The Knoxville News Sentinel had a bold headline on the front page of today's local section proclaiming "Electronic exchange of patient info close" with the sub heading "AT&T and Tenn. create system for accessing, sharing medical records." The opening paragraphs state:

AT&T Inc. is partnering with Tennessee to provide the country's first statewide system to electronically exchange patient medical information, the telecommunications company will announce today.

The system is designed to securely transmit detailed patient information between medical professionals.

It will allow doctors to access medical histories, prescribe medicines over the Internet and transfer images like X-rays, MRIs and CT scans.

The problem is that the system is not a medical records system and it does not manage patient histories or medical imaging as one might conclude from reading the article.

Instead, if you read closely it says that the system allows "exchange" and "access" and is designed to "securely transmit" information. That's all it does, as far as I can tell. But what do you expect from a cut and paste wire report rewrite of an AT&T press release?

It's like the cable guy coming in to your home or office and setting up a broadband modem and a VPN ("virtual private network") for you and then giving you an 800 number to call if you have a problem. That's what they're selling.

The only value-add that I can see is the "Covisint OnDemand Platform" which is a generic collaboration software application (think Netmeeting) that also provides a single login for applications in the network. I guess the other value add is that the state has negotiated pricing and is providing grants (by way of various federal grants) for physicians and clinics to pay for the network connectivity. If I understand it correctly, they will still need software and systems for medical records and other clinical applications.

The article doesn't mention that there are several competing electronic medical records applications, multiple regional electronic records networks operating in the state and that they use different software and databases, or that usage among hospitals, clinics, and physicians isn't universal, and that there aren't really any standards for exchanging electronic medical records.

Gov. Bredesen should be applauded for his "eHealth" initiatives, because there is no doubt that better access to better medical records will improve health care and reduce costs.

There is also no doubt that the U.S. is way behind on the use of electronic medical records. According to a 2006 report by the Commonwealth Fund, only 28% of U.S. primary care physicians use electronic medical records, as compared to 98% in the Netherlands, 92% in New Zealand, 89% in the U.K., and 79% in Australia.

So it is good to see Tennessee taking the initiative. But this deal looks more like a way to funnel federal grant money to AT&T than any kind of breakthrough statewide electronic medical records system. It also takes more money out of our health care system in the form of profits for AT&T. But, the state can't operate it's own internet, so it makes sense to outsource that and to negotiate the best deal. Were other backbone providers invited to bid?

We have a long way to go before the U.S. has a reliable electronic medical records system in place. Medicare reporting is the closest thing we have to a standard, but it's mainly for billing. The federal government should take the lead in establishing standards for records storage and exchange, certifying vendor compliance, and regulating the industry to ensure accuracy, privacy, and reliability. Leaving it up to the states will result in a hodgepodge like we have in Tennessee multiplied times fifty.

Disclaimer: I am not an expert on any of this and am happy to be educated on what standards and systems are available and how they are being deployed and regulated.

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djuggler's picture

AT&T Spys on the citizens

With AT&T's lack of ethics and willingness to spy on citizens, is this just an opportunity for them to install another secret room for the purpose of spying on our medical records?

See also this article about the secret room.

Doug McCaughan
(link...)

bizgrrl's picture

Good info. Thanks. I really

Good info. Thanks. I really don't want AT&T handling medical records. At least all they are doing is pretty much providing the backbone.

Dave Goetz's picture

Actually Covisint is a

Actually Covisint is a security system to insure the only people with access to the system are doctors who are authorized, and it also provides an audit trail on access and use. The auto industry and the Dept of Defense are among their other customers. What we are actually doing is using the state's private production network as the backbone, and ATT currently manages that, although it is up for rebid. The trick is getting the doctors onto the system. In order to do that we are using grants for equipment, software and connectivity. In return for that the doctors agree to eprescribe for two years. Think email in 1995. Once the system is in place, it can be used for imaging (xrays, etc.), remote diagnosis, electronic medical records (eventually), all kinds of things. But we are trying to get this started in stages. Thanks.

R. Neal's picture

Thanks

Dave, thanks for the additional info and background. If you're so inclined, I had a couple of other questions.

Do the grants provide doctors any software for EMR, or just the connectivity?

Is the eprescription a standardized software application that will be provided with this, or is it part of whatever practice software they use? Are there technical/interoperability standards for it?

Is the idea to promote participation by physicians, clinics, and hospitals in the existing regional HIE systems such as CareSpark, Innovation Valley Health Information Network, Midsouth eHealth Alliance, and Shared Health?

Is there any thought to merging these networks into a statewide network at some point in the future? With so many different EMR systems, is that even practical? Or needed? Is a regional solution better?

I'm all for EMR and easy, secure access by physicians, clinics, and hospitals. I hope this new network will help move that along...

P.S. Thanks for participating here, and welcome.

Andy Axel's picture

That may be "Dave" as in

That may be "Dave" as in "Commissioner Goetz."

(link...)

____________________________

With the possible exception of things like box scores, race results, and stock market tabulations, there is no such thing as Objective Journalism. The phrase itself is a pompous contradiction in terms.

R. Neal's picture

Yep, I assumed it was really

Yep, I assumed it was really him (judging from the IP address).

Is it improper to address him as "Dave" in blog comments?

I'm not sure of blog comment protocol when it comes to high ranking public officials.

(We routinely address high ranking local officals by their first name. Hope we haven't offended anyone!)

Andy Axel's picture

Actually, I was pointing out

Actually, I was pointing out that if this is the commissioner responding in comments, it's nice to see him going on record on your weblog. Not everyone may know that this was coming from someone actually qualified to clarify some things about the initiative.

____________________________

With the possible exception of things like box scores, race results, and stock market tabulations, there is no such thing as Objective Journalism. The phrase itself is a pompous contradiction in terms.

R. Neal's picture

I figured that was your

Sorry, I figured that was your point. Just kidding around a little (and confirming your observation which I appreciate you making for those who might not have known).

Some days are really strange on the hyper-local blogs. You never know who might show up.

Just today, we've had the Tennessee Commissioner of Finance and Administration, the City of Knoxville Director of Policy and Development (hope I got that title right), a Knox County Commissioner, a Knox County School Board vice-chair, and the publisher of local weekly papers posting and commenting on the blog. Not to mention press releases from the Knox Co. Mayor's office.

Government officials participating in blog conversations is a good thing because it helps promote open government, and I hope we see more of it. The flip side is to have responsible bloggers and commenters (like we have here) helping create an environment where government officials are willing to participate.

R. Neal's picture

See, just five minutes later

See, just five minutes later Bill Lyons advises that his proper title is "Senior Director of Policy and Communications" for the City of Knoxville. Sorry 'bout that Bill, er, Director Lyons. :)

Jack Lail's picture

And it was embargoed

And its release was designed for Monday morning consumption.
---
HOLD FOR RELEASE UNTIL 12:01 a.m. EST MONDAY. THIS STORY MAY NOT BE PUBLISHED, BROADCAST OR POSTED ONLINE BEFORE 12:01 a.m. EST MONDAY

Pam Strickland's picture

I guess I'm confused. Why

I guess I'm confused. Why should it matter that the release was embargoed? In my experience, embargoed means that you hold it for publication, but it doesn't stop the staff from working on the story. Maybe the question is why they wanted it embargoed. It doesn't look to me like it was doing anything other than guaranteeing a spot on a historically slow news day.

I'm also a bit perplexed about the reluctance of doctors etc to move to electronic records. Maybe my problem is that I was part of a trial run by my doctor in Little Rock as long as 20 years ago. He wrote his own program for his beloved macs, and off he went. By the time I moved about four years ago, the program covered the entire clinic -- 10 docs and a couple of nurse practitioners -- and they were doing eprescriptions. His mac program had also been adapted for PC's and was off and running in other parts of the city and state.

I'm glad Tennessee is working in that direction.

Pam Strickland

"We are what we pretend to be, so we must be careful about what we pretend to be." ~Kurt Vonnegut

Dave Goetz's picture

Um, I guess I am me. and

Um, I guess I am me. and Dave is fine. I don't get on here much, hence the delayed response.

As to your questions:

"Do the grants provide doctors any software for EMR, or just the connectivity?" A: What the doctor wants is up to him. The $3500 is for hardware and software. If someone had a wirelss system with a tablet pc already, they might use it to bootstrap into an EMR system, which can be expensive. We have heard of some EMR companies developing an EMR lite to go along with this grant. There is eprescribing software available, or they can use their own, as long as it is compliant with standards. The connectivity is what is important, and then they can use it at whatever level of sophistication they are comfortable with. There is up to $6000 per site to pay for connectivity, a fully managed network solution including a router in the office. We also are working with Community Health Network and their recent $7.9M FCC grant aimed at not for profits and clinics, particularly rural ones.

"Is the eprescription a standardized software application that will be provided with this, or is it part of whatever practice software they use? Are there technical/interoperability standards for it?" See above. We are following SureScripts standards for eprescribing, and all recent EMR software is compliant. We also are compliant with federal standards for EMRs.

"Is the idea to promote participation by physicians, clinics, and hospitals in the existing regional HIE systems such as CareSpark, Innovation Valley Health Information Network, Midsouth eHealth Alliance, and Shared Health?" We are definitely working with the existing RHIOs and trying to grow more. This can be the pipe through which people access those RHIOs.

"Is there any thought to merging these networks into a statewide network at some point in the future? With so many different EMR systems, is that even practical? Or needed? Is a regional solution better?" Our philosophy here is that we should provide infrastructure and follow along with national standards on interoperability. I am not smart enough to pick who will win the EMR race. Regional solutions do tend to work better, as people trust other people they know, a critical part of building a system. But if I have a car wreck in Knoxville, it would be nice for the ER to have access to my records.

R. Neal's picture

Dave, thanks again for the

Dave, thanks again for the thorough response and the info.

It sounds like what you said earlier, it's internet circa 1995. The infrastructure is being put in place, and now the applications will have to follow and grow around it.

As I said in the original post, I hope the federal government gets more involved and doesn't leave it up to the states. But at least Tennessee is taking a leadership role while we wait.

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