical practices to advance secure electronic interchange of patient care data to improve care while protecting privacy. That sure is a mouthful! Folks in Santa Barbara spent $15 million in an unsuccessful attempt at electronic health information exchange, so we are proceeding carefully. By working on the "low hanging fruit" we hope to learn from other communities' successes and failures and build the trusting relationships that make for effective partnerships. After a well-attended summer series of educational sessions on health information exchange in other communities, the IT task force is coming to consensus about the directions to take. The principle we endorse is "radical incrementalism" to take achievable steps that build to a larger end goal. In general, we have to get medical providers used to electronic health data and work out the rules concerning exchange of existing electronic information as a prelude to developments requiring more investment. The first goal is to continue (and build up) the successes we have achieved, namely the electronic diabetic patient registry and ELINCS, automatic electronic transfer of laboratory information directly into the registry. The registry keeps track of care given to diabetic patients and reminds medical providers and patients when tests and preventive care are due. Outcome data from the registry has shown significant improvement in diabetic management in the county as a result. The next goal of the task force is to promote secure electronic prescribing. Four providers have been testing the free software, eRx. These four can give valuable feedback to eRx to improve the product. Virtually all the pharmacies participate. We have identified six other providers across the county who are interested in electronic prescribing and plan to offer technical support to bring them on board. Meanwhile they are working to make the product ever more useful by populating it with data from insurers or linking it to formulary and other prescribing information. Cultural and technological challenges and historical inertia have limited electronic exchange of health information. St. Josephs and Mad River hospitals staff have expressed support for making their electronic records available to emergency room physicians, hospital-based doctors, and radiologists across the county. The clinical gains are obvious once we work out reasonable credentialing, monitoring of access, and discipline procedures in the event of a breach of confidentiality. The next move could be to create an administrative staff category to enable non-hospital providers to access data electronically to help with out-patient continuity of care. This would be of particular help to physicians in outlying areas of the county. The Community Health Alliance's Access to Care task force is looking into creating insurance coverage options for small businesses and other creative solutions to expand health insurance coverage in the county. There are obviously many challenges for this group in the shifting scene of health reform and health care finance. One product under consideration is a Humboldt County health insurance plan, the goal of which would be affordable pricing and reasonable reimbursement. A Workforce task force is looking into creating a multi-specialty medical practice in order to make a more attractive patient care environment here. Recently trained physicians are flocking to Kaiser because of the practice environment which promotes quality improvement and allows creative solutions to improving patient care and sharing the workload. There has been discussion about addressing training, recruitment, and retention of nurses and medical technicians, but concrete plans in this direction have been beyond the capabilities of the group at hand. The Community Health Alliance would welcome leadership for addressing this critical concern. If interested, contact the Community Health Alliance at 445-2806. This is the final editorial in a three-part series on vital health considerations in Humboldt County. |
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