In the future, consumers will be able to view and manage their health information online with the ease that they presently do their bank accounts.

Consumers will be able to enter a password and access all their health care records from various providers, as well as test and laboratory results, so the vision being crafted both locally and nationally goes. They will potentially be able to receive messages from providers, make appointments and get health care tips online.

Local planners hope consumers will even be able to interact with the system. For instance, a person tracking blood sugar levels at home could enter in results, providing instant access to a provider and potentially alleviating the need for an office visit. Or that person might be referred to an informational video on a pertinent health subject.

The fluid access to information will also extend to providers.

An emergency room doctor, for instance, could learn with just a few clicks which medications a patient takes at what dosages, and that no blood work is needed since a test was performed two weeks ago. The doctor will also be able to zip off a message alerting the patient’s primary care physician about the need for a possible follow-up.

And this scenario will be true whether the patient’s emergency happens down the street or on the other side of the country.

The vision is part of a new digital infrastructure being built for health care records called health information exchanges, or HIEs.

Although some of this interconnectivity is now in place, the grander vision is still years away from fruition.

“You would want information available to the different institutions where you’re going to seek care,” said Abby Sears, CEO of OCHIN, a Portland-based nonprofit organization that specializes in health information technology. “And you would assume it’s already there, but it’s not.”

Experts say an overarching network is needed due to the range of electronic health records systems in use. Practices, clinics and hospitals, each with their own particular specialties and records needs, often have systems that can’t talk to each other.

That hurdle becomes more critical in light of state and national health care reforms. To reduce costs and better manage patients, the right hand of the health care system needs to know what the left hand is doing.

“There is a real sort of business need that’s evolving out of a lot of the health reform efforts,” said Susan Otter, the state’s coordinator for health information technology. “We’re really looking now at what we need to build or facilitate in terms of the technology to support (reform).”

Efforts are under way at the local, state and national levels to create HIEs.

Locally, representatives from several of the region’s biggest health care providers, including St. Charles Health System, the Central Oregon Independent Practitioners Association and Deschutes County Health Services, have been meeting for about a year to form an HIE for the region. The group recently filed for nonprofit status for a new organization, Central Oregon Health Information Exchange.

“I would think there’s going to be significant progress in the next 12 to 18 months,” said Shane Irving, chief business administrative officer for Bend Memorial Clinic.

Ready to connect

The greater vision has long been for an electronically interconnected health world, with doctors readily able to access patient information.

The first step toward that, which has been taking place over the past decade, has been to get health care providers to transition from paper to computerized records.

The federal government has been pushing this agenda for years, Otter noted. Lawmakers included financial incentives for practices to switch to electronic health records in the federal stimulus bill.

Some organizations started switching to electronic health records years ago. Others are in the process of doing so — Deschutes County converted on Oct. 31, for example, and the hospitals in Madras and Prineville are slated to go electronic in August. A few small practices might never go that route.

Yet the interconnected vision hasn’t been fully realized. As health care organizations adopted electronic records, they chose various companies.

Each provider also has different needs in a system. A neurologist tracks different kinds of data than a primary care physician, for example.

“That’s what electronic health records don’t do well, is they don’t follow patients across points of care,” said Dan Stevens, senior vice president of government programs for the insurer PacificSource.

Health information exchanges are now seen as the answer. Dr. Mary Dallas, medical director clinical informatics for St. Charles Health System, likened them to hubs for all the spokes of the health care wheel. How HIEs work — whether they’re Web- or software-based — varies.

So far, Sears said, each region of the country appears to be approaching HIEs differently.

In some places, like Central Oregon, the development is happening locally. In others, states are leading the charge. A significant number of states are waiting to see how the federal government’s HIE develops.

Otter said Oregon has opted to move incrementally, particularly since health reform is still unfolding and is changing the landscape so rapidly.

Sears said who pays for HIEs and who keeps them running are currently key points of discussion, as well.

“I think it definitely has to happen,” Sears said. “The question is just how does it have to happen? Does it happen at a local level, does it happen at a state level, does it happen at a national level, and what happens at each of those three levels?”

Going local

In Central Oregon, the answer has been to go local.

“There’s a recognition in Central Oregon that if you wait for the perfect federal HIE or state HIE to happen, then you might wait a long time,” Stevens said.

He said the HIE is also seen by local health care professionals as critical to making Central Oregon’s health reform efforts work.

The region’s coordinated care organization, or CCO, is taking shape. Under the effort, the CCO will be given one pot of money to manage Medicaid patients. The concept is that the pressure of changing the pay model — one limited funding source for bills rather getting paid for every service or visit, whether it’s warranted or not — will contain patients’ costs. The model is expected to act as an incentive for providers to better manage their care.

Without the HIE, it’s difficult to track a patient’s care, avoid duplicating services and find ways to cut costs.

Stevens, who sits on the committee forming the HIE, said the region appears ready. A survey showed that locally, roughly 80 percent of providers now use electronic health records.

Some of these systems already are interconnected.

For instance, High Lakes Health Care and nine other Central Oregon clinics all have the same electronic system, thus sharing information as needed in a few clicks, said Dan McCarthy, administrator for High Lakes’ management services company, Adaugeo HealthCare Solutions. High Lakes also added a portal on its website last year to allow patients online access to their records.

OCHIN also has such networks with its member providers, Sears said.

Some initial work has also been done on the local HIE. Dallas said St. Charles Health System has been accessing and adding lab results to the system since about May 2011.

It’s also experimenting with a secured messaging system. For instance, a clinic wanting to schedule a surgery at the hospital can send a message, attaching the needed documents instead of faxing them over.

“One of the positive things we’ve found is it doesn’t lose things,” Dallas said. “It’s a lot more efficient of a process because you’re not scanning and faxing and waiting.”

Moving forward

Several foundational pieces still need to be ironed out in designing a local HIE.

One discussion revolves around security. Health care professionals know some patients are uncomfortable with personal information on electronic networks. Those crafting the network concepts are even discussing opt-out possibilities for patients who want to keep certain issues confidential with a provider.

That’s a significant issue for Deschutes County, said Christina Grijalva, the county’s clinical information systems analyst. The county provides drug and alcohol counseling that is confidential under federal law and must be kept separate from the HIE.

“I would encourage patients and advocates and others that patient health info can be moved very successfully safely, just like our personal financial data can be,” Sears said.

The other discussion revolves around who will pay for the HIE and how to govern it.

Bill Winnenberg, chief information officer for the St. Charles system, said forming a board to manage the HIE was important for Central Oregon. Now they’re talking about how to share the costs.

“It helps us to govern it from a community perspective, not from a St. Charles perspective or another provider perspective,” he said. “We’re all working together to govern the information that’s in it, to make sure it’s the right information that’s used appropriately. And nobody is using it to the advantage of their organization. We’re using it to the advantage of the community.”

And ultimately, the goal is to give the best care to patients.

“Any patient, when they go anywhere for care, deserves to know that their information is already there waiting for them so that the care they receive is as good as it can possibly be,” Sears said. “There’s technology now to … make that happen.”