A system linking all hospital, patient and physician records via an online database would cut medical costs in Hawai'i and improve patient care by giving doctors immediate access to key information.

That's the stance of several state lawmakers who hope to fund the database project with federal stimulus money.

Lawmakers estimate that with more than $20 billion appropriated for health information technology in the federal stimulus plan, building a system in Hawai'i could bring more money to the state than any other project save for rail transit.

"This particular initiative would be a tremendous boost to the state," said State House Speaker Calvin Say, D-20th (St. Louis Heights, Palolo Valley, Wilhelmina Rise), a supporter of the initiative.

A House bill introduced by state Rep. Jon Riki Karamatsu, D-41st (Waipahu, Village Park, Waikele) would create an office of state coordinator of health information exchange to assist in developing a health information exchange program.

Proponents of the system say it would do much to improve patient care.

The comprehensive state health database envisioned by lawmakers would allow physicians immediate access to patient medical records, patient history, lab results and prescription medications. Ideally, data would be collected from all public and private healthcare providers in Hawai'i.

The task of putting the system together would be enormous and require years of collaborative effort. The idea of a comprehensive medical database has been discussed for more than a decade and issues over who owns patient records, the healthcare provider or the patient, remain murky.

"Obviously unified medical records is something that everybody has dreamed about for a long time. It is extremely difficult to do and people have been talking about it for decades," said Dr. Jeffrey Yu, chief technology officer for The Queen's Medical Center. "We would always be interested in taking advantage of such an opportunity and taking a look at it. It's a very interesting problem and it's something that needs to be looked at. The privacy concerns are definitely an issue."

MATCHING DOLLARS

Early estimates put the price tag of preparing each state hospital for the system at $11 million.

The system would help reduce medical errors and streamline services for patients, according to lawmakers, and they say that the federal money and job creation would be well worth the state investment.

"It's going to be for the whole state of Hawai'i," Karamatsu said. "This could potentially be the biggest federal drawdown next to rail (transit)."

Lawmakers are trying to take advantage of the Obama administration's efforts to move more doctors and hospitals to adopt electronic records. The stimulus bill signed last month includes $20 billion for development of healthcare information technology.

If the state adopts Karamatsu's proposal and moves quickly, the federal stimulus, known as the American Recovery and Reinvestment Act, will match each state dollar invested in the initiative with $10 of federal funds in fiscal year 2011. That formula moves to $7 in federal funds per state dollar in 2012 and $3 in 2013 and beyond.

A study conducted by Kaiser Permanente published this month by the medical policy journal Health Affairs explores some benefits of having patients' medical records readily available for doctors for decision-making purposes, and online for members to view and track their health.

One result may be more efficient patient contact, with Kaiser members using more telephone calls and e-mails instead of office visits. From 2004 to 2007, office visits per member declined 26 percent, while scheduled telephone visits increased more than eightfold, according to the study.

Prior studies have noted links between electronic health records and patient safety improvements, better coordination of care and better documentation.

SOME SYSTEMS IN PLACE

Locally, the Hawai'i Medical Service Association has tried to help physicians acquire electronic medical record software and systems through $20 million in funding. Kaiser began implementing its KP HealthConnect electronic medical records in 2004 with two secure systems — one being a system for internal management of member information.

Kaiser made another system available online for members, allowing them to go on the Internet to look at lab results, prescriptions, past visit information, appointment scheduling and e-mail links with doctors.

Of Kaiser's 222,594 members, almost one quarter, or 50,293, have registered for online accounts.

The e-mail function was attractive to members, with 51,000 messages being sent in 2007. Lab tests have been viewed 250,664 times.

The Hawaii Health Information Exchange Inc. — a nonprofit corporation made up of stakeholders in the Hawai'i healthcare community, including representatives from various hospitals, health insurers, physician organizations, and other providers — supports the state's plan.

HHIE is already working toward the creation of a health information exchange system in Hawai'i to allow a secure and rapid exchange of medical information. HHIE officials acknowledge the task is enormous but say the end result would revolutionize healthcare.

"To get everyone on one system, I don't know how far into the future we'd have to look for that," said Christine Maii Sakuda, HHIE director. "A coordinated, concerted effort needs to occur between all the providers. It's a new area for the nation to be in. If we work on it collectively ... we'll make great inroads in the years to come."