|
|
For other articles and previous issues click here. January 17, 2005 Connecting
the Docs Healthcare communities in California and Ohio are sharing information and reaping the rewards of a system that stresses patient safety and cost savings. One of the loudest rallying cries in the healthcare industry today is for the development of regional health information organizations (RHIOs)—local health information infrastructures that give connected practitioners electronic access to the community’s healthcare data. Leading the call is National Coordinator of Health Information Technology David Brailer, MD, PhD, who has vigorously pushed for public and private support for such an interoperable infrastructure. The current administration has demanded the development of electronic medical records (EMRs) that can help prevent inefficiencies and financial waste when physicians practice without adequate patient history and information. While an enterprisewide electronic record helps a facility achieve these goals on an individual or system basis, Brailer is optimistic that the program can be achieved on a more widespread basis so that as patients travel within the healthcare community, their information goes along for the ride. The ultimate goal is that data will be shared as patients cross regional boundaries as well—a national network throughout which medical information can be safely moved. According to Lorraine Fernandes, RHIA, RHIT, senior vice president, healthcare practice, Initiate Systems, “There’s an enormous focus in the healthcare industry on accurate and consistent patient identification so that data can be linked on a regional or even national level.” While the industry isn’t yet deeply involved in this data linkage, she says, Brailer is urging it to embrace the fact that such regional data sharing is necessary to facilitate care for patients who move within a community or change healthcare providers or insurers. “There are some very strong patient safety and cost-savings benefits that will come out of greater interoperability and data sharing,” insists Fernandes. “There’s a great deal of redundant testing that takes place today because doctors don’t know what patients had done at another office, or they can’t get timely access to what’s been done.” She says patient care suffers because a lack of information leads to doctors and emergency departments prescribing medications that may be contraindicated. “They either delay treatment while they’re trying to get data points or they do things in haste that they might do differently if they had better data.” Fernandes acknowledges that there are obstacles to overcome, but the rewards will be significant. “We’ve got a long way to go, but the technology is there and the desire is there. Grant moneys are going toward demonstration projects to get it off the ground, and there are some successful regional data-sharing initiatives out there,” she says. One such initiative is spearheaded by software vendor Axolotl, which has been instrumental in helping collaborative models of interoperability take flight. The company, says spokesperson Nicole Spencer, was founded in 1995 with a mission “to create community health information networks that combine data from competing hospitals and labs and deliver it electronically to the physicians to improve the timeliness and quality of patient care.” Its overriding purpose, she explains, is to equip providers with the information they need to provide the best care possible. The company’s second-generation clinical messaging technology, called e2, facilitates the exchange of clinical data among hospitals, physicians, laboratories, radiology centers, and payors. Through the Internet and use of industry-standard digital messaging, e2 integrates data from disparate sources. Because the technology uses the Health Level 7 (HL7) standard, healthcare facilities can use the system with their existing EMRs and legacy systems. Clinical and administrative information can be sent to and received from multiple sources all at once and in an instant. Physicians are also able to order lab tests and renew prescriptions online, which saves time and helps prevent medical errors. The first community to begin using Axolotl’s products was Santa Cruz, a coastal county in California’s Bay Area, where there’s now interoperability among three competing hospitals, a major reference laboratory, a smaller laboratory, safety net clinics, a payor, two independent radiology centers, a county health department, many physician groups, and all the physicians affiliated with the hospitals. All receive their clinical results electronically from the labs, radiology center, and hospitals. “Once the physicians receive this data, they can manage it,” explains Spencer. “That might include consulting with a specialist, writing a prescription, ordering another lab test, combining the data into a repository to review reports, for example, if diabetic patients are improving over time.” Furthermore, she says, the tools exist that allow participants to determine how the community as a whole is improving over time. “They might look at the data to see how many diabetics live in Santa Cruz County, how many are getting the care they need, and if they are effectively managing their disease,” Spencer says. Thus, the technology already exists to fulfill Brailer’s mission. However, obstacles stand in the way of wider adoption and application—for example, fear of the competition. “Hospitals that are competing with one another want to have a competitive edge. In many cases that edge has been the ability to distribute their physician reports electronically to the physicians, ensuring timely receipt and eliminating lost reports,” explains Spencer. When it comes to putting data into a community repository, there’s a completely understandable—not to mention HIPAAmandated—protectiveness about proprietary information, an unwillingness to expose data to competing hospitals. Santa Cruz hurdled that obstacle and made a strong start in interoperability, but Axolotl discovered yet another obstacle. It was difficult to identify a buyer, says Spencer, or get hospital A and hospital B to agree to work together. The current climate is more hopeful, warmed by the Bush administration’s appointment of Brailer and his enthusiasm for RHIOs. As a result, says Spencer, “there’s funding now for an infrastructure to support RHIOs. All the tools needed to have an effective healthcare delivery system are in place, and the possibilities are wide open.” In Cincinnati, the possibilities have already been realized as 18 competing hospitals have been linked, through the help of Axolotl and a unique entity called HealthBridge. According to Executive Director Robert Steffel, HealthBridge is a trusted third party of the entire healthcare community—that is, health systems, hospitals, managed care organizations, and physicians of all types working in groups of all sizes. HealthBridge and its parent company, the Health Improvement Collaborative of Greater Cincinnati, are not-for-profit organizations, subsidiaries of the Greater Cincinnati Health Council, which evolved from the local hospital council. The name change, says Steffel, reflects the broader focus embracing the entire healthcare sector. HealthBridge, he explains, is working with all these stakeholders to realize a shared vision. “The basic notion is to improve both the quality and the efficiency of our community’s healthcare delivery through a collaborative network of organizations and technology,” he says. Like many communities in the early 1990s, greater Cincinnati was involved in something Steffel calls the Community Health Information Network (CHIN) wars. “We had as many as three different competing community health information network efforts pulled together into a single network with a vendor at the center and the notion of creating a patient data repository.” The vision, he says, was grand, but the wherewithal to actually achieve it simply wasn’t there. HealthBridge was proposed as an alternative to the CHIN—something the community could actually afford and achieve. At the root of this effort was the desire and ability to learn how to collaborate and how to develop not only the technology but also the trust that’s so essential for collaboration. Instead of developing a CHIN, the community formed HealthBridge in 1997. Although people dubbed this new effort a CHIN, Steffel says the organization has always tried to distance itself from that concept. “There are a few things that we do that are subtly but extremely important that make us something other than a CHIN, one of which is that we’re actually successful,” he notes. Steffel says HealthBridge has already achieved much of the vision of interoperability Brailer espoused. “We are truly a multistakeholder collaborative entity with a critical mass of clinical content, broad physician and hospital participation, and stakeholder financial support. In other words, we’re going to be here for a while because we are providing value to our stakeholders. Part of the reason we’ve been successful is that although it’s made possible by a vendor, it isn’t vendor-driven. “If you go out and hire a vendor to create collaboration, you’re unlikely to be successful. The health club membership doesn’t make you healthier—you have to show up and do the work yourself. And if that doesn’t happen, you’re not going to develop the trust and communication channels that are necessary. The healthcare community stakeholders in Cincinnati did show up and do the work.” In the beginning, HealthBridge had five health systems that constituted approximately 90% of the community’s acute care activity and two managed care organizations that gave it seed capital. “We didn’t know at the time how much movement there was of physicians, and, therefore, of patients across the different entities, so we didn’t want to buy some monolithic and very expensive application until we had a better understanding of the need for the application.” To get started, HealthBridge created what’s now called an intranet. “In 1996, we decided that this Internet thing might develop into something,” Steffel says, laughing, “so we adopted Internet standards but made HealthBridge a private Internet.” Each of the participating organizations made their clinical applications available through a single physician portal. HealthBridge also added community-licensed content of interest to physicians. “We told physicians if they had a browser, they could connect to us and get access to all of the different clinical content that’s out there because we had that critical mass,” Steffel recalls. After physician interest and willingness to participate was demonstrated, the HealthBridge board began to look into an application that would help move the clinical results from the hospitals to the physicians, which Steffel describes as a “painful, expensive, and unreliable process.” Beginning in 2000, HealthBridge reviewed vendors, examining 12 software companies that seemed to have a notion of being able to move clinical results between hospitals and physicians. “The one that really struck us as knowing what we wanted to do was Axolotl,” says Steffel. “They had actually coined a term—clinical messaging—and their whole idea of taking clinical results and moving them to an HL7 standards format and routing them based on a communitywide physician directory was exactly what we were looking for.” HealthBridge entered into a five-year contract with Axolotl and set out to implement the clinical messaging system across the community. Now, says Steffel, more than 1 million clinical results are sent each month to more than 3,000 physicians affiliated with those hospitals. Approximately 90% of these results are transmitted electronically. Axolotl had developed the concept of electronic message delivery and used it successfully in Santa Cruz but was able to adapt it even more precisely to meet HealthBridge’s needs. For example, it was able to deliver information across many departments and applications in the manner preferred by physicians, whether that was by mail, fax, or electronic delivery. “Being able to print and deliver results through a single system is a huge money saver for the hospitals and gives them a completely auditable, verifiable results delivery process,” says Steffel. “Everything is logged and we can do a true HIPAA audit, a capability Axolotl added to the software with the advent of HIPAA. It created the ability for us to audit at a specific patient level and see everyone that touched their results electronically or to audit at a user level and see every patient the user touched electronically.” The vendor, Steffel insists, has grown with HealthBridge, with its concept maturing as the collaborative gains experience. This model of interoperability has many benefits that differ depending on the stakeholder. But the bottom line effect tends to drive the enthusiasm. “You can sit down with each and every customer and talk about how this does good in the community, how it improves the quality of care, how it makes patients happier, and how it gets results delivered in a more timely and legible fashion. They’re in favor of all those things, but the benefit that seems to move them to action is return on investment,” Steffel acknowledges. In addition to exploring e-prescribing, Steffel says HealthBridge is working toward expanding the system, moving it to a communitywide ambulatory order system. Physicians without an EMR will be able to use an application licensed by HealthBridge that will allow them first to order laboratory tests, and later other types of tests, from any of the participating hospitals. “We’re publishing a set of standards that will allow any EMR vendor that chooses to participate with us to pick up the catalogs from the laboratories and to offer them inside of their EMRs. So physician groups that do have EMRs won’t have to leave them to place orders with participating labs,” Steffel says. “The most exciting aspect of this effort is that it was initiated by a health system stakeholder who brought the idea to HealthBridge, saying ‘this needs to be a communitywide effort. We will get much broader participation and reduce overall operating costs with this approach.’” This is an example of the rewards of using the collaborative—interoperability models such as the one developed at HealthBridge, says Steffel. The most significant barriers to a more widespread adoption of this model, he says, is not financial or technical but lack of experience with collaboration. Some organizations’ strategies have been to use technology to exclude other organizations, he says, explaining that a collaborative approach is distinctly different. It strives to develop standards so anyone with a legitimate need to participate and share data can do so in a straightforward and fair way. “It’s about developing a willingness to collaborate, to sit down and spend the time and energy to understand that you’re part of a larger system, and that by giving up a little of your sovereignty, you’ll be able to participate in something that will have real returns for you,” Steffel says. “Competition doesn’t decrease but it shifts from trying to use technical barriers to ‘lock in’ customers to using the same technology ‘front end’ but providing better customer service. We think this shift is an unmitigated good thing for all our stakeholders—especially the patient.” — Kate Jackson is a staff writer at For The Record. |
 |
 |