Achieving a Community-Wide Approach to M.D. Connectivity

Brenckle: We have two electronic medical records. And we’ve taken the approach, for a patient being seen here at UMass Memorial, that it is a patient-centric record. So there is one record on the ambulatory side. We’re not being practice-specific, we’re being patient-specific, across primary care and specialists. And that’s taken some work to work through the details of that, particularly in the specialty areas. Now one of the things we’ve got to recognize is that not everyone has an inpatient encounter, and actually a very small proportion of our people have an inpatient encounter. In fact, of all our patients who had an outpatient visit, only 9 percent had an inpatient stay. Then we looked and said, OK, we’ve got a separate record for the inpatient encounter. The ambulatory record is single and longitudinal, and the anchor is ambulatory; everyone has that.

HCI: So then, as a patient, if I’m admitted to UMass Memorial, is a link created?

Brenckle: Yes. When you think about the inpatient encounter, it tends to be very specific: You’re coming in on a certain date, you’re treated for a specific time, and for a specific condition, and you’re released on a specific date. Indeed, inpatient stays are very specific and also very information-intensive. So we recognize this is a different kind of thing, but there’s continuity we want to flow through it. So we want access to the problem list, the medication list, so we can do medication reconciliation upon admission and [see an] allergy list, and we want access to their history, background, etc. So when we create the inpatient record, we will bring across those key pieces of information. And those pieces are populated into the inpatient workflow in an automated way. We’ve been implementing Allscripts, we have about 600 physicians up on Allscripts; we’re in the process of implementing Soarian, but we’re not live yet right now. We are running Meditech, and are moving to Soarian, and will build this capability within Soarian; we go live next summer.

And there’s one more piece of this. There’s that information that comes from the ambulatory setting into the acute-care encounter; and then at the end of that encounter, what goes back? We’re looking at discharge summary, discharge labs, discharge meds, and they will go back and be in the ambulatory record. And what we’re trying to deal with here is, what kind of information is appropriate? What does the referring physician need to know? Probably not my vitals on day two of my inpatient stay. We’re trying to avoid dumping huge amounts of data out there. Because particularly when you’re in an ICU, you’re generating massive amounts of data. So we’ve been having discussions with our physician groups, asking, what kinds of information do you need going in and what kinds going out? And what are the transitions, and what kinds of information need to flow through those transitions? And how do we get to information that we need? So recognizing that we have a dual environment, we created the capability for a sort of a health information exchange/aggregation engine/portal, and we’re using dbMotion for that.

HCI: That’s the element involving the dashboard, correct?

Brenckle: Yes, it’s related to the capability of seeing a composite view of the patient, regardless of the setting of care. We’ve architected this so that when you’re admitted to the hospital, you just need the most basic stuff from outpatient, and to be able to look at it quickly. So when you’re in Soarian, and you’re a hospitalist on the floor, you’ll be able to click on a button and get the dbMotion dashboard; the same thing if you’re an office-based physician in Allscripts. The unifying factor will be the dbMotion dashboard.

Now the thing is, if you start saying, I want to reach out to the community, and I want to make this work for independent physicians out in the community as well as ourselves, and not everyone has Allscripts or Soarian, this approach has enabled us to say, for example, if we’re working with a primary care practice that’s implemented Epic, we can do this for them as well. And we’ve actually done this for a few small practices that are using GE Centricity and eClinicalWorks; we’re talking to community health centers using NextGen; and we’ve done it with a large physician practice using Epic; and we have some pretty good examples.