Medical records are easily shared in a CT system called Connie. Here’s what you need to know.

These days, when you go to a new doctor, even when you’re out of state, he or she can pull up your medical record without having to have them sent over from your primary physician.It’s a system called Connie, formally the Connecticut Health Information Exchange, a nonprofit health care technology company mandated by the General Assembly to make electronic medical records more accessible to health care providers and patients.“The reason we were enabled was really to make sure that physicians and health care providers get the right data on the right patient at the right time and securely,” said Jenn Searls, Connie’s executive director. “And so that’s essentially what a health information exchange is.”Jenn Searls, executive director of Connie health information exchange (Courtesy of Connie)Searls said that when she previously worked at ProHealth, “our patients would go to see (Consulting Cardiologists) in Wallingford, or they would go to see a sleep doctor at someplace else or they would show up at Hartford HealthCare. Anything that happened in those other sites of care, my docs had no visibility in until that institution, if they knew, would fax us a report.“Now I’ve got this fax report, and we have to pay staff to scan that fax report into the medical record, hopefully put it in the right spot in the medical record, hopefully alert the physician when that information comes in,” she said.Instead of all that faxing and scanning and possible mistakes, “we facilitate the secure electronic exchange of that information,” Searls said. Connie facilitates sharing of 275 different electronic medical record systems in Connecticut, including two different Epic systems at Yale New Haven Health and Hartford HealthCare, Searls said.“What Connie does, it sits in the middle of all of these various health care organizations and we connect to them,” she said. “If you imagine Connie here in the center, I’m connected to Yale, I’m connected to East Granby Family Practice, I’m connected to … Litchfield Hills Family Medicine, all of these different organizations.”Then, when a caregiver needs a patient’s record, he or she can access it from Connie.Searls called Connie “the great equalizer,” because a patient whose primary care physician is part of Hartford HealthCare doesn’t need to feel tied to that system because any doctor can access the patient’s medical record without being a member of Epic.‘This large database’But while Connie makes it easier for any doctor to see a patient’s medical record, some in behavioral health care are concerned that they are being asked to share personal information such as diagnoses and care plans. Patients also have expressed concern.A primary care physician or gynecologist does not need to see that information, says the executive director of the National Association of Social Workers’ state chapter.“We were very concerned that confidential information would be going into this large database,” said Stephen Wanczyk-Karp. “We don’t feel that it’s necessary. … Our state laws for all the mental health professions are a little different, but the bottom line of all of them is that we are not to release information without clients’ consent, except under certain circumstances, which really tends to be in a risk for self or others or in a situation of emergency.”Cheryl Wilson, chairwoman of NASW Connecticut’s board, but speaking for herself, said, “One of the disclaimers that we put out there when we start working with someone is letting them know that everything that we discussed is protected by the HIPAA and privacy laws and then also, of course, explaining to them that the only time that we would have to breach confidentiality is if there’s an event that we become aware of, potential self harm or them harming someone else. … So with Connie coming into the picture, it compromises that disclaimer.”For now, NASW members have been advised to register with Connie, which they are required to do by state law, but not to upload client information, Wanczyk-Karp said.“There is a state mandate that does require any licensed health care provider to connect to and participate with the statewide HIE and Connie is that designated HIE,” Searls said. “Some of the caveats include patients can opt out. This is a voluntary benefit for patients.”She said the Office of Health Strategy dictates the rules for what health care providers must share with Connie.Wendy Fuchs, spokeswoman for the Office of Health Strategy, said in an email, “Recent legislation … supported by OHS, clarifies that providers are not required to share patient information with the Connie if: 1. Sharing such information is prohibited by state or federal privacy and security laws. 2. Affirmative consent from the patient is legally required and such consent has not been obtained.”Fuchs also said, “Behavioral health providers may supply administrative and demographic information including schedule and patient registration data to the statewide Health Information Exchange (Connie). “Providers may also provide summary of care or progress notes typically included in a continuity of care document. OHS has previously provided guidance that psychotherapy notes and any privileged communication are specifically restricted from being shared with.”‘We use it every day’Diane Manning, president and CEO of United Services, a community behavioral health center based in Killingly, called Connie “a linchpin of our care-coordination efforts so that we can ensure that the individuals we’re working with, that their care is coordinated across the various providers.”One of United Services’ clients may end up in an emergency room, for example, and be given a medication that must be coordinated with other drugs.“We’re right in there making sure that people understand and can wend their way through the care system,” Manning said. “And so we use it every day. We’re heavy-duty users, mostly for looking at what other parts of the system our individuals are interacting with, because we tend to be their base provider.”She said as mental health providers they do send diagnoses to Connie, but not therapy notes or treatment plans.“We let (clients) know that we will be sharing information with their other providers and vice versa,” Manning said. “We’ll be accessing information from the other providers.”While her clients know they can opt out of having their information shared, “I can tell you nobody opts out,” Manning said.“And frankly, we’re fighting stigma, so trying to hide what’s going on with the mental health side is supporting stigma, and we don’t believe in that,” she said. “It’s a medical diagnosis and it needs to be treated and that’s just it.” Dr. Albert Villarin, chief information officer for Nuvance Health, said the health care system, which includes seven hospitals in Connecticut and New York, started using Connie two years ago at Sharon Hospital.“One of the biggest gains through this utilization of the ability to move information is if a patient comes from Yale, and they’re seen in a primary care office, they can pull that information right away, so they don’t have to ask the patient, give me all the paperwork, give me all the information, which takes time because now they’re 15 minutes for the appointment.”The short time it takes to look up information on Connie is important, Villarin said.“All that information is available immediately,” he said. “That’s the expected speed of health care today is facilitating that automatically. We have moved away across our network from faxing … removing the hardware and waste and burden of faxing and automating that in our cloud technologies, such as health information exchanges like Connie.”Similar to the Epic portals that Yale New Haven Health and Hartford HealthCare use, Nuvance Health uses Cerner, which connects to Connie.“But what is shared is a limited packet of information that’s important for any other caregivers to provide,” Villarin said. “So we don’t share behavioral health, psychiatric information. We don’t share certain types of female histories. Those kinds of things are not shared by practice just because of privacy issues. So it’s very limited to the clinical care access that is allowed.”Joel Vengco, chief information and digital officer for Hartford HealthCare, said that, while the health care system connects with Connie, it mainly relies on Epic for the electronic medical records of its patients and its Community Connect partners, such as Connecticut Orthopaedics.“We submit data to Connie for patients who are being requested by another facility to have access to their record,” Vengco said. “We are connected to Connie in that way,” he said. “We both submit data, but we also at times pull data from Connie and through Connie so that we can have access to a patient who maybe we’re seeing them for the first time or they went to an emergency department that we don’t have an Epic connection to, and so Connie becomes the conduit for getting that.”Hartford HealthCare still relies primarily on Epic, however, Vengco said.“It’s always been our strategy, as a health system, to have a single record,” he said. “This was before my time as well, as we bought practices and hospitals, we basically converted their EHR to our single EHR instance in Epic, so that we can have that seamless exchange. And that’s been really our strategy for electronic health record, a single patient record.”Ed Stannard can be reached at estannard@courant.com.

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