Fremont Area Medical Center is building a health information exchange to serve the 36,000 residents of Dodge County, Neb.

The 202-bed hospital, under the Stark Act exemption, also is subsidizing Web-hosted practice management and electronic health records software for nearly 50 physicians in independent practices across the county.

The hospital is using the Cloverleaf interface engine and clinical data repository from the Healthvision unit of Lawson Software Inc., and the enterprise master patient index software of the Initiate Systems unit of IBM Corp., as its HIE platform. Technically, the HIE is a private initiative, but the hospital does not have competitors in its region and doesn't think of the service as private, says Richard Beran, director of hospital information systems. "It's a community HIE sponsored by us," he adds.

The goal of the HIE and subsidized software is to improve the efficiency and quality of care, achieve a more level playing field with larger hospitals 35 miles away in Omaha, and aid community physicians in meeting EHR meaningful use criteria, according to Beran. "If our physicians can gain a state of meaningful use and we have an exchange in place, that opens the door to community health reporting to identify disparities and other areas for improvement."

Physicians selected the ambulatory software of eClinicalWorks Inc., Westborough, Mass., which the hospital will host. Fremont Area Medical Center is providing a higher subsidiary for upfront costs and a lower subsidiary for ongoing subscription and maintenance fees. The hospital will integrate the HIE with eClinicalWorks and three disparate EHRs being used by about 10 physicians in the county if they join the HIE. The hospital also will integrate with a cardiology practice in Omaha that regularly sends physicians out to Fremont if the practice adopts an EHR.

Beran expects the HIE to be operational in six to nine months, then start looking to link to the Nebraska Health Information Initiative, an emerging statewide HIE. "We look at NeHII as being very critical to our success in the future."

The Fremont HIE initially will support lab and radiology results reporting, transcribed reports, admissions/discharge/transfer documents, followed by problem lists, allergies, and procedures as those data are populated in EHRs. The goal is to be able to offer clinicians and patients a continuity of care document as soon as possible, and to be able to integrate the CCD into the EHR.

Asked if Fremont's initiatives would have started without enactment of the HITECH Act and its meaningful use incentives, Beran says planning started before HITECH, but the law certainly helps. "I think we would be doing parts of it, but not all of it in a quicker period of time."

--Joseph Goedert

 

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