Keeping Hoosiers Healthy

Gary Baldwin, Editorial Director
Health Data Management Magazine, July 1, 2009

This is the fourth in a six-part series on provider organizations that have made headway with electronic health records. Part 5 looks at physician group practices and will appear in October.
    
 Tucked in the northeast corner of Indiana, Fort Wayne is an unlikely mecca for health care connectivity - or care delivery. It lacks a big-name academic medical center, and the state is not exactly synonymous with technological innovation. Yet, the former military outpost may qualify as health care I.T.'s best-kept secret. Its two main health systems - which have the majority of the market in the city of 250,000 - sport highly automated inpatient operations. Furthermore, the town's physician practices are also highly digitized, with local experts pegging their EHR penetration rate well above national averages.

 "When I came here in 1980, I could not believe the caliber of physicians I could practice with here," says Mike Schatzlein, M.D., a former cardiac transplant surgeon who now serves as CEO of Lutheran Health Network, one of two key hospital players in the region. "They were doing kidney dialysis here in the early 1960s and transplants in the early 1980s. There has been a pioneering spirit on medical things that has bled over to clinical I.T."

 Look into Fort Wayne's inpatient settings, and you will find bar code medication administration, computerized physician order entry, and "one patient, one record" technology unifying delivery across health systems with multiple facilities. The local physician groups have adopted EHRs with vigor as well. For example, among the 130 physicians at practices owned by Parkview Health - the area's other key hospital system player - virtually all are using EHR technology in their private practices. Even the town's free clinics and public health centers use EHRs to document their care.

 Despite their headway, Lutheran, Parkview and the city's physician practices face serious interoperability and other challenges as they continue their push to the fully digital health record. The city may serve as unwitting test bed for the nation as it promotes clinical connectivity.

 When it comes to I.T. deployments, Parkview and Lutheran bring markedly different strategies to the table. Seven-hospital Parkview has taken a step-wise approach to implementing applications, attempting to standardize technology at each member hospital before moving to the next level. Thus, hospitals share a common pharmacy, picture archiving and lab system. Medication administration is the cornerstone of its patient safety effort. The health system - which staffs about 800 total beds - runs a bar code bedside medication administration system at each of its facilities. On average, 97% of all medications are scanned, with about 9,300 daily transactions, says Greg Johnson, M.D., associate chief medical officer. "We scan Tylenol, not just the high-risk drugs," he says.

 In contrast, Lutheran has relied on one facility - DuPont Hospital, located on the city's North Side - to serve as its I.T. testing ground. DuPont is well ahead of the seven other Lutheran hospitals in the applications race. When it opened in 2001, the hospital had many pieces in place, including bar code medications and nursing documentation. Earlier this year, DuPont went live with computerized physician order entry, the final step in a "closed loop" medication administration system. Some 200 physicians use the system to enter orders directly, says Matthew Sprunger, M.D., a gynecologist who also serves part-time as medical director of clinical informatics. "We process about 60,000 orders a month," he says. "And 90% of those are placed directly by physicians."

 For its part, Parkview is holding off on CPOE. The system offered by its primary vendor, GE Healthcare, Waukesha, Wis., is cumbersome to use, says Ron Double, CIO. He's optimistic that a system upgrade - currently under way - will facilitate adoption. "Some places say they are doing CPOE, but the system is only used by 20% of the medical staff," observes Johnson, the CMO. "Our goal is that it will be done by everyone." Parkview's target date for the CPOE module is early 2011.

 Lutheran's eight hospitals run software primarily from McKesson Corp., San Francisco. The health system's EHR vision dates to the mid-1990s, when it established a goal of becoming "paperless and filmless," recalls CEO Schatzlein. "We were the weak sister to Parkview and we wanted a competitive advantage,'" he says. "We looked at I.T. as a physician relation building tool."
    
Misguided Philosophy

 That philosophy, Schatzlein concedes, proved misguided. "I.T. is a difficult area to build physician relationships around," he says. "The products are not well integrated or easy to implement. They are not very physician friendly. In 15 years, we have had only one product that was a clear home run win for the doctors - McKesson Horizon patient folder. It gets physicians out of the business of schlepping the medical record to sign charts. They can do record completion anytime, anywhere in the world."

 Many of the other McKesson modules proved to be poor fits for the hospital's workflows, he says. It's an industry-wide mismatch, he contends, one that confounds software vendors and provider organizations alike. "Our workflows were sub-optimal to begin with," the CEO says. "You would not expect a hospital to be optimized for bar code medication administration. So you find out that if you automate a workflow, it doesn't get better, it gets worse. It is a very complex issue. You have to reengineer workflows plus implement new systems."

 Despite the difficulties, neither Parkview nor Lutheran is turning back. Parkview is building out its suite of GE modules, adding an OR documentation system this year that will manage supplies, physician preference cards and scheduling, Double says. The health system also is looking at expanding its network into the community.

 Lutheran's next big challenge is digitizing physician progress notes. And Sprunger, the clinical informatics director, says he'd like to offer clinician users the ability to suspend their computer sessions, then log back on at another workstation, and resume working in the same place in the system. "We're looking at biometrical identifiers, like a fingerprint or an iris scan," he says. "We're trying to find a solution that is safe and secure, but also promotes sufficient care."
    
Group Practice Challenge

 Fort Wayne's real claim to I.T. fame may lie with its physician group practices. Compared to their national peers (whose EHR adoption rate hovers at an estimated 10-15%, according to most polls), these group practices have eagerly seized the technology. At Parkview, up to 90% of the top 200 admitting physicians - who account for the bulk of the health system's inpatient volume - use EHRs, Johnson says. At DuPont Hospital, Schatzlein estimates that about one-third of the entire medical staff - about 1,000 physicians strong - use EHRs in their clinics. One local EHR vendor - Medical Informatics Engineering, or MIE - says that well over half the physicians in Fort Wayne use EHRs in their practices.

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