With over five million people under its wings, the Israeli Healthcare Information Network (HIN) of Clalit Health Systems, Sheba and Rambam Medical Centres has proven itself. Hospital IT Europe spoke to Dr Orna Blondheim, CEO of Emek Medical Centre and member of the network's steering committee, and the executive in charge of development, about the benefits of health information exchange.
As a patient you expect your doctor to know more than you do. But that's not always the case, especially when things start to go missing. A universal problem across healthcare is inaccessible patient information. A cross-sectional survey in the US showed that clinicians reported missing data in 13.6% of patients' visits. Not only frustrating for clinicians, missing data can also waste patients' time and impair care.
Dr Blondheim explains that mistakes are made when physicians can't access patients' records: "Sharing medical information between various health-givers is very important because taking decisions without a comprehensive picture of a patient's medical history can present serious challenges to proper diagnosis and treatment."
She adds that lost information can result in reduced quality of care: "Missing patient information means wasting time and often unnecessary and duplicate testing that can lead to mistakes and related additional expenses."
A hospital's or clinic's electronic medical record system (EMR) can help to facilitate efficiency and organisation. But when an individual is treated across a number of hospital and community settings with independent EMRs, their medical records are not available to all. "If we all used the same EMR, it might not have been a problem," says Dr Blondheim. "But we don't, and in Israel when we were looking for a solution for effective medical information sharing we knew that we would not be going to change to one universal EMR system, so the only way to solve this challenge was to find a solution that could combine all the information in an intelligent, integrated and interoperable way."
The search for just such an "intelligent" solution that would provide Clalit Health Services with integrated patient records at the point of care became the basis for Israel's health information network (HIN). Today, in both acute and ambulatory settings, access to the patient's real-time integrated medical record is facilitating more effective and qualitative healthcare, with family physicians now able to follow their patient's progress throughout the continuum of care.
Dr Blondheim explains that Israel's impressive HIN came from small beginnings. It all started in 1999 when Clalit Health Services, Israel's largest HMO, began a one-year pilot for health information exchange at Soroka Medical Centre, southern Israel's largest tertiary medical centre, in partnership with healthcare IT software vendor dbMotion. The Soroka pilot's success was extended throughout Clalit's 14 hospitals (+5,500 beds) and 1,300 clinics and is now known as the Ofek network. Clalit's Ofek network was joined in 2004 and 2005 by two of the country's largest government-owned hospitals, Sheba Medical Centre and Rambam Medical Centre, to create Israel's large, national-scale cross-enterprise HIN that serves over 60% of the country's population.
Clalit's high hopes for the Ofek network's implementation, namely to allow clinicians to quickly and securely access a patient's full medical history at the point of care in real time, have been realised. A central Clalit motto is: "Better health and better care at every point of care." "We didn't want it to look like a chart with a thousand pages," says Dr Blondheim. "We wanted to ensure that the first thing the caregiver would see is what we defined as the minimal dataset. For example, we wanted all the lab results, allergies, medications and hospitalisations to be in one place."
Upon request, caregivers with relevant permissions can see a set "summary page" of integrated information that has been gathered in real time from the disparate information systems throughout the network. They can then drill down into the relevant data to see more detailed information related to past diagnoses, allergies, lab results, X-rays, pathology results and more.
But not every caregiver is allowed to see everything. In the interests of patient security, each caregiver has their own username and password and can only access information according to their relevant roles and user profiles. The system includes auditing and logging functionality that records all entrances into the network. Most information is shared, but a few things are not, such as mental health information and details about HIV. Dr Blondheim notes that the system can accommodate a patient's specific request not to share their medical information. "We've had a few cases, for example a woman who had an abortion, who did not want her primary care giver to know because he is a relative of hers," she explains.
Patients are pleased with what they get. "I think that patients, when they come to the physician and see their medical information is there, are amazed," says Dr Blondheim. "They're very pleased that the physician already has the correct information, that they are no longer expected to collect and provide the records or are being relied upon to accurately remember their medications or past procedures."
Clinicians' lives have also been eased by the network. According to Dr Blondheim, staff now spend far less time looking for information and making duplicate tests and can now deliver safer medical care. Among the rare complaints, the most common has been having to wait "too long" for the system to provide a fully integrated view. However, according to Dr Blondheim, this is due to Israeli physicians' characteristic impatience: "Once they have requested the information, they really want it to be available immediately; anymore than 10 seconds is sometimes too long for them." This problem is caused by slow communication infrastructure and dated computer systems. But Clalit has recently modernised much of this infrastructure accordingly to meet caregiver's demands; consequently, the HIN's typical response time from request to viewing of the fully integrated patient record is less than eight seconds.
The network's clinical viewer (user interface) is intuitive and user-friendly, with little need for formal training. "Staff are not obliged to use it," says Dr Blondheim. "We expect them to understand that they need the information, and indeed in many internal medical departments they'll look at the data of every patient that is hospitalised. They have realised that by using the system, they can learn more about the patient than the patient can recite himself."
Currently, there are no plans to mandate staff to use the system; however, as Dr Blondheim notes, "The network's usage increases every month, and once caregivers discover its benefits they quickly become reliant on the system, and many cannot imagine ever having worked differently."
So, with a network spanning 16 hospitals with more than 8,100 beds, 1,300 clinics and five million people, can the Israel Health Information Network aspire to anything more? The plan is, first, to make the system more specific for individual users in different professions, such as emergency department personnel who have very specific needs; and secondly, to allow patients to access the information from home.
The Israeli HIN of Clalit, Rambam and Sheba already covers over 60% of the country's population, providing the proving ground for the country's aspirations for a truly all-encompassing nationwide HIN – not such an unrealistic dream. But achieving this goal is a question not of time but of money. "The health ministry has to decide, and this is a financial issue, what to do if the director of the hospital says: 'I don't want to pay now'," says Dr Blondheim. "So unless the state forces him to join or the state puts in money, it really depends on the interest and understanding of each hospital CEO to the importance of shared medical information.
"And for those of us already connected to the system, its value and importance is proving itself each day."
This article is also available on-line at Hospital Information Technology Europe.