Thousands of health care providers have joined Oklahoma’s health information exchange

OKLAHOMA CITY — Thousands of Oklahoma health care providers have joined a statewide health exchange that allows a patient’s digital medical records to follow them to most doctor’s offices.

And, thousands of Oklahomans now have their information stored inside that health information exchange that’s been in the works for more than a decade.

A law requiring participation in the exchange previously faced pushback and criticism from some patients and health care providers, but a new rule that allows providers and patients to opt out for any reason seems to have quelled most resistance.

Offering such broad exemptions, though, has raised questions about whether the database will be comprehensive. And some providers question if the new system will result in improved health outcomes.

Currently, about 600 health care organizations and 40,000 providers are connected to the exchange, but those numbers are expected to grow, said Stephen Miller, state coordinator for the exchange, which is overseen by the Oklahoma Health Care Authority.

Each month, all of those providers combined look up the medical records of about 35,000 patients. When a physician looks up a person’s medical records, there’s an 85% chance that patient will be in the exchange, Miller said.

“We’ve had significant growth in the usage of the HIE over the last year,” he said.

All of the state’s major hospital networks are connected, but some smaller, rural providers have not joined, Miller said. The exchange is operated by MyHealth Access Network, a Tulsa-based nonprofit that has run a health information exchange since 2010.

All health care providers, including pharmacists, dentists, cosmetic surgeons, optometrists and mental and behavioral health professionals are expected to join. Access to a patient’s medical information is limited to the physicians or medical professionals directly involved in their care.

With the exchange, many people’s medical history is just a few mouse clicks away, Miller said.

“For the patient, it really is a question of do you want your record portable? Do you want to be able to move from doctor to doctor, hospital to hospital and have the confidence that they have a full understanding of your medical history?” Miller said.

Some providers, though, don’t want to participate.

In response to those providers, the state offers exemptions that allow any provider to opt out for any reason. About 3,000 exemptions have been requested, all of which will be granted, Miller said.

About 500 behavioral health professionals have already opted out. But another 17,000 including all certified community behavioral health clinics, are participating, Miller said. Some mental and behavioral health professionals have resisted joining the exchange citing possible patient privacy concerns.

Rep. Marcus McEntire, R-Duncan, who co-authored legislation implementing the exchange, said allowing wide-ranging exemptions could create “gaping holes” in health care data for the 1.3 million Oklahomans on Medicaid.

Care coordination officials at the Health Care Authority can use data from the exchange to help improve patient care for Medicaid recipients.

McEntire urged every provider to participate in the new system. The exchange could especially help rural providers, some of whom are still transmitting medical records through faxes, he said.

“I think the HIE is a real benefit for providers to be able to consume the data to figure out what’s going wrong or what they need to do better to care for their patients,” he said.

Medical providers must notify patients that their health information will be added to the exchange unless they opt out of the system, Miller said. Patients can opt out at any time by filling out a form in their doctor’s office. Fewer than 600 people have opted out, he said.

Behavioral health providers, on the other hand, are required to get written consent from a patient before adding a person’s information to the exchange, Miller said.

All providers have to pay a one-time connection fee to join and then monthly fees thereafter. The average connection fee is about $5,000, but state lawmakers set aside $30 million for the Health Care Authority to offer grants that will help cover those costs.

Monthly fees vary and are calculated through a system established by MyHealth. Primary care physicians are charged $55 per month. Pharmacists are charged $20 a month, and behavioral health providers are charged based on the number of patients they see each year, Miller said.

The fees are intended to cover the costs of operating the network, he said. The Health Care Authority did not respond to a question about the cost of running the exchange.

Oklahoma State Medical Association President Dr. Diane Heaton said she’s hopeful the grant money can cover the start-up costs for all providers who need financial assistance. Participating in the exchange has been cost-prohibitive for many physicians with small practices and those in rural areas, she said.

She also questioned whether the exchange will improve health outcomes. Oklahoma ranks poorly in most health rankings.

“It’s nice to be connected in an emergency,” Heaton said. “I think someone needs to ask what percentage of time does it make a difference because we went hundreds of years without it.”