Medical breakthrough: VA, Kaiser to share records

Medical breakthrough: VA, Kaiser to share records

National-level alliance has been elusive goal

By Keith Darcé, UNION-TRIBUNE STAFF WRITER

Wednesday, January 6, 2010 at 12:01 a.m.
Patient Jeff Baker (center) is flanked by the VA Medical Center’s Chief of Staff Dr. Robert Smith (left) and Kaiser’s chief medical information officer Dr. John Mattison.

Nelvin C. Cepeda

Patient Jeff Baker (center) is flanked by the VA Medical Center’s Chief of Staff Dr. Robert Smith (left) and Kaiser’s chief medical information officer Dr. John Mattison.

Kaiser Permanente and the U.S. Department of Veterans Affairs today will launch an electronic medical-data exchange program in San Diego that could become the seed for the much touted but equally elusive national health records system.

The collaboration, which will be detailed at a news conference in La Jolla, marks the first time a computerized patient-records system operated by a federal agency has been linked to one operated by a private organization.

Under the new partnership, Kaiser and VA doctors in San Diego County will gain instant access to certain files from both institutions for about 1,000 patients who receive care from both providers.

The U.S. Department of Defense, which uses a separate set of electronic records, will join the program in a few months, Kaiser and VA officials said.

While the pilot program has stirred interest among experts on electronic medical records, some of them doubt it will mean much to the thousands of smaller physician groups and hospital networks that make up most of the nation’s highly fractured health infrastructure.

“I’m very excited (about the project) as a symbolic thing,” said Dr. Ashish Jha, associate professor of health policy and management at the Harvard School of Public Health. “It’s great to see these large organizations begin to share data, but it’s not a model that’s replicable. It’s one step in a very long journey.”

Kaiser, the VA and the Department of Defense “are very large, closed health care systems. The real battle has been for the fragmented pieces,” said Dr. David Brailer, who served as the country’s first coordinator for health information technology under President George W. Bush. Brailer now heads Health Evolution Partners, a San Francisco private equity firm that invests in health information technology and services ventures.

Initially, the pilot program will be limited to personal identification information, such as a patient’s name and age, and lists of allergies, drugs and medical conditions.

Over time, the project will expand to include more types of medical records — perhaps X-rays, laboratory test results and doctor’s examination notes, said Dr. John Mattison, chief medical information officer for Kaiser’s Southern California region.

Other medical providers across the country will be invited to join the program, said Dr. Stephen Ondra, senior policy adviser on health affairs for the VA. No cost estimate has been given for the project.

Signaling the importance of the records exchange, the White House has been deeply involved in its development during the past year, Kaiser and VA officials said.

They said the undertaking represents a major step forward for two significant initiatives by President Barack Obama’s administration.

Obama is pushing for all Americans to have an electronic medical record by 2014, and he directed $20 billion toward the effort in his $825 billion economic stimulus plan last year.

In April, Obama announced a separate plan to create an all-encompassing lifetime electronic record that would follow military personnel from the time they enlist to the time they die.

“Over half of the care for service members and veterans occurs in the private sector,” Ondra said. “To really provide the highest quality and safest care to patients, we need to be able to exchange authorized information with our private-sector colleagues.”

It’s unclear whether the Kaiser-VA project will eliminate barriers that so far have blocked development of an electronic information network linking hospitals, doctors’ offices, pharmacies, laboratories, clinics and insurers nationwide.

Previous attempts to establish regional electronic medical-records exchanges have been limited by the cost of buying computers and software, the lack of a single technical standard for sharing information and debates over how best to protect the privacy of patients.

Some medical providers that compete against each other have resisted making it easier for their patients to see other doctors or go to other hospitals.

So far, about 500 of the 1,000 eligible patients have agreed to let Kaiser and the VA exchange their health records, said Mattison at Kaiser.

Jeff Baker, 64, of San Diego’s Clairemont neighborhood, said he signed up right after learning about the program.

“I thought it was a pretty darn good idea,” Baker said.

When Baker was diagnosed with cancer two years ago, he already was seeing Kaiser physicians through insurance coverage provided by his wife’s employer. Because the illness was linked to his exposure to Agent Orange, an herbicide used by the U.S. military in the Vietnam War, he became eligible for treatment at the San Diego VA Medical Center in La Jolla.

“I go to both places to get separate opinions and weigh them,” Baker said. “I get physicals and blood work at both places.”

Moving paper records among his doctors often was a hassle.

“It was like a two- or three-week process,” Baker said. “It was a lot of legwork. I would physically pick them up and hand-deliver them.”

Now, his basic medical files are available to the staff of both institutions at all times.

Like most health networks, Kaiser and the VA record patient data through different software systems that use their own sets of words and codes to identify particular conditions, treatments and drugs.

Kaiser’s version is called HealthConnect, and the VA’s is dubbed VistA.

For the two institutions to share information, the words and codes must be translated into a third language that both computer platforms can understand.

That lack of universal coding has held back development of other health information networks. Last week, the federal government started addressing that problem by proposing the first of several sets of “interoperability” standards to be incorporated into medical-record software.

The Kaiser-VA pilot program will adopt those standards as they are released, Mattison said.

In the years ahead, the overall project will provide a road map for other exchange systems, said the VA’s Ondra.

“I’m more optimistic than others,” he said. “As we help create a standard that others can adopt, we are going to improve (health care) quality, safety and efficiency. In the end, I think consumers will want access to that kind of care.”