Regional health information exchanges are being developed across the US to allow electronic sharing of medical records between healthcare providers. This reduces costs by eliminating duplicate tests and improves quality of care by giving doctors access to full patient histories. States are taking a leading role in establishing HIEs due to the large costs of healthcare for their budgets. Telemedicine is also expanding, using technology to allow remote patient consultations and care. National electronic sharing of records may eventually be possible if technical, financial and privacy challenges can be overcome.

1. Trend Report: Medicine
eHealth Initiatives Streamline
Medical Record Sharing
new health information Recently, a Man dIagnoSed wItH an aggReSSIve foRM
of cancer walked into a Memphis hospital looking for a second
exchange technology opinion. Rather than immediately ordering a battery of tests to
promises to improve the confirm the diagnosis, his doctor logged on to the MidSouth
eHealth alliance, a new health information exchange (HIe) that
quality of health care lets Memphis area hospitals share patient medical records. the
and reduce costs. doctor discovered that the requisite tests had already been
performed at a nearby medical center and that their results
were instantly available through the HIe’s electronic database.
Using existing test results, he was able to quickly confirm the
patient’s diagnosis without subjecting him to additional and
unnecessary discomfort.
for years experts have argued that the U.S. could offer better
and more cost-effective health care if it could find a way to
electronically aggregate patient records—often scattered in the
far-flung file drawers and hard drives of family medical practices,
specialists’ offices, clinics, pharmacies and hospitals—and make
them readily available to health-care providers everywhere. when
HIes provide patient records electronically, a doctor in california
will be able to immediately access the medical history of a visit-
ing Pennsylvanian needing care. cost savings would accrue by
eliminating duplicative medical tests—enabling faster and more
complete diagnoses—and by reducing the time spent tracking
down and sharing hard-copy medical records. costly mistakes
could be minimized too, if a doctor knew, for example, that a new
patient was allergic to certain types of medications.
this is becoming an increasingly realistic goal with the develop-
ment of regional HIes like the one used in Memphis. dozens are
springing up across the country, representing the leading edge of
the growing eHealth movement, which seeks to use information
technology to improve the quality and reduce the cost of health
care. other common eHealth initiatives include ePrescribing,
which uses the Internet and other online tools to create and >>

2. Trend Report - eHealth Initiatives Streamline Medical Record Sharing __________________________________________________________________________ 2
>> sign prescriptions electronically. eHealth experts say it can reduce
medical errors, decrease pharmacy costs and increase efficiency, in
daRRIn KlIMeK/dIgItal vISIon/getty IMageS
part by giving prescribers real-time information about potential drug
interactions and allergies and eliminating mistakes associated with the
interpretation of handwritten prescriptions. ePrescribing reduces the
need for phone calls between doctors and pharmacists and provides
patients with safer care. telemedicine leverages telecommunications
technology to enable long-distance patient consultations and delivery
of clinical diagnosis and other medical services. for example, physi-
cians can employ videoconferencing to consult with and in some cases
examine and treat patients in remote locations who otherwise might
not have access to their expertise. this reduces the need for travel by
patients and physicians, facilitates faster and more consistent treatment State eHealth initiatives are making it possible for doctors to access
of injuries and illnesses, and allows some patients to be treated at home patient records electronically, saving both time and costs.
rather than in a hospital.
States Take the Lead tennessee is among the leaders of the movement to create state-
State governments are providing leadership in bringing eHealth’s wide HIes. Its governor, Phil Bredesen, co-chairs the State alliance for
promise of broadly shared electronic medical records to reality. as eHealth, an organization created by the national governors association
partners with the federal government in administering Medicaid and to increase the efficiency and effectiveness of health information
the State children’s Health Insurance Program and as employers of technology initiatives developed by states. In addition to helping fund
millions, states are among the largest buyers of health-care services in the MidSouth eHealth alliance, tennessee has contributed money to
the country. Rising health-care costs, which now consume about 16% of the launch of a regional HIe in eastern tennessee and is overseeing
U.S. gross domestic product, have a direct impact on their budgets. “we the development of the tennessee eHealth exchange Zone. the Zone,
have to be involved in this,” says dave goetz, commissioner of finance a statewide HIe, is intended to enable ePrescribing as well as the
and administration for the state of tennessee who oversees its eHealth sharing of high-density medical images and secure exchange of
advisory council. “Making health care more effective and affordable is health information among all health-care providers in tennessee.
a worthwhile goal for us as a purchaser and as a government.” cara
campbell, a policy analyst for the national governors association’s announced at the beginning of 2008, the eHealth exchange Zone is
center for Best Practices says, “States perceive health information scheduled to go live with its first users at as many as 400 sites before
exchanges to be the top priority for the next two years.” the end of the year. Its rapid launch was made possible partly by the
decision to build the exchange on the back of the state’s existing at&t
virtual private network (vPn), which reaches into all 95 tennessee
counties. at&t has created a vPn-based portal for the network’s
Trend Report Note
users and has tapped a third party—covisint, a division of compuware
HIEs aren’t the only promising eHealth initiatives, of corporation—to provide a dual-factor user-authentication protocol to
course. Telemedicine applications that allow health- further ensure the privacy and security of the system. “It is very safe
care providers to deliver their services electronically are for the sharing of files,” says Melissa Hargiss, interim director of the
also becoming popular. Such applications let doctors tennessee eHealth advisory council, which is overseeing the initiative.
meet with patients remotely via videoconferencing;
receive readings from their diabetic patients’ glucose A National Solution
monitors via the Internet; send advice to their patients’ Ultimately, forward-thinking health-care professionals and policymak-
cell phones via text messaging; and share high- ers envision a day when americans will be able to reap the benefits of
resolution medical images with other physicians via a national HIe. Before that can happen, though, the industry will have
high-speed Internet connections. Read more about these to overcome an array of technical, financial and social challenges.
innovations in the Healthcare Research Library from for example, beyond figuring out how to get many different medical
AT&T at www.att.com/healthcare. information systems to communicate with one another, the industry
will have to persuade patients and health-care providers alike to >>

3. Trend Report - eHealth Initiatives Streamline Medical Record Sharing __________________________________________________________________________ 3
State and Federal Governments
Push eHealth Initiatives
A number of states have joined Tennessee in pursuing
eHealth initiatives, many of them financed at least in part
by the Federal Communications Commission’s (FCC) Rural
Health Care Pilot Program, with $417 million aimed at
JIM cRaIgMyle/coRBIS
furthering the development of eHealth programs.
Doctors may soon be Minnesota, for example, has passed a law requiring
able to create and sign that medical-care providers embrace ePrescribing by
prescriptions using Jan. 1, 2011, and is offering grants to support the creation
Internet-enabled PDAs. of health information exchanges (HIEs) in rural and
underserved communities.
>> participate in the effort. despite the seemingly obvious benefits, Rhode Island operates KIDSNET, an HIE for children that
that hasn’t always been an easy sell. Some patients harbor privacy and integrates information from the state’s immunization and birth
security concerns, and some health-care providers worry about the registries and health-care providers. Ultimately, the state
cost of participation and the return on their investment. plans to link it to an HIE for all Rhode Island residents.
Other states that have announced HIE initiatives in the past
that said, a true national HIe would seem to be inevitable, and if two years include Colorado, Connecticut, Kentucky, Maryland,
governments do not make it happen, private enterprises might. at&t is New York, Pennsylvania, Oregon, South Carolina, Virginia
among the companies working on a solution. Healthcare community and Washington. In addition, Arizona, Connecticut and New
online, at&t’s patented vPn-based eHealth network and portal Mexico are among the states that have also announced
platform, will enable patient data located in disparate systems to be ePrescribing initiatives.
aggregated into a single-patient view. It will also provide secure access
Meanwhile, the FCC isn’t alone in driving eHealth initiatives
for caregivers to patient information and eHealth applications such
at the federal level. In October 2007, the U.S. Department of
as electronic Medical Records (eMRs) whenever and wherever it is
Health and Human Services (HHS) awarded $22.5 million to
needed. at&t has also partnered with Microsoft and covisint to develop
nine state and regional HIEs to begin trial implementations
a nationwide HIe aimed at individual users. It would allow them to
of an envisioned Nationwide Health Information Network.
use Microsoft’s Healthvault platform to store their personal health
information and share it with any health-care provider connected to HHS also announced in July 2008 an ePrescription incentive
the at&t Healthcare community online. “It’s not that difficult to create program for physicians and other eligible health-care
a regional data repository that is beneficial to consumers,” observes professionals who write prescriptions for Medicare patients.
tom eng, founder and president of Helia.com and the eHealth Institute, Beginning in 2009, doctors who use ePrescribing will receive
a private charitable organization that promotes eHealth initiatives. “But a payment equal to 2% of their total Medicare billing. The
knowing how mobile people are, you really need to make this a national incentive will drop to 0.5% by 2013. Those who have not
and eventually a global solution.” implemented a successful ePrescription program by 2012
will incur a payment reduction.
developing the appropriate financial incentives to spur widespread
adoption will help, and federal and state governments are working to
create them. (See sidebar at right, “State and federal governments
Push eHealth Initiatives.”) tennessee, for example, has offered grants— medical history from a much more global standpoint,” says charlmain
$3,500 per physician and $2,500 per midlevel health-care provider, Johnson, clinical director for centennial Pediatrics. “this is a wonderful
such as a nurse practitioner—to medical practices that agree to opportunity for the practice to take much better care of our patients in
join its eHealth exchange Zone. centennial Pediatrics, a practice a more efficient and safe way.”
with 13 locations in central tennessee, is applying those grants to
the cost of medical-records software it will need to connect to the that, of course, is the great promise of eHealth, and the reason that
network sometime in 2009. “once we’re connected to that portal, government organizations and private entities alike are pursuing
we’ll be able to access patients’ information and understand their its implementation.
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organization’s challenges, visit us at www.att.com/healthcare.
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