This summer, when Dr. J.T. Finnell was tending to a patient visiting an Indianapolis emergency room for the 10th time in two-and-a-half weeks, he knew he needed some extra help. The patient, whom Finnell described as “extremely complex and refusing help,” was making his shift difficult.
Finnell, an associate professor of clinical emergency medicine at the Indiana University School of Medicine, also directs a fellowship program on health informatics, which focuses on applying electronic health records (EHRs) and other forms of health information technology toward improved patient care. When Finnell pulled up the patient’s record in the Indiana Health Information Exchange, which now connects 117 hospitals across the state, he saw a longstanding pattern of ER overuse and unruly behavior. That information allowed him to have a meaningful conversation with the patient about what she was really looking for, which in this case turned out to be pain management.
What Finnell was demonstrating was more about the potential of health IT and medical informatics than the current reality. Increasingly, we’re coming to expect that when we visit a doctor’s office or an ER, a physician will have access to our entire health history. But given the slow progress of developing underlying medical data systems, that’s still the exception, not the rule. “Patients don’t realize that we often only see part of their whole story,” Finnell says.
One reason for the slow rollout of comprehensive health information systems is the sheer complexity involved. “You have documentations from pharmacists, physical therapists, primary care physicians, dentists,” says Dr. Andrew Boyd, assistant professor of health information sciences at the University of Illinois-Chicago. “Within electronic health records, they’ve tried to make a system that holds all of this with an interface where you can grab decades of co-morbidities in a 15-minute visit.” Developing a system that fulfills that promise, he says, is a slow process characterized by a lot of trial and error.
Nevertheless, several states, like Indiana, are well along the way in launching health information exchanges that allow providers to see updated data from across disciplines in real time. Massachusetts’ system has been especially helpful in grappling with the opioid abuse epidemic, says Tom Land, director of informatics at the state Department of Public Health. While most fatal overdoses in the state are from illegal drugs that would be unlikely to show up in an EHR, the system still allows providers to look for additional risk factors. “Health IT can give you a spotlight for where interventions can be as fruitful as possible,” Land says.
It has taken years for Tennessee to upgrade an old patient billing management system to something “more robust,” says that state’s health commissioner, Dr. John Dreyzehner, and the process has involved not only a technical struggle but also some strategic rethinking of health-care jobs. For example, the state is now employing “clinical application coordinators,” tech-savvy troubleshooters who can help providers find the best ways to use electronic health records and other innovations.
That’s the essence of health informatics, and Dreyzehner says Tennessee’s system is showing its worth in, for instance, documenting and preventing the overprescribing of medications. “For example, we now know that from 2012 to 2017 we’ve had a 22 percent reduction in the prescribing of morphine and a 63 percent reduction in doctor-shopping,” he says. “Until you had access to that data, you didn’t know what you didn’t know.”