Online Alerts: Technology to Improve Patient Care

A system called The Health Care Notification Network (HCNN), publicly unveiled in March, is intended to speed up and ultimately replace the long-standing process of mailing drug and device warnings and recalls to healthcare providers.

"We’re talking about moving patient safety online and out of the U.S. Mail," says Nancy Dickey, M.D., president of the Texas A&M Health Science Center, College Station, Tex. Dr. Dickey, a past president of the American Medical Association, is chair of the iHealth Alliance, the governing body of Medem, a physician connectivity service founded by national medical societies that is providing the technology for HCNN.

Dr. Dickey calls calls the network a "single, simple organized source for all product-related safety information" that helps physician practices, hospitals, pharmacies, and other providers adhere to the FDA’s stated preference to disseminate public information by e-mail and other electronic forms of communication. The agency has agreed to participate in the HCNN.

Others endorsing the project include the Medical Group Management Association, UnitedHealth Group, Aetna, and Health Care Service Corp., which runs Blue Cross and Blue Shield plans in Illinois, Texas, Oklahoma and New Mexico. Medem CEO Edward Fotsch, MD, says there have been "discussions" with the Centers for Disease Control and Prevention and with the Department of Homeland Security to identify effective ways to alert health professionals in case of pandemic outbreak or incident of bioterrorism such as the 2001 anthrax attacks.

In addition to speeding up the notification process, the HCNN site, www.hcnn.net, adds "interactive bells and whistles" to help deliver "more robust information" to clinicians and their patients, according to Dr. Fotsch.

A typical HCNN screen contains the actual alert in the center column, formatted in the same fonts and colors the FDA recommends for paper notifications. The left-hand column has links for more information on the drug or device in question—including images—as well as a link to enable the user to contact the manufacturer. The right side of the screen has suggestions on how care providers can notify patients about each alert, plus a link to the FDA MedWatch reporting program.

Doctors who have Web portals through Medem can elect to have HCNN alerts posted to their sites and can e-mail the information directly to patients with Medem’s iHealthRecord personal health record, according to Dr. Fotsch. Users can choose to have the notifications sent to anyone within the practice. "I think routing to the office staff is important," says Dr. Fotsch.

Alerts will be tailored to specialties so physicians are not overwhelmed with every notice for every device or drug. "Nothing will make people discard information faster than receiving a large number of irrelevant alerts," Dr. Dickey says.

There is no charge for healthcare providers to participate. "If you can get patient safety today on a free network, you’re hard-pressed to wait two weeks [for a manufacturer to print and mail a paper alert]," Dr. Fotsch says.

Malpractice insurance carriers, through the Physician Insurance Association of America (PIAA), are supporting HCNN as an essential element of patient safety, and the Joint Commission has endorsed the effort. "I am asking our insured physicians to enroll in the HCNN and receive their FDA-related patient safety notifications online," says David Troxel, MD, medical director of the malpractice insurer The Doctors Company.

Dr. Troxel was not willing to commit to offering premium discounts for participating. As with EHRs, liability carriers want hard, actuarially sound evidence that technology reduces risk.