To diagnose renal disease, nephrologist Derek Fine relies on a blood test that measures creatinine, a waste product that is filtered by healthy kidneys. But a single test result paints an incomplete picture because it does not show changes over time. Fine gets more information when he compares his patients’ current creatinine levels with past results of the same test.
“If a patient’s creatinine was normal two weeks ago and now it’s elevated, that could be ominous,” he says. “But if it’s been high for three years, I can tell a patient: ‘There’s no reason to panic.’”
His challenge, until recently, was accessing those past test results in a useful format and without delaying treatment. All of Fine’s patients are referred, frequently from institutions outside of Johns Hopkins, so their histories are not stored in the Johns Hopkins Epic electronic medical record system. “In the old days, it would take me days if not weeks to track down information,” he says. “I’d get a pile of papers coming in by fax.”
Now, Fine, who practices at The Johns Hopkins Hospital, uses the Care Everywhere function in Epic to easily access past lab results from more than 1,000 hospitals and 26,000 clinics nationwide that use the system.
Even when patients can’t remember where previous tests and treatments took place, Fine can often find their records by typing in their home ZIP code. Care Everywhere then lists all the nearby institutions that use Epic. With a single click, he can request information from all of them.
In 2014, clinicians with Johns Hopkins Medicine used Care Everywhere 158,277 times to share information with 172 hospitals and clinics in 44 other states, according to a report generated by the electronic medical record company. The top exchange partners were Mercy Medical Center, Anne Arundel Medical Center and the University of Maryland Medical Center.
Kelly Cavallio, administrator for Epic operations, says Care Everywhere is particularly useful for patients who come to Johns Hopkins with complex conditions, sometimes toting thick folders of documents that are not organized in any particular way. With Care Everywhere, clinicians can easily find the information they need, which they can add to patients’ records in the form of notes.
To protect patient privacy, clinicians must indicate that they are using the information for treatment purposes only, and patients must give consent to the institution relinquishing the records, explains Donald Bradfield, senior counsel and leader of Johns Hopkins’ health information privacy group. When other Epic-using institutions request patient information from Johns Hopkins, patients must sign a form created by Johns Hopkins, Bradfield says. If the patient is unable to give consent, a clinician must sign.
“Not a week goes by that I don’t see some patient from another Epic institution,” says John Flynn, internist and Epic medical director. With Care Everywhere, he can study recent test results and spot patterns that can lead to improved treatment. For example, he says, he ordered a liver biopsy for a patient after looking through records from a different hospital and recognizing signs of alcoholism.
Care Everywhere reduces test duplication, saves money and speeds up treatment, says Fine. “On at least two occasions I can think of, I didn’t order a number of studies because they had been done the week before,” Fine says. “Having that information helped us make decisions on the spot.”