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By BETSY TAYLOR

When a patient arrives at an emergency department or visits a doctor's office for a chronic condition, the treating clinician routinely asks questions about medical history and checks the individual's electronic medical record.

But what about all the information the clinician doesn't have, say, if the patient is new or has been treated by multiple care providers at multiple locations across multiple health systems and can't remember all the details of those visits? How does the treating clinician find out what tests have been administered and where, the ultimate diagnosis and the prescribed treatment?

SSM Health's Dr. Richard Vaughn, left, and Dr. Peter Schoch support the National Record Locator Service. The tool makes it easier for clinicians to determine where a patient has received care and solicit test results and treatment information that inform current diagnosis and treatment decisions. Vaughn is SSM Health's chief medical Information officer and a corporate vice president. Schoch's title is medical director – value-based care delivery for SSM Health St. Louis.
Photo courtesy of SSM Health

To better answer those questions and to expand upon the data available in its patients' electronic health records, this summer SSM Health became the first health care system in the nation to go live with Surescripts' National Record Locator Service. Surescripts is an Arlington, Va.-based health information technology company. Its new record locator service allows 10,000 clinicians within SSM Health to more easily determine where a patient has received care in order to locate patient records, including test results from outside of SSM Health that flesh out the patient's medical history.

Dr. Richard Vaughn, SSM Health's chief medical information officer and corporate vice president, said of the record locator service, "It's part of the tool kit you need to have when working in health care today." Having a more complete patient care history should allow providers to make faster and better decisions, avoid reordering expensive tests and ensure that patients receive the best care possible, according to St. Louis-based SSM Health. SSM Health is not being charged for the record locator system during this early phase of use.

A description from SSM Health explains how the system works. When a patient is registered at an SSM hospital, doctor's office or urgent care site in Missouri, Illinois or Oklahoma, that patient has the choice of opting in or opting out of Health Information Exchange. The exchange is a secure method of sharing patient information electronically and includes the National Record Locator Service. If the patient opts in, an automatic electronic query is made to a Surescripts master patient index. The algorithm compares multiple data points to make sure retrieved records relate to the same patient.

The national record locator query generates a list of places where the patient has been for care that can be opened in the Epic software that SSM uses for its patient medical records.

Then clinicians can request records of treatments and test results conducted outside the SSM system through Carequality, a broad health care industry collaborative that has developed a common interoperability framework to share health care data in a standard format that can then be displayed in the patient's electronic medical record. Requests made through the system comply with existing law and privacy standards. Vaughn said patients can opt out of the National Record Locator Service.

The list of places a patient has received care also includes contact information, so a doctor's office or hospital can call to request a particular record or test result, Vaughn said.

When a patient is registered by a doctor's office for a medical appointment in an office that uses Surescripts, an automated query is sent to Surescripts to check the patient's medication history and to check the person's eligibility information related to pharmacy benefits. These queries give Surescripts a record that a specific patient had an appointment at a specific doctor's office on a given day, explained Tara Dragert, Surescripts' director for product innovation. Surescripts says its database of patient contacts with clinicians covers 2 billion patient interactions for over 140 million patients nationwide.

Surescripts built on that network for the National Record Locator Service. Dragert said she knows of no other health information technology business offering a national record locator service. She said Surescripts designed the new service to allow clinicians a way to access medical information from outside of their own system, but she noted that Surescripts does not store the documents centrally. "We are not operating a repository of documents," she said.

Each organization that joins the National Record Locator Service agrees to provide access to its own patient records, as long as patients give consent for their medical records to be shared with other health care systems treating them. Dragert said each organization that joins the network goes through a process to make sure its technology systems are secure, and that the people accessing documents have been cleared to do so.

Currently, the National Record Locator Service is not available at SSM facilities in Wisconsin, the fourth state where SSM has hospitals, Vaughn said. The plan is to expand the service to Wisconsin after it is piloted in the other three states.

Both Vaughn and Dragert said additional work will be done to help clinicians manage the volume of data they have on patients. Dragert said she recently spoke with a specialist who had to review about 1,000 pages of documentation related to a kidney patient with a complex case. She said Surescripts is working on software that can pull out the relevant details from a patient's medical records, creating something like a summary document, with the key points a clinician needs to treat a patient. "It's a problem we still need to solve," she said.