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The Hospital as the Network Hub
Health Data Management Magazine, August 1, 2008
A growing number of hospitals and integrated delivery systems are tired of the “hurry up and wait” game involved with many regional health information organizations. So they’re taking matters into their own hands, building hospital-centric networks to share data with physicians.
“It’s always amazed me that some organizations that are part of RHIOs are not yet effectively exchanging information among their own facilities. It’s like putting the cart before the horse,” says Deborah Kohn, principal at Dak Systems Consulting, San Mateo, Calif. For broader, collaborative networks to succeed, Kohn argues, the participants must first have their own networks in place.
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The hotbed of networking activity in health care today involves hospitals linking with their referring physicians, not broader RHIOs or health information exchanges, says Mark Holland, program director, health care provider research, at Health Industry Insights, a unit of IDC, Framingham, Mass.
Integrated delivery systems have struggled for more than a decade to use information technology to link their hospitals to clinics they own as well as independent physician offices, the consultant notes. “Now it’s really beginning to take hold,” he says.
Competitive pressures are forcing hospitals and their parent delivery systems to invest in networks, Holland says. They want to use these networks to make it easier for community physicians to refer patients for hospitalization.
This is becoming more urgent, he says, as fewer patients are hospitalized because of the continuing shift to outpatient care.
“Most physicians in our area admit to two or three hospitals,” notes Matt Ebaugh, CIO at Silver Cross Hospital in Joliet, Ill., just south of Chicago. “We knew that if we made it easier for physicians to access data, it would be a way to bond with them and offer us a temporary competitive advantage.”
Ebaugh believes that, ultimately, a broad HIE will serve the region, and most patients will have personal health records. But until that day comes, his 306-bed hospital is building its own network links to local physicians.
The Motivation
Hospitals seeking to improve their reputations as centers for excellence, especially for cardiology or oncology, are particularly motivated to build their own electronic links to specialty physicians, says Michael Mytych, principal at Health Information Consulting LLC, Menomonee Falls, Wis.
Exchanging data with specialists is vital to avoiding duplicative tests and providing efficient care–important steps in a hospital’s effort to dominate a local market niche, he adds.
And more of these hospitals are concluding that they can’t afford to wait for broader communitywide HIEs to take hold, he contends.
Catholic Healthcare West, a San Francisco-based organization with 41 hospitals in nine markets, has concluded it can’t afford to play hurry up and wait.
“We’ve had to move ahead more quickly than the timelines of most RHIOs,” says Eric Leader, chief technology architect. “Anything we can do to make it easier for doctors to work with us makes for a better patient care environment. When physicians realize that, they come to us.”
Some hospitals and delivery systems are taking ambitious steps to facilitate the two-way exchange of clinical data with group practices.
For example, a few pioneering doctors affiliated with Catholic Healthcare West can send data to some of its hospitals and receive information on hospitalized patients.
Others, Mytych, notes, are taking a simpler approach. For example, they’re enabling doctors to view hospital data in a read-only mode. “That’s the poor man’s HIE,” he says. “But it’s better than driving in the dark without your headlights on.”
University of Pittsburgh Medical Center, for example, enables its 2,500 employed physicians at 400 sites to look up data on a read-only site while it awaits progress in improving interoperability between its inpatient and outpatient records systems.
The ASP Approach
A growing number of hospitals are serving as application service providers to area physicians, giving them remote access to outpatient electronic records systems via the Internet to help jump-start clinics’ automation efforts. These hospitals’ ASP efforts are designed to pave the way for eventual clinical data exchange.
“This ASP approach represents a long-term marriage, so a hospital has to be very committed to it,” Mytych stresses. “They have to realize that the physician is now their customer. So they have to be very customer-focused just as any service provider would be.”
And in some cases, hospitals are subsidizing a portion of the cost of ASP access to electronic records, taking advantage of recent federal rulings on the issue (see sidebar, page 38).
Silver Cross Hospital’s networking efforts came as a result of requests for assistance from physicians in the far south suburban area of Chicago, who generally practice in small groups, says Ebaugh, the CIO. The doctors wanted help obtaining EHRs and exchanging data with their peers as well as the hospital, he says.
The hospital offered physicians two options for using EHR software from Misys Healthcare Systems, Raleigh, N.C. (Misys is merging with Allscripts LLC to form Allscripts-Misys Healthcare Solutions Inc., which will be based in Chicago.)
They can either buy a license from the hospital and install it on their own servers or “rent” it via the ASP model. So far, all 17 participating practices, with a total of 48 physicians, have gone the ASP route, Ebaugh says. Silver Cross hopes to eventually sign up about 100 physicians to use the software as part of its data-sharing effort.
“The ASP is priced to cover our costs and break even after five years,” he says. “If we make any money, we will return that to the physicians in the form of a rebate.”
Regardless of whether physicians use the ASP, they can access the hospital’s information system, from Medical Information Technology Inc., Westwood, Mass., and certain other inpatient systems via a secure Internet connection. The hospital is using Terminal Services software from Microsoft Corp., Redmond, Wash., and application delivery technology from Citrix Systems Inc., Fort Lauderdale, Fla., to enable the connections.
So far, about 100 of the hospital’s 150 active admitters are remotely accessing these systems, Ebaugh says.
Doctors using the Misys software can exchange data, such as when a primary care physician refers a patient to a specialist, he explains. Ebaugh expects that eventually, as personal health records become more ubiquitous, data exchange among other types of EHR systems will become easier.
And a communitywide HIE ultimately will be necessary, he believes. That’s because Silver Cross, for example, does not offer open heart surgery and would like to share data for those patients with other hospitals in the region that offer the surgery.
A Multi-decade Evolution
While it awaits broader HIEs, an Ohio delivery system that’s been reselling software to area doctors since the 1980s is building on that long-term strategy using the ASP model.
Since 1988, Mt. Carmel Health System in Columbus, Ohio, has licensed practice management software to about 440 area physicians, nearly half of whom are employees of the delivery system, says Doug Blair, senior director, physician information services. The effort stemmed from physicians asking for advice on how to automate their practices, he explains.
For most of this decade, the four-hospital delivery system has relied on the ASP model to provide the software. “This helps us assume good relationships with the physicians in the community,” Blair says.
Recently, the hospital also began offering ASP access to electronic records software from NextGen Healthcare Information Systems Inc., Horsham, Pa. So far, eight physicians have taken advantage of Mt. Carmel’s 50% subsidy of the software cost (see story below).
Blair sums up his organization’s networking strategy this way: “We are backing into a health information exchange infrastructure.”
Mt. Carmel is devising plans to create a read-only database that would give area physicians access to historical patient information gathered using practice management software it phased out when it switched to NextGen, Blair says. In phase two of this effort, the delivery system hopes to build a truly interactive HIE for exchanging all clinical data among area clinics and its four hospitals.
For now, doctors can access certain clinical data on hospitalized patients using a Web-based system from MEDSEEK Inc., Birmingham, Ala.
Start at Home
Networking must begin at the delivery system level rather than regionally, Blair stresses. “You have to start within your own health system, where you have linkages built, and take advantage of that first,” he contends.
Mt. Carmel hopes to eventually enable its doctors and hospitals to exchange a complete continuity of care record. That’s also the long-term goal at Wellspan Health, a two-hospital delivery system in York, Pa.
Wellspan already provides all its approximately 300 employed physicians and a handful of independent doctors with electronic records software via an ASP. The doctors access the software, from Allscripts LLC, Chicago, using application delivery technology from Citrix. The organization also uses identity management technology from Courion Corp., Framingham, Mass., to ensure security for data that passes through what amounts to an intranet, says Mark Jacobs, director of technology services.
Today, community physicians can access hospital data stored in a system from Cerner Corp., Kansas City, Mo., via a Web portal. Longer-term, Wellspan hopes to integrate its Allscripts and Cerner systems so it can exchange all clinical data among all inpatient and outpatient sites, Jacobs says.
After many years of hospitals buying information systems that were not interoperable, they are now making progress with integrating their inpatient systems, Jacobs says. “Now we have to integrate those with outpatient systems and then share the data among them.”
Once delivery systems like Wellspan achieve true enterprisewide interoperability, Jacobs says, they’ll participate in broader RHIOs or HIEs for disease reporting and other communitywide functions. Until that day arrives, however, Wellspan can play an important networking role because it’s the dominant provider in a primarily rural region, he adds.
Moving Forward
Some of the nation’s largest owners of hospitals are forging ahead with bold network initiatives, leveraging their major market presence.
Because its 41 hospitals serve nine communities, Catholic Healthcare West is using more than one approach to hospital/physician networking to address local needs.
“Ultimately our networking efforts are about providing the best patient care that we can, and that requires providing the best access to the most recent clinical information,” says Leader, the chief technology architect.
Since late last year, the organization has focused on building hospital-physician links primarily by using portal technology from MobileMD, a division of Intraprise Solutions Inc., Warminster, Pa. Catholic Healthcare West has four ongoing efforts in this arena, enabling about 50 physicians so far to send demographic data to the hospital where a patient is being admitted and, in turn, receive access to such hospital data as medication lists, test results and discharge summaries.
Participating physicians pay a monthly fee for accessing the ASP-based networking effort, Leader says.
Another eight Catholic Healthcare West hospitals use technology from CareFx Corp., Scottsdale, Ariz., to provide physicians with remote access to data housed in those hospitals’ systems from Meditech.
Catholic Healthcare West expects to roll out the MobileMD portal effort to all its markets, except for those using CareFx, within about a year, Leader says. “We initiated it with some larger group practices with larger I.T. departments first to get it off the ground,” he says. “Now we’re opening it up to the general community.”
Sharing inpatient and outpatient data throughout an enterprise is challenging even when a delivery system employs most of its physicians.
University of Pittsburgh Medical Center, which owns 20 hospitals, was frustrated by its inability to meet doctors’ demands for easier access to data from the hospitals’ Cerner information systems and the group practices’ records system from Epic Systems Corp., Verona, Wis., says G. Daniel Martich, M.D., chief medical information officer.
Because the medical center’s 2,500 employed physicians were reluctant to standardize all outpatient and inpatient clinical data on technology from one vendor, the organization determined that the only truly pragmatic solution was to install middleware from dbMotion Ltd., Pittsburgh. Using the middleware, about 150 physicians so far have read-only access to hospital and outpatient data from multiple sites.
“If a patient comes to one of our ERs and they sign a consent form, the ER physician can access data to help improve the patient’s care,” Martich says.
This approach, which involved creation of a read-only data repository, was the best fit for the medical center because it could not devise a way to make the Cerner and Epic systems truly interoperable, he adds.
While the organization awaits continued progress in broader HIE efforts in the region, “it’s far easier to get something like this going,” Martich says.
Kohn, the consultant, encourages other hospitals and delivery systems to get the networking ball rolling.
“It sure would help if the participants had their own networks in place before attempting a broader RHIO,” she says. “If a node in the RHIO is exchanging information internally, it makes it much easier to win support for a broader networking effort.”
More information online
For more information, visit the health information exchange channel at healthdatamanagement.com. Also visit the hospital portal for more on hospitals’ I.T. strategies.
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