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IT Landscape Changing for Sharing Oklahoma Patient Medical Records

Nonprofit networks will compete for the business of hospitals, doctors’ offices, pharmacies and health-care providers statewide.

A new Web-based platform to which state health-care providers can connect to share medical records of patients and provide better transitional care is scheduled to go live April 22 with the business of most Oklahoma City-based hospitals and their affiliates statewide.

Meanwhile, Tulsa-based MyHealth Access Network reports it soon will complete a transfer of assets from Tahlequah-based Secure Medical Records Transfer Network (SMRTNet), which MyHealth has managed since late 2012 and to which the Oklahoma City hospitals are connected. Their contracts expire May 1.

The new Norman-based network, Coordinated Care Oklahoma, and MyHealth — both nonprofit organizations — will compete for the business of hospitals, doctors’ offices, pharmacies and health-care providers statewide, who, based on the number of providers, pay monthly subscriptions for connectivity, much like Internet companies compete for market share.

Fees range from $20 a month for a one-physician practice to hundreds of thousands of dollars annually for large medical systems.

Coordinated Care Oklahoma Chief Administrative Officer Brian Yeaman, whose consulting company manages Coordinated Care Oklahoma, believes two networks will be good for the state, driving competitive pricing and improved service. David Kendrick, chief executive of MyHealth, disagrees.

“Think of the exchange like a public utility,” said Kendrick, who believes one network would lower operating costs. “You don’t need two exchanges any more than you need two water supply companies.”

What Yeaman and Kendrick, who are both physicians, passionately agree upon is the benefit and need to electronically share records. Since 2008, both have helped build Oklahoma’s connectivity, which includes some 70 percent of health-care providers, compared with only 20 percent nationally.

All providers are required to connect to an exchange by fiscal 2016, or face reduced Medicare and Medicaid reimbursements.

Yeaman, a Norman family physician who built and runs the information exchange of Norman Regional Health System, recently saw a patient who had received care at the Oklahoma Heart Hospital a few days prior.

“She was acting confused, and I asked her if she was sure she didn’t have a stroke,” Yeaman said. “She said she didn’t think so, but that she was put on three new meds.”

Yeaman logged onto SMRTNet to check his patient’s medications, and instantly realized a common side effect of one of the drugs she was prescribed is confusion. He was close to sending her back to the hospital, but instead simply changed her medication, he said.

Similarly, Kendrick, an internist and pediatrician at the University of Oklahoma’s School of Community Medicine in Tulsa, said the exchange regularly keeps him from sending patients to the emergency room.

“I can check their records and see that their cholesterol is normal, or their EKG (electrocardiogram) hasn’t changed,” he said.

Some not connected

“Patients choose their doctors, not their hospitals, and shouldn’t have to worry that their medical records won’t follow them across the street to different providers,” Kendrick said.

Studies show sharing electronic health records reduces duplicated orders, harmful drug interactions and missed diagnostic opportunities, while boosting better health care, lower health care costs and better health outcomes. But despite the far-reaching benefits, some Oklahoma providers — including Variety Care — haven’t yet connected to a health information exchange.

Variety Care Chief Executive Lou Carmichael said her organization, which operates 17 community health centers across Oklahoma County and in three western Oklahoma towns, had been waiting to decide between MyHealth and SMRTNet and, since their pending merger was announced early last year, has been waiting on the merger.

“Now that the Oklahoma City hospitals have determined that they will have their own exchange, we’re back in the same position of trying to decide between two,” said Carmichael, who wishes the state had implemented one network, as the state of Virginia has. “Our patients go to all of these ERs, but we cannot afford to pay the subscription fees to both exchanges.”

Meanwhile, Duncan Regional Hospital soon plans to migrate from SMRTNet to Coordinated Care Oklahoma because most of its patients traveling outside Stephens County for care go to Oklahoma City or Lawton, Chief Information Officer Roger Neal said. So far, Duncan Regional Hospital, with the help of $3.8 million in federal incentives, has invested $4.2 million in its electronic records infrastructure, Neal said.

Both Kendrick and Yeaman said they discussed a statewide merger, but couldn’t agree on technology or governance, including board representation.

Still, Yeaman promises seamless, transparent service.

“We’ll have agreements in place, much like Verizon and AT&T, to ensure sharing of one another’s networks,” he said.

Creating rural connections

As private competition is heating up, the Oklahoma Health Information Exchange Trust (OHIET) last month spent the last of the $10.6 million in federal stimulus grant money it was given to help providers, especially rural ones, connect to a network.

The trust used the grant money, matched with some $1 million in in-kind state donations, to help 74 rural hospitals, 27 behavioral health centers, 445 physicians and other providers, and 47 optometrists connect to an exchange, reported trust Chairman Robert Roswell, endocrinologist and OU public health professor, at a recent Crowe & Dunlevy law seminar.

Roswell said the trust also developed an affiliation agreement that ensures information can be shared across state exchanges, and established a certification process for exchanges to ensure secure sharing of patient health information. Under the Health Insurance Portability and Accountability Act, patients at any time may opt out of electronic sharing, he said.

Trustees of the Oklahoma Health Information Exchange Trust continue to meet monthly, Roswell said, though the trust has no funds, for months has operated with five versus seven trustees, and survived an unsuccessful attempt by Rep. Lewis Moore, R-Edmond, to kill it.

Some skeptical

Moore said the trust used federal funds to support a better alignment with the Affordable Care Act, which he strongly opposes.

The lawmaker said he also worries about the privacy of sharing electronic medical records.

“Truly, is there really any secure information anymore?” Moore said.

Keith Smith, an Oklahoma City anesthesiologist and co-owner of The Surgery Center of Oklahoma, also is more than wary.

“As the French philosopher Albert Camus once said, ‘The welfare of the masses is always the alibi of tyrants,’” Smith said. “An individual’s health information is simply none of anyone else’s business, particularly the government’s.”

©2014 The Oklahoman