Some of Massachusetts’ largest health plan companies, hospitals and prescription providers are uniting to pilot technology aimed at getting critical patient information quickly and easily in the hands of emergency room caregivers. Dubbed MedsInfo-ED, the project is designed to give healthcare providers in hospital emergency departments real-time access to patients’ prescription histories.
Existing emergency department processes for collecting medication history are incomplete, error-prone and time-consuming, experts say. The information that patients verbally provide to staff can be lacking.
“Patients typically do not recall the medications they are taking, such as, ‘I take a blue pill twice a day for high blood pressure,'” says John Halamka, CIO of CareGroup, a network of four Boston-area hospitals.
The goal of MedsInfo-ED is to supplement the information patients provide to emergency department staff. The Web-based application processes and aggregates a patient’s medication history in a secured portal interface.
The Massachusetts Health Data Consortium, a nonprofit coalition of private and public healthcare organizations, is spearheading MedsInfo-ED. The effort is part of a program the group launched last year to develop common patient identification technology, data aggregation services, and privacy and security standards. It’s being funded in part by a $400,000 contract the consortium received in July from the Foundation for eHealth Initiative.
The first three hospitals to pilot MedsInfo-ED are Emerson Hospital in Concord, Mass., which went live with the program in late October; Boston Medical Center, which went live this month; and Beth Israel Deaconess Medical Center in Boston, which is part of the CareGroup network and is expected to go live this month. The hospitals serve a combined 14,000 emergency patients per month.
The success of the project requires bringing together electronic medication history from all possible data sources. The health plans and pharmacy benefit managers that are providing patients’ prescription information include Blue Cross Blue Shield of Massachusetts; Harvard Pilgrim Health Care; Massachusetts Group Insurance Commission, a state employees benefit plan; MassHealth, a Medicaid program; Neighborhood Health Plan; and Tufts Health Plan.
The breadth of these data sources is what makes MedsInfo-ED significant, according to Halamka. “Typically, medication lists are limited to a single hospital or doctor’s practice,” he says. “MedsInfo presents a complete, longitudinal history of the meds a patient has actually filled.” Having accurate medication lists in hand can help reduce medical errors from drug interactions.
One challenge in designing MedsInfo-ED was making sure all the organizations would provide consistent information – such as identifying what drugs were prescribed, accompanying instructions, dosages and the pharmacy that filled each prescription – and use the same database look-up fields. “It’s getting everybody together; that’s the hard part,” says Mick Kowitz, CTO at Zix, which did much of the development of MedsInfo-ED.
MedsInfo-ED is built around Zix’s electronic prescription technology, which lets doctors in outpatient clinics and family practices use handheld devices to determine a patient’s health plan eligibility and medication history, then checks for drug interactions and known allergies before electronically sending a prescription to a pharmacy.
MedsInfo-ED uses Zix’s technology for checking eligibility and medication history, but stops short of delivering prescription-filing tools. “It’s really a subset of our existing technology,” Kowitz says.
Zix hosts the application in its Dallas data center, where it makes connections to the various pharmacy benefit managers involved in the MedsInfo-ED project.
Integration challenges have been a key obstacle to clinical connectivity projects like this.
“Medication is stored in heterogeneous ways, and building standards-based, interoperable connections among companies that host medication data has taken a great deal of time,” Halamka says. “Eighty percent of the effort is process/organizational and 20% is technical.”
From its work as an electronic prescription vendor, Zix already had tackled the job of integrating with three major medication data providers, via the third-party RxHub exchange, Kowitz says. For MedsInfo-ED, Zix added direct links to two additional data providers.
When an authenticated user sends a patient query from one of the hospital emergency departments, the MedsInfo-ED application sends a request to each participating prescription data provider. The software aggregates the responses – no small task.
“They all return information in a little bit different structures, with different wrappers around the data,” Kowitz says. Some use Simple Object Access Protocol wrappers, others use standard XML, for example. “Behind the scenes, there’s a lot of asynchronous communication, wrapping the data together and unifying the architecture and formats,” he says.
At the hospital sites, IT staff can tie the MedsInfo-ED application into their existing systems. For example, Boston Medical Center linked the application to its Active Directory system to enable single sign-on. When users access the MedsInfo-ED application, all the controls and permissions are set based on their existing Active Directory preferences, Kowitz says.
At Beth Israel Deaconess, the MedsInfo-ED application is linked to the hospital’s admissions systems so users don’t have to log on twice or do duplicate data entry. Patient information is passed via XML to the MedsInfo-ED search interface.
To meet legal privacy and security requirements, MedsInfo-ED doesn’t store any clinical data. Once a query is answered – which can take upwards of 10 seconds, according to Kowitz – MedsInfo-ED dumps the drug-history-related information. “All we keep is an audit trail of what the request data was, who responded and how many responses we got,” Kowitz says.
To comply with Massachusetts law, the application will screen out sensitive classes of medications for treatment of HIV and AIDS, mental health and substance abuse.
The Massachusetts Health Data Consortium expects to have 10 hospitals participating in MedsInfo-ED by the end of next year.
