treating patients who recently went to an emergency room. Townsend believes the latter case is where the exchange may prove most valuable.

"ER docs are used to working in the dark all the time and do a good job," she said. "But primary care docs could really use the information that someone went to an ER recently and had an X-ray or a lab test done. That is really beneficial, so you don't duplicate tests."

One participant in the prototype is Ochsner Health System, a group of 700 physicians with offices in New Orleans and Baton Rouge. Ochsner uses electronic medical records, and its network survived the flood, said Dr. Lynn Witherspoon, vice president of information systems. Nevertheless, the storm drove home the urgency of the problem, he said. "We know full well the value of health information exchange," he said. "We're all passionate about getting it up and running on a routine basis."

Stepping Stones

Although Witherspoon considers the prototype a success, some technical issues remain. Uploading the data to the exchange is straightforward, but the patient identifier doesn't work well yet, he said.

There is no unique national identifier, and Social Security numbers can't be used for security reasons. He said if a patient was seen at Ochsner, at Louisiana State University Hospital and by a clinic in Baton Rouge, the master patient index is challenged to pull all those pieces of data on Mr. or Mrs. Jones into one clear picture.

It's a big issue, and Witherspoon said a solution does not seem to be forthcoming on a national level.

Other challenges include getting more physician groups to use electronic records and involving more organizations in the exchange. "The fact that we chose to do it with a small number of organizations so we could rapidly show proof of concept means we now have to reach out to other providers and insurers," Witherspoon said.

A big piece of phase two will be to make the exchange more inclusive, so all providers will have some sense of ownership. The grant period ended in September 2006, and the goal now is to take it from the prototype to the pilot phase, and deploy it in emergency rooms and doctors' offices. To do that, the state will have to secure additional funding.

Townsend admits that the state has put the cart before the horse.

"We have a working prototype, but all of the things you usually work out beforehand, the policies and procedures, we haven't worked through yet. That's why we're not ready yet to take this live."

Still to be resolved are the tough issues of governance. Who owns the exchange? Who makes decisions? What are appropriate levels of privacy and security?

Yet Townsend said she and her colleagues feel a sense of accomplishment about what they've done in the wake of Katrina.

"We're trying to answer the question, 'Can you make a difference in people's health care with shared electronic records?'"

David Raths  |  contributing writer