November 1, 2014
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Many still wary of free life-saving database
John Grow
ADAMS

Within a few weeks the health information exchange (HIE) for Rhode Island called CurrentCare is set to reach a major milestone: It will finally provide access to up-to-date health records to every hospital in the state.

"Right now only Landmark and The Providence VA are not a part of CurrentCare. Landmark will be on before the end of the year, and the VA should follow shortly after that," Jonathan Leviss, MD, chief medical officer for Rhode Island Quality Care, CurrentCare's parent organization, said during an interview at RIQI offices in Providence.

"Landmark has some issues that held it up. The VA chose to start using CurrentCare because it isn't the only source of health care veterans use. About 40 percent also have a provider other than the VA. Initially, the VA will access health records from outside sources. Ultimately, we hope that health care professionals outside the VA will be able to use their data when needed.

"But the most important point is that soon CurrentCare will be in every Emergency Room in Rhode Island," he said.

Laura Adams, president and CEO of RIQI and the driving force behind CurrentCare, explained just how big a deal this is. And she made it personal.

"You're the parent or grandparent of a child with a peanut allergy. You know all about it and your doctor knows all about it. But what if your child is off somewhere, attending a school sports event or something, and suddenly has a reaction, and nobody there knows about the allergy? What happens then?" she asks.

"What if you or your child are in a car wreck, and the EMTs take you to an unfamiliar hospital? Do you carry your medical history around with you in a paper bag? Do you carry your elderly parents' prescription information everywhere you go, just in case you get that call from the emergency room everyone dreads? No," she said, "nobody does.

"Early on in my career I made a catastrophic medical error on a 7-year-old pre-op child, so I know firsthand what can happen," Adams explained.

"I was working in a very small, 35-bed hospital. That night we had 42 patients – some had to be out in the hallways. I was getting ready to leave when our surgeon came on the intercom. I'd worked with him long enough to know something was very wrong. He said, 'Laura, I don't know what you gave this little girl down here but we're losing her – she's not breathing. What did you do?'

"That's the one thing everyone in medicine fears being told. That's what I felt: Fear, horror. I thought I was going to throw up. I went over to the medication area and looked down, and immediately realized I'd given her 10 times the overdose of [the prescribed drug].

"Somehow – maybe it was by the grace of God – she lived. I couldn't understand how this could happen and I decided to find out how I – me, who was born to do this work – could almost kill a child. So I personally investigated, and I discovered that that medical order had been hand-transcribed six times before it ever got in my hand. It was an accident waiting to happen.

"And that's the point. When a decimal point means death, we need a better way to communicate absolutely accurate health information. Not faxes and phone calls. Twenty-first Century technology. And we have to change the way we provide care from a ‘come and get it’ system to one that really treats the patient, not just the sickness.

"That's why CurrentCare is so vitally important," said Adams.

Laura Adams has been on the project from its beginnings. In 2005, funds became available to develop an HIE program in the state. Senator Sheldon Whitehouse was the Attorney General at that time, and chaired the committee involved. When it came time to appoint a head of the newly created RIQI, they picked Adams.

Dr. Jonathan Leviss came on board as RIQI's first chief medical officer more recently. It took a lengthy search to find a person who had the particular résumé RIQI wanted: A practicing physician who also had an extensive background in information technology. In addition to his private practice, Leviss recently worked for Microsoft on a project similar to CurrentCare.

"CurrentCare is a free service – free to the medical providers who use it, and free to the patients who enroll in it," Dr. Leviss said. "We can eliminate some of the work involved in administering health care, so providers can focus on treating patients, not generating records."

"About a third of Rhode Island residents are taking advantage of CurrentCare right now. Now that we have all the ERs in the state getting ready to go on line, we want to see a lot more people in CurrentCare," Adams added.

If it's free, and if it can save lives, why hasn't it already been universally accepted by Rhode Islanders?

Both Adams and Dr. Leviss agree the problem may largely be due to a misunderstanding of the privacy protections in place for medical records accessible through CurrentCare.

"Some people seem to think that their personal medical information might be hacked if it's electronically transmittable through CurrentCare. But the data is already there – already computerized. It can already be hacked," Dr. Leviss said.

"We have the best security system available," Adams added. "But that's not the only privacy provisions built into CurrentCare.

"Another factor is the way we use personal data," she explained. "We are the only HIE program in the country that asks you to 'opt in' the type of health information you want to be made available. Everywhere else you automatically have all your records made available, and you have to go in and choose which ones and under which circumstances you want to 'opt out.'

"That we think is very important, because someone may have health records they consider highly sensitive. Maybe potentially embarrassing for them, they believe. They'd rather keep them just where they are," she said.

"CurrentCare gives you three levels of options: Number one, you opt to make your health records available only for an emergency; Two, you opt in only the doctors you want to be able to see your records. The third option is to make all of your records available to health care providers who need to read them. Actually, most people choose number three," Adams said.

Dr. Cedric Priebe, who practices at both Kent Hospital and Women and Infants Hospital, uses CurrentCare frequently.

"It saves a lot of time. If a mother comes in with her child, and we aren't familiar with them, we may not have to do time-consuming procedures – testing, for example, which may have already been done recently. We don't need to rely on anyone's memory. We do a quick look-up, and the data we need is often right there from another provider," Dr. Priebe said. "It's like a very secure e-mail, with a high level of encryption.

"We also have the ability to send and receive hospital alerts on patients. The most important information often comes from other facilities."

"It reduces the time it takes to care for our patients. In the long-term, it will help reduce the cost of health care," he said.

Right now, CurrentCare is only available in Rhode Island, but the potential benefits could well be felt nationwide one day soon, Dr. Priebe and the people at RIQI maintain.

"The high cost of health care in the U.S., and the traditional way it has functioned here, has to change," Laura Adams said. "As a nation, we make an annual investment on health care of $2.6 trillion. A recent study found that $1.2 trillion of that is wasted. Imagine that – nearly half.

"It stems from unnecessary hospitalizations, medical and surgical procedures, duplicated tests – take MRIs, that's a telling factor. We had more MRIs in Rhode Island than in all of Canada," she said, "That's changing.

"There are two key factors for the cost of health care in the U.S. One is how it's financed," she said," what's paid for, by whom and at what price: And two is how health care is designed – it's an error prone, ‘sick care’ system, when what we need is a real ‘health care’ system.

"Medicine is the only place where we can make a mistake and then bill you to fix it. We have to change how we pay for our health – we need to pay for results, not the number of visits it takes."

Adams says that a diagnosis of breast cancer a few years ago brought home another lesson on how important CurrentCare is. "I was heading into Boston, and I was given stacks of files and x-rays they would need there to make surgical decisions. The last thing they handed me was a computer disc with my MRIs on it, and they said, ‘This is critical, make sure you get it in their hands.’

"My mother was with me and I was having a hard time getting anything organized. So when we got to the parking garage in Boston, I couldn't locate that disc. We tore the car apart. Then my mother saw it; on the cement about two inches behind a rear tire," she said.

"Later, on the operating table they were about to put a mask on me to administer anesthesia and it suddenly struck me that the advanced directives I'd prepared were still in my purse, locked up in my cubby."

With CurrentCare, advanced directives can be a part of one's records.

"That's a common problem solved," Adams said. “Probably 80 percent of all advanced directives are sitting underneath a magnet on a refrigerator at home. CurrentCare makes them accessible when they're needed, but always secure."

Adams continued, "A study showed that of all the things that factor in to premature death prevention right now, 40 percent are strictly behavioral. Health care, and that $2.6 trillion annual price tag it carries, has a factor of just 10 percent.

"Our next step for CurrentCare will be to focus on the 40 percent. We envision an application for your smart phone that will let you access your health data wherever you are. It's somewhere in the future, but it can have major effects on the quality and cost of health care.

"CurrentCare will help us get there," Laura Adams said.

Many doctors' offices have the mail-in forms needed to start enrollment in CurrentCare. They also maintain a website, www.currentcareri.com, and a toll-free number, 888-858-4815, where all policies, privacy and otherwise are detailed.


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