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Patients鈥� records in state health information exchanges are readily available to be shared electronically by many physicians. Yet, in a 2013 survey, the most recent by management consultant company Accenture LLP, many U.S. doctors said they see limited positive impacts of the new health information exchanges on treatment decisions, medical errors and health outcomes.

Interviews with physicians from across health care disciplines paint a many-colored portrait of why many doctors still don鈥檛 embrace health information exchanges.

When the exchanges were created, their goal was to allow 鈥渋nformation to follow a patient where and when it is needed, across organizational, vendor and geographic boundaries,鈥� notes the Office of the National Coordinator for Health Information Technology, or ONC, a federal agency that supports states with grants, awards and guidelines.

However, Paul Kempen, an anesthesiologist at the Weirton Medical Center in West Virginia, doesn鈥檛 see it happening that way. One of his big complaints is that various state systems don鈥檛 鈥渢alk to each other.鈥�

For instance, Kempen鈥檚 pain clinic is within a 10-mile-wide point of the state鈥檚 panhandle, near Ohio and 23 miles from Pittsburgh, Pennsylvania.

鈥淎 third of my patients come from each of the three states,鈥� he said. 鈥淓very time we administer pain therapy, we look up the patient in three databases. Maybe he鈥檚 doctor-shopping, with prescriptions from multiple physicians. It is time-consuming.鈥�

At the University of Maryland School of Nursing, Ronald J. Piscotty Jr., assistant professor of informatics, agreed. Preventing 鈥減olypharmacy鈥� between the primary care provider and specialists such as psychiatrist, cardiologist, gynecologist and/or endocrinologist, is costly and often unnecessary, Piscotty said.

鈥淚f a patient had a normal complete blood count two days ago, there is no need to repeat it,鈥� he said.

No long-term strategies

In March 2010, ONC announced that 56 states and territories qualified for federal awards to build health information exchanges. The agency gave $16 million more to states to create and implement up-to-date privacy and security requirements for the exchanges, to coordinate with Medicaid and state programs, and to set strategies to meet gaps in the exchanges鈥� capabilities.

However, only a handful of states, such as Delaware, have been able to develop a financial strategy to maintain their health information exchanges after the federal money is exhausted, said Mansur Habib, cybersecurity technology program chairman at the University of Maryland University College.

鈥淲hile the federal government gave states the money to build HIEs, states needed to develop a financial strategy to keep these exchanges running,鈥� Habib said.

In theory, a health information exchange allows a physician to look into a patient鈥檚 record, review lab tests, radiology, medications, surgical procedures and then assess whether a test is needed or new therapies should be prescribed.

In Accenture鈥檚 survey of 601 physicians across a wide range of disciplines averaging 16 years in practice, 74 percent said they access patient clinical data from different organizations, such as a laboratory, hospital or another physician practice/office. Yet, of those, only 51 percent said they routinely access patient data from a different health organization, 19 percent sometimes, and 4 percent rarely. The survey also found that 79 percent said they were more proficient using electronic health records than two years earlier.

Other factors

Cyber-savvy youth may be a defining factor. Corrine Russo, physician鈥檚 assistant at Anne Arundel Medical Center in Annapolis, Maryland, said, 鈥淲ith anything like that, the younger doctors would tend to use (health information exchanges) more than older ones.鈥�

For a doctor to participate in health information exchanges, his or her state must have an exchange, Habib said.

鈥淯nfortunately, the implementation of these exchanges became politicized and several states shunned the federal money to build these exchanges,鈥� Habib said.

The Connecticut State Medical Society is creating its own health information exchange after a frustrating decade of waiting for state action, according to Matthew Katz, the society鈥檚 vice president. He said he hopes the CTHealthLink will be operational before clinicians miss Medicare and Medicaid incentives.

Still, many physicians said they find the exchanges of limited value, and some said they worry about treading on patient confidentiality.

鈥淭he HIEs depend on this wasteful, dysfunctional electronic system few of us trust and few of us care to waste our time on because it takes away from patient care, is about as secure as Equifax and about as useful as spoiled milk,鈥� said Thomas W. LaGrelius, a geriatric and family doctor in Torrance, California.

LaGrelius said he uses electronic medical data 鈥渨hen forced to鈥� at his hospital but not in his private practice.

Curtis Caine, a retired Mississippi anesthesiologist, said most patients do not fully understand what they are signing when entering a physician鈥檚 office as 鈥渁 multitude of forms are shoved in front of them鈥� to sign with a consent to share their medical history in the exchange.

Caine maintained that the patient should own the record.

鈥淣o one should have access to it without his permission,鈥� he said, especially when they are 鈥渘ot feeling their best and don鈥檛 read every word. People have been indoctrinated to be 鈥榮heeple.鈥欌��