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.
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