Written by Karen Haywood Queen
Sharing medical information between private, public and other hospitals can make both physicians and patients more informed.
The middle-aged man came into the emergency room at the Hunter Holmes VA Medical Center in Richmond feeling like he was going to pass out. He was tired, light-headed and had no energy. More worrisome, his heart rate was an extremely low 36 beats per minute, says Dr. Katherine Gianola, an emergency room physician and chief of health informatics at the Veterans Affairs medical center.
The man’s low heart rate was caused by a double dose of medication. “He was taking one beta blocker prescribed by the VA and—unbeknown to us—he had seen an outside cardiologist who prescribed the very same drug,” Gianola says. Beta-blockers are used to treat high blood pressure.
Even though the VA Medical Center has electronic medical records, those records were not synced with the records from the outside physician that veteran also was seeing. Fortunately, his family had brought his bag of meds from home.
“The family had no idea that the bottle I was holding from the [outside] cardiologist was the same as the prescription from us,” Gianola says. Veterans Affairs hospital physicians describe drugs by their generic names while outside providers tend to use the brand names.
The medical team flushed the man’s system of the excess beta-blockers, monitored his condition and adjusted his meds, Gianola says. “He was admitted to the intensive care unit, but he didn’t have to have a lot of extra testing to see if there was something intrinsically wrong with his heart,” she says.
The fact that the patient was seeing an outside doctor was not unusual. For example, 65 to 75 percent of veterans get some component of the medical care from physicians other than the VA, including both private physicians and doctors with the Defense Department, says Gianola, also the Hampton and Richmond community coordinator for the Virtual Lifetime Electronic Records (VLER). The initiative shares electronic records among VA, Defense Department and private community hospitals.
If doctors know their patient is being seen at another medical center, they can request that paperwork. “But typically these things happen in the middle of the night,” Gianola says. “A 24-hour, readily available solution is what we need.”
Medication reconciliation—making sure patients seeing different physicians aren’t taking the same or similar medications—is a huge issue, especially for patients who see doctors in different hospital systems, Gianola says.
“Short of being a walking Physicians’ Desk Reference, the public is not going to realize they are taking the same medication [by a different name] or the same class of medication,” she says.
Gianola’s patient’s story might have unfolded differently if the family had not walked in with the bag of pills, she says. The man likely would have been undergone an invasive cardiac catheterization, gotten an external pacemaker until his condition stabilized and possibly endured other tests.
Electronic medical records are improving patient care, but as with any communication tool, results are partly based on who has access. Riverside has its Healthy Link. Sentara and Bon Secours have My Chart. The U.S. Department of Veterans Affairs and the Department of Defense have their own systems.
But without electronic medical records accessible among different systems, the burden is on the patients and their caregivers to make sure each physician knows the whole story.
“My boss shows this slide where one of his in-laws [is] carting all his meds in a box from appointment to appointment,” Gianola says. “We’ve seen new patients come in with a stack of 500 pages of documentation. People have been faxing and scanning and counting on the family rather than the health care system to connect the dots. For me as an emergency room physician, that can lead to gaps in available information or information that is not there when I need it. In the ER, time is everything. The fact that the information is available next Thursday doesn’t help when I’m evaluating a patient tonight. Clearly we should be doing a better job of looking out for our patients—not expecting them to be carting their meds around.”
But that’s changing. For more than a decade, VA and Defense Department medical providers have shared information, Gianola says. Now, the initiative is moving to three-way access with civilian hospitals. And civilian hospitals are investigating how to access each other’s information, too.
If such a system had been up and running in her patient’s case, “the minute he came in, we would have seen he had just been discharged from an outside hospital,” Gianola says. “It’s the need to coordinate and communicate between providers that is driving this initiative.”
Sharing is easier among medical systems that use the same technology. For example, Sentara and Bon Secours use the same My Chart technology by Epic, says Bert Reese, Sentara’s chief information officer.
Any such sharing is “view only.” If you broke your leg skiing in Colorado, you’d give doctors there your EMR password, Reese says. Those doctors could see your record and set your leg. Once you were back home, your primary care physician could update your medical record with the information from the Colorado physician. “Your primary care doctor acts as the gatekeeper to maintain clinical quality control and integrity of your medical record,” he says.
The VA hospitals in Hampton (September 2010) and Richmond (March 2011) have been participating in a pilot program linking medical records at VA hospitals and private hospitals, and in some cases Department of Defense hospitals, too, Gianola says. Eleven sites across the country are participating.
Virginia is well represented. Of those 11 sites, the second national site is in Hampton and the third is in Richmond. In Hampton, the partners are Department of Defense hospitals at Portsmouth Naval Base, Fort Eustis and Langley Air Force Base. The private partners are Bon Secours facilities Maryview and DePaul medical centers and Mary Immaculate and Hospital. In Richmond, the partners are the McGuire VA Hospital and Bon Secours facilities St. Mary’s Hospital, St. Francis Medical Center, Memorial Regional Medical Center and Richmond Community Hospital.
Currently, the Hampton program has 2,490 enrolled patients and the Richmond program has 4,915, Gianola says. For enrollment forms, contact the toll-free VLER Health Information Line at 1-877-771-VLER/8537.
“The information is there,” Gianola says. “These are all systems that are already using a fully electronic health record. It’s a matter of extracting it.”
Different hospital systems are handling the shared information differently, and VA patients must authorize any information sharing, Gianola says. Some of the other medical systems don’t require patient authorization.
“I certainly want a well-informed patient,” Gianola says. “The best informed patient is the one who makes the best outcome.”