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What’s in YOUR Luggage? Reflections on the HIE Journey

2-lane road with blurred lights from passing cars

I recently started a new job as a senior advisor at InterSystems. As a remote employee, I’ve been looking for ways to maximize my time at the Cambridge, Mass., headquarters office, and I just had the first of what will likely be many “crossover” weekends – where I bookend a weekend with two consecutive work weeks in Cambridge.

I opted to take the train from Boston to Maine to stay with family for the weekend. As I made my way to North Station, I ambled by Massachusetts General Hospital (MGH), where I worked some years back in the emergency department. I started to think about all the patients, a nephew being one, who seek specialist care at MGH or other fine medical institutions in Boston, but then make their way back to Maine or New Hampshire where they might live.

Even though great strides have been made with electronic health records, health information exchange (HIE) across state lines is far from seamless or common.

As I pulled my rolling bag behind me, I remembered when patients traveled with suitcases full of medical files, results and X-rays. Those of us working in healthcare know this still happens – even across a single town where physician offices or hospitals aren’t connected. There are many reasons health records are not shared broadly, but it’s hard to fathom why the disconnect remains acceptable when, at the push of a button, my phone can tell me almost everything I want to know about my day and the world. For that brisk trek from Cambridge to the train, my phone told me just how long it took me and what my heart rate was, and even displayed my Downeaster travel ticket. That’s the kind of instant access to data we have come to expect.

Is it too far-fetched to imagine that one day a single patient record might be accessed by physicians in multiple states? That local community service providers might also share and add to that patient’s care plan? That the patient as well as family caregivers might view and contribute to a comprehensive care plan that any provider could also see, no matter where they are located?

I read recently that MGH handles nearly 1.5 million outpatient visits annually. That’s a lot of health records. A report by the American Society of Clinical Oncology noted that nearly 97% of oncology specialist physicians practice in urban areas or urban clusters, approximately 3% practice in rural areas, and more than 70% of U.S. counties have no medical oncologists at all. That’s a lot of travel and record toting for cancer patients.

Some states and regional affiliates have successfully and laudably created HIEs, and their physicians and care providers can access a patient’s record from any participating health system regardless of the EMR or information system. I know, because several of these organizations leverage InterSystems solutions to do so. But more should be, I think to myself, as I thank my lucky stars that my suitcase is full of personal belongings, and not my health records.


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