With the addition of San Diego’s three largest health systems, more than one million patients soon will have the opportunity to participate in the region’s health information exchange, San Diego Health Connect. The community-wide HIE allows patient medical records to be shared among the region’s competing health care providers, large and small.
Scripps Health, Sharp HealthCare and the UC-San Diego Medical Center join about 100 other facilities already participating in Health Connect in San Diego and Imperial Counties, including Rady Children’s Hospital San Diego, Kaiser Permanente, the Department of Veterans Affairs and the Department of Defense.
The exchange currently has consent from about 1.5 million patients.
To expedite participation among patients from Scripps, Sharp and UC-San Diego, and otherproviders, Health Connect and its participating organizations recently adopted a new policy to gain patient authorization. Patients must now opt out of the program, rather than explicitly give consent to participate.
“We had a solid infrastructure and base for our HIE, but we weren’t getting the uptake in consents. The original community policy for opt-in was just taking too long. It was too slow, and it wasn’t convenient. Effectively, we weren’t scaling in our adoption and our utilization of the HIE,” said Health Connect Executive Director Dan Chavez.
The change in policy leads Chavez to predict the number of patients with digital consent forms on file will rise to nearly two million by mid-June.
Privacy and Consent
U-T San Diego recently conducted a poll in which it asked readers if they would want to be part of a health records exchange. Of the 731 respondents, 72% answered no.
The results likely reflect widespread anxiety over the security of the medical information being shared, experts said.
It’s not hard to understand the public’s concern.
According to information housed by the HHS Office for Civil Rights, in 2015 alone, 32 health data breaches occurred as a result of hacking.
In February, insurer Anthem announced a cyberattack that infiltrated a database containing the personal information of nearly 80 million patients. In March, Premera Blue Cross announced a breach of 11 million customer records.
A handful of additional breaches were reported last week, including one affecting 220,000 patient and employee files housed at a two-hospital health system in Indiana following a phishing attack.
However, unlike the insurers and provider organizations who suffered data breaches, San Diego Health Connect does not house medical records.
“It’s a key point, a key differentiation,” Chavez said. “We are completely federated at San Diego Health Connect. We’re not a repository of any kind.”
Clinical data will continue to be housed at each of the participating facilities. Health Connect will only have files on patients that contain their first and last names, middle initial, gender, birth date and Social Security number.
“We will store the demographics and the tags to where your medical record number is, which locates your medical record at each of the facilities,” Chavez said.
Health records are transmitted between providers via encrypted networks.
No medical information is shared until patients are at another institution and their provider requests the information. Each of the three large provider organizations say they have implemented systems to accommodate the new request function, in some cases incorporating Health Connect queries into their existing electronic health record systems.
To help quell anxiety over privacy, Scripps, Sharp and UC-San Diego customers will receive a letter that company officials said does a good job of explaining how the exchange works and what patients can expect. In addition, patients are being given ample time to opt out if they choose, and can change their mind about participation and rescind authorization to share their records at any time.
A New Day for Data
The ability to transmit patient medical information among both regional and national providers has become increasingly important.
Brian Clay, chief medical information officer for UC-San Diego Health, said the public sentiment tide is turning toward sharing information.
“I think that the pendulum has moved a little bit from, ‘We want to make sure that a patient’s privacy is protected at all costs,’ to, ‘In this mobile age when patients get their care in a number of institutions … it’s now more desirable to have ready access to that information for treatment of the patient,'” Clay said.
Ken Lawonn, CIO at Sharp HealthCare, said Health Connect will allow for quicker access to information across the community, as well as a reduction in redundant testing, and fewer calls asking for chart information to be printed and faxed.
Patients have perhaps the most to gain from EHR sharing, experts say.
“A trip to the emergency department is the best example of this because physicians can access urgently needed information about the patient when the patient can’t supply it him or herself,” said Clark Kegley, assistant vice president of information services at Scripps Health.
San Diego Health Connect began as one of 17 Beacon Community programs — part of the federal government’s overall push to increase the use of EHRs. UC-San Diego was awarded a $15.3 million grant from the Office of the National Coordinator for Health IT in 2010. The school’s clinical informatics team set up the San Diego Beacon Project’s governing structure and the organization that ultimately became San Diego Health Connect.
“Over time, that group has reached out to many of the other health care providers here in the region to get them organized to be able to communicate health care information with San Diego Health Connect as well,” Clay said.
In the near term, Chavez said Health Connect will be working to improve the exchange and the quality of the data being made available through it. One major goal, for example, is to create uniformity, which currently does not exist, among the information shared. “We’re working to make it 100% complete and uniform in its presentation,” Chavez said. “We want to be able to share a complete continuity of care document.”
San Diego Health Connect also will play a role in public health reporting and in clinical research.
Another major goal and challenge the network will face is bringing individual physicians into the network.
“All the information about you or me is in our primary care physician’s office. We haven’t accessed that yet. So, we’re kind of thin in information because it’s largely hospital and clinic-based,” Chavez said.
He expects San Diego Health Connect will begin tackling the primary care physician marketplace later this year and continue throughout all of next year.