A Tower of Babel’s worth of languages and customs make Brooklyn, N.Y., a captivating place to live or visit but a challenging arena in which to practice medicine. The variety of spoken languages creates gaps in health information, and an aging population adds to the complexity.

“We have a population [that] is a melting pot,” said Justin Schwartz, director of patient information systems at Sephardic Nursing and Rehabilitation Center. The 279-bed facility is one of 11 medical centers in the Brooklyn Health Information Exchange (BHIX), which will launch later this year.

“Some people speak Spanish, some people speak Russian, some speak Chinese,” he said.

In addition to language barriers, for Brooklyn’s elderly, lost paperwork and misunderstood medical directions are common occurrences on the circuit from hospital to nursing home and back again.

“Many times, we may have the doctor’s name but not their telephone” number, said Nancy Daurio, a registered nurse and associate vice president of management information systems at Maimonides Medical Center. About half of the patients at the teaching hospital are elderly.

Both Schwartz and Daurio believe a new regional health information organization (RHIO) anchored by Maimonides and 10 other Brooklyn hospitals, nursing homes, home care providers and payers will ease those difficulties.

BHIX has received a $4 million start-up grant from New York state and another $3 million from Maimonides. A pilot project should be operational by May, with the full system online by late July.

The organizers say they are confident that the new network will improve the quality of health information — and, consequently, overall medical care — across the community.

Speaking the same medical language
As befits a United Nations of cultures, Brooklyn’s health exchange will adopt a universal medical language. Officials said BHIX will start by sharing six data elements: patient demographics, allergies, medications, problem lists, provider care teams and advance directives. They are deciding how to define each of those elements, which is not simple.

“Allergies,” for instance, can mean drug, food or environmental allergies such as bee stings. Instead of limiting the types of allergies, BHIX will take an inclusive approach. Users “expressed their preference for seeing all the different types of allergies, and if they can be sorted by type, so much the better,” said Irene Koch, BHIX’s executive director.

Clinicians will access patient information via a Web portal connected to an enterprise master patient index, which will link to records managed by the member institutions.

Initiate Systems’ Initiate Patient software will locate the appropriate records, and MedPlus, an information technology subsidiary of Quest Diagnostics, will provide clinical software, a data exchange engine, and a document management and imaging system.

BHIX bought perpetual licenses to both companies’ software.

Under BHIX’s governance model, each member institution will designate which employees can access the network. The primary restriction is that data can only be used for providing health care.

“The rule is that you are doing it for the purposes of treatment,” quality improvement and disease management, Koch said. Clinicians will be the main users, although nonclinical employees involved in quality management will likely have access, too, she added.

When BHIX goes online later this year, users will be able to view all of the available information. That openness could change as more data elements are added and if BHIX’s managers decide some information should be reserved for specific users. For example, they might choose to restrict access to data generated from physicians’ notes.

The BHIX system can track caregivers by job title — such as “physician” or “nurse” — and will limit some functions to specific roles.

Emergency medicine doctors, for example, will be able to search for patients’ records even it it’s not clear that the patient has consented to sharing his or her data. A quality management user wouldn’t have that power.

BHIX members say they have big plans for the future, including expanding the number of data elements and providing access through local clinical systems. For now, logging on to the BHIX portal is the only way to access shared data. Members are also considering introducing clinical decision-support software and letting patients enter their own health data via a Web portal, Koch said.

Next-round financing
Of course, such enhancements will depend on funding. BHIX has relied on grant money to get started, and officials hope to finance the next round of expansion through further grants, including some from New York state.

The state has wholeheartedly embraced health IT. Officials chartered the Office of Health IT Transformation in April 2007 to coordinate policy and, in 2004, established a program called the Health Care Efficiency and Affordability Law for New Yorkers to fund health IT efforts at a promised rate of $1 billion in four years. BHIX won one of the state’s largest initial grants — $4 million — in May 2006.

“New York is really incubating and fostering a lot of health information exchange projects and tends to appreciate the potential benefits of using RHIOs,” Koch said.