Glendale Adventist Medical Center is joining the health care information superhighway. The hospital will partner with Los Angeles Network for Enhanced Services, or LANES, to implement a digital platform that will allow for a secure exchange of patient health information. “We care for large populations of patients whom we encounter in multiple venues of care,” said Sharon Correa, chief information officer at Glendale Adventist. “To support continuity of care with USC, FQHCs (federally qualified health centers) and other locations, we wanted a way to securely connect to patient information in order to provide the best care.” Essentially, Glendale Adventist will join a health care information exchange provided by LANES. This system connects different health facilities from large hospitals to local clinics, allowing them to securely share their electronic medical records. So far, all Los Angeles County-funded hospitals and clinics are connected, with other hospitals such as Glendale Adventist in the process of joining the network. Exchange funding Under the Affordable Care Act, hospitals that serve Medicare and Medicaid patients were given incentives to adopt and implement systems that would migrate the physical files containing patient medical histories and information to electronic formats. Many hospitals have since adopted this practice, because technological advances have made the digitization of records easier. However, most facilities were siloed inside their own network, unable to electronically share the information they had. This is where the health information exchanges come in. The purpose of an exchange is to provide a real-time information to facilities that do not have access to medical histories of the patient they are caring for at the moment. For example, if a regular patient of Glendale Adventist visits an emergency room at Los Angeles County hospital, now the doctors can look up that patient’s medical history immediately on the exchange, without waiting for phone calls or faxes. According to Dr. Anish Mahajan, chairman of the board at LANES, doctors’ inability to obtain patient records in a timely manner can lead to duplicative care, meaning the patient may be given unnecessary exams and tests already conducted by their previous health provider. “Duplicative care can often cause risks to the patient and add extra expenses,” Mahajan said. “This is where hospitals see a value in joining (LANES). They want to provide the right care, and not duplicative care.” Despite their potential benefits, exchanges have not been widely implemented in California. “Health information exchanges have been around for a long time,” said Correa at Glendale Adventist. “But only a few are sustained, because they are grant funded and expensive to maintain. There has been trouble sustaining one at a state level.” In the past, a big push for a large exchange, created the CAL Index, which was operated with funds from Blue Cross Blue Shield. But this resulted in another silo because the medical information available came only from Blue Cross Blue Shield patients. Privacy concerns LANES on the other hand touts itself as a joint effort by the county and local health providers, with stakeholders like County of Los Angeles, Hospital Association of Southern California and UC Davis Institute for Population Health Improvement. Its goal is to connect all facilities that provide health care to L.A. County residents on Medi-Cal or even ones who are uninsured. “We knew LANES was a significant component of L.A. County infrastructure and we are committed to being early adopters,” said Correa. “We expect to see improvements in patient care, timely access to care and additional information to support clinical decision-making.” The efficacy of health information exchanges is still mixed, however. In a recent study conducted by researchers from State University of New York published on Social Science Research Network found that “a practice’s tenure with (exchanges) significantly lowers the repetition of therapeutic medical procedures, while diagnostic procedures are not impacted.” Mahajan said that most studies are using data from a period when exchanges were nascent, when many hospitals did not participate and therefore doctors did not see much value spending time on them. Personal privacy of medical information is also a concern. Under the LANES program, patients will have the choice to opt out and the information will only be available to health care providers such as nurses and doctors. As a nonprofit, LANES will only seek to cover the cost of operation. “The cost structure will be based on the size of the enterprise,” said Mahajan. “They are not meant to be inhibitive to participation.” Simply connecting Glendale Adventist and its sister hospital White Memorial Medical Center in Boyle Heights to the exchange will take about three months. In fact, the longest step in the process was reaching the legal agreements. “Hospitals and clinics want to be very careful about how to share the information,” said Mahajan. “We want to find a place where the legal teams of the facilities are comfortable with the data exchange agreements.”
