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By EMMA L. CAREW, Star Tribune
May 24, 2008

In treating medical emergencies, physicians need as much information as possible -- something that can be difficult to obtain if a patient is unconscious or unstable.

University of Minnesota physician Michael Aylward said emergency room providers need to know quickly if a recent medical procedure or perhaps an allergic reaction prompted the emergency. Otherwise, they might make diagnostic mistakes and uninformed treatment decisions.

Minneapolis-based Mednet USA and the Community Health Information Collaborative (CHIC) in northern Minnesota are working together to develop and test a program that allows hospitals and clinics to search quickly for a patient's full medical history and records.

The U.S. Department of Health and Human Services recently awarded Mednet and CHIC one of six grants to work on the Nationwide Health Information Network.

They plan to develop and test a system that can send electronic patient data securely and to create policies that would protect patient privacy, according to Mednet CEO John Fraser.

"The benefits of having access to current information are very clear," Fraser said. "It makes the health care system more efficient."

Fraser said the network could allow clinics to eliminate new-patient health history forms and other questionnaires.

The current testing phase has been funded by a federal grant of about $100,000. Subscription fees for providers haven't been determined, but Fraser said future costs would fall to the hospitals and clinics.

"Patients will never pay anything for this infrastructure," he said.

Twila Brase, president of the Citizens' Council on Health Care, a Minnesota-based patient advocacy group, said there are major privacy concerns with the idea of a service that exchanges health information.

Brase said patients should remain in control of their medical records to protect their privacy. "This is the information era," she said. "Data has become the latest gold mine for financial success."

Although written consent is required for a provider to access records, Brase said, patients may give oral consent to allow a search of their name, which shows the physician which other hospitals and clinics hold their records.

Brase calls this list a "micromedical history," and said it may release more information than patients realize, such as whether they have been treated for pregnancy or by an HIV clinic.

Fraser said the Mednet system plans to exceed the state's legal minimums for consent and security. Patients could sign a form at any time, telling the system never to search for their names, he said.

Another level of patient security and privacy protection in the system is "role-based access control," Fraser said. That means an ambulance driver would have access to different records than a surgeon or dentist would.

The university's Alyward said medical information is vital to a patient's care.

"It's really critical to know as much of a patient's history as possible," he said. "Not telling someone who's taking care of you [about a condition] puts you at higher risk."

CHIC has done similar work in this area with an immunization registry used primarily by schools in northern Minnesota, executive director Cheryl Stephens said.

CHIC and Mednet are testing the system at three Minnesota hospitals: St. Luke's in Duluth, Virginia Regional Medical Center and Riverwood Hospital in Aitkin.

Stephens said they are focusing on how to send the data securely and privately, while also devising consent policies and patient opt-outs.

All six grant recipients are testing their own systems, she said. Ultimately, they hope to plug into a national backbone.

The five other organizations receiving Nationwide Health Information Network grants are Kaiser Permanente, the Cleveland Clinic, HealthLINC/ Bloomington Hospital in Indiana, HealthBridge in Cincinnati and Wright State University, also in Ohio.

Health and Human Services describes the fledgling computer system as a "network of networks" that would allow health information to follow patients, facilitate medical decisionmaking and help improve public health policies.

Aylward said the ability to access a patient's medical history is more efficient, so doctors and patients don't have to wait for consent forms to be faxed and files to be sent.

"Information is a tool of the trade," he said. "If the patient doesn't bring any records, then it is very challenging to get information from other sources."

But Brase maintains that convenience should not trump a patient's privacy rights. Mishandling that concern would be detrimental to treatment and would "put the patient and the doctor at odds," she said. "The patient who feels naked in front of the public is going to do their very best to cover themselves."

Emma L. Carew • 612-673-7405

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