Health Information Exchange: Bridging the Digital Divide

By Chad Johnson
08:57 AM

We’ve all heard and can probably sing along to the classic song Small Town by John Mellencamp, which romanticizes growing up and living in some place other than the big city. I, too, am what most would consider “small town,” and every time I hear that song I can’t deny getting flashbacks of Main Street parades and the pancake fundraisers I attended growing up in the Texas Panhandle.

I now live in a large metro area and have become accustomed to convenience and access to the best of any and everything that is available. I literally live three miles from three different grocery stores and five Starbucks Coffee shops – one even has a drive-thru so I don’t have to be inconvenienced by having to get out of my car and walk… exactly what Mellencamp hand in mind when he sung:

“Still hayseed enough to say, ‘Look who’s in the big town.’”

Many aspects of small town life haven’t changed a lot since I left. While the jobs may be harder to find and the median age of the residents has risen, there is still the ritual of attending Friday night football games and a good chance you’ll see someone you know when you stop in at the donut shop Saturday morning.

That small-town simplicity, however, also exists in the local health care facilities, which is something I witnessed as my grandmother passed away last February. She was a “tough ‘ol bird,’” as my Dad says, and she had a very long and fulfilling life, but I can’t help but think what a little bit of that big city convenience would have meant to her and the rest of us during the long process that eventually resulted in her passing.

About a year prior to her death at age 89, my grandmother was diagnosed with congestive heart failure after spending several days in the ICU in the nearest city hospital, located about an hour from her home town. She received several diagnostic tests and met with a handful of specialists while at the city hospital.

Twice over the next year, she was rushed from her assisted living home to the local, smaller critical access hospital for treatment of circulatory issues. Each time, she was stabilized and then placed in what probably is best described as a holding pattern because the local physicians were unable to make a diagnosis of her condition without first consulting with her cardiologist.

To us, this pattern was difficult because we were waiting to receive two very different messages: one, she would recover and live; two, this was the end and she would soon die. We only could worry and wait for three or four days until she was seen by her cardiologist.

Why couldn’t her local doctors tell us what was going to happen to her? Why did we have to wait for the doctor in the city to see her? What if she dies before he can make a diagnosis?

Now that I know more about the health IT and the groundwork that is being laid for clinical information exchange, I can only ask, “What if?” What if my grandmother’s local and city doctor could access her health records electronically, through a local Health Information Exchange? What if the local ER physicians knew the extent of her heart failure and the resulting symptoms it produced? What if we all knew that her third visit to the ER was not just another false alarm?

My grandmother’s medical story is not unique. There are millions who live in small towns, without access to the best doctors or the newest technology. Many of these patients are elderly and in need of regular medical care.

Would EHRs and a working HIE prolonged my grandmother’s life? It’s doubtful – but we would have known more and, more importantly, her caregivers would have had access to critical information. A connected, modern medical system has the ability to arm doctors with better information to help them save the lives of patients who have been misdiagnosed or who received the wrong medication.

HIEs can help bridge the digital divide between the hospital “haves” and “have nots.” While smaller, community hospitals may not be able to purchase the newest CT scanner, they should have access to the reports and tests that have been previously performed on a patient to make better decisions and help inform worried family members.

The good news is that the future for community hospitals and health information exchange is bright. The government awarded states $161 million last year in the forms of grants to encourage HIE development, and several have begun operation. And, according to a study published Nov. 14, 92% of critical access hospitals have implemented EMR systems or are in the process of doing so – hopefully with the goal of connecting to a local HIE.

Combine those results with the recent announcement from National Health IT Coordinator Farzad Mostashari that “We can’t wait another five years to have exchange” and last week’s news that the Interoperability Workgroup issued technical specifications for standardized connections between providers and HIEs, and the connected health care system so many have dreamed about is quickly becoming a reality.


Chad Johnson blogs regularly at the Health Standards Blog.