Getting wired can link both care and coverage
Separate networks connect players
Major health systems in Dayton, OH, have given a whole new meaning to the idea of getting wired and they are not talking about drinking too much coffee.
Currently in the greater Dayton area, more than 1,000 doctors’ offices in 20 health care facilities (including seven hospitals) and an insurance company are all linked together through a computer network that, in essence, is the region’s own mini-version of a medical Internet.
The system, known as a community health information network (CHIN), is one of a handful of regional medical networks that have sprung up around the country to address the major concerns of managed care efficiency and quality.
Today the Dayton CHIN consists of two main networks. One is the patient health information network (PHIN), which links the emergency and medical records departments of the seven major hospitals in town. The second is the Greater Dayton Area Health Information Network, also called the integrated health information network (IHIN), which forms a triangular linkage between doctors offices, hospital patient records, and insurance companies.
Speed data transfer
Before the patient health information network went live in March 1995, emergency department medical staff would have to wait between 30 minutes and two hours before receiving the paper medical records of a presenting patient, says Lisa Paige, RRA, director of medical information services at Miami Valley Hospital in Dayton. "Now they can access that information in about five minutes," Paige says. "It’s a huge increase in efficiency."
The PHIN was started in the emergency departments of the seven leading hospitals in the Dayton area because caregivers there "have the greatest need for accessing patient information rapidly," Paige says. "[For example], someone comes in unconscious and that person has a drug allergy. Now physicians can find out that information within minutes."
To make the system vastly more useful, project administrators started by polling emergency department physicians to determine exactly what kind of information they needed on a presenting patient. Now an emergency department physician who calls up the record of a patient who has previously been an inpatient at any of the participating hospitals will find the patient’s address, lab test results, EKG strips, X-rays, and other medical history information.
"There’s no doubt that this has increased the quality of care," Paige adds. "If you have to transfer the records across town, it’s easy to see the time saved by electronic transfer. Physicians get the records faster, which allows them to make medical decisions faster, [resulting] in better care for the patient."
The network is structured in a way that requires each hospital to maintain its own electronic patient database. When looking for patient information, each hospital then searches the others’ files. This system eliminates the need for one central repository, which would have raised questions as to who would own the repository, maintain it, and control access, Paige says.
Administrative, medical efficiency
PHIN’s counterpart, IHIN, forms a desktop computer link with physician offices, hospital records, and Blue Cross/Blue Shield. Information transferred includes medical records, insurance coverage and claims information, and physician referrals. IHIN also has Internet access and e-mail functions.
This network began in 1993, about the same time integration and managed care started to become a force to be reckoned with in the Dayton area. Not surprisingly, the two have evolved together, says Joseph Krella, MPA, president of the Greater Dayton Area Hospital Association and the Greater Dayton Area Health Information Network. "Clearly a project like this helps make our managed care efforts all the more efficient," Krella says. "By increasing quality and increasing efficiency, obviously we will help our member institutions succeed in a managed care environment."
Currently, Blue Cross/Blue Shield is the only insurance company wired into the network. The major use is to check insurance eligibility, which is done with a few keystrokes rather than having staff phone the insurer, and to submit claims, which is easier and more efficient when done electronically.
Success may attract new payers
The success of this pilot project has attracted the attention of other insurers in the area. "Now that we have the infrastructure in place and have demonstrated that it is working successfully, I think that other payers will come on board," Krella predicts. "Our plan is to expand it to Medicaid and Medicare and other significant payers in the region. It’s a savings for them just as much as it is for us."
Dayton’s CHIN began in 1995 as part of a beta site demonstration project sponsored by IBM and Ameritech, a Chicago-based vendor. IBM provided the hardware and software, and Ameritech provided the fiber optics to link the sites. Because it was a beta site, all the hardware and software were free, but each hospital pitched in $50,000 to pay for outside consultants to troubleshoot problems and help each site get the most out of the hookup, Paige adds.
Lisa Paige, Director, Medical Information Services, Miami Valley Hospital, 1 Wyoming St., Dayton, OH 45409. Telephone: (937) 208-8000.
Joseph Krella, President, Greater Dayton Area Hospital Association, Greater Dayton Area Health Information Network, 32 N. Main St., Suite 1441, Dayton, OH 45402. Telephone: (937) 228-1000.
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