With the policy landscape emerging out of healthcare reform having been clarified by a Supreme Court ruling and the November federal elections, and with the meaningful use process under the federal American Reinvestment and Recovery Act/Health Information Technology for Economic and Clinical Health (ARRA/HITECH) Act proceeding apace, there has never been a more urgent need for clinicians and others to share information across the inpatient-outpatient divide.
But the basic reality of disparate, multiple electronic health record (EHR) systems involved in most hospital-physician communications remains a stumbling block to easily facilitated sharing of key clinical information at the point of care or use. That reality is proving to be thorny on multiple levels, as healthcare IT leaders try to help lead their organizations forward towards such important goals as accountable care, health information exchange (HIE), analytics for value-based purchasing, and other efforts.
A report published last year by IDC Digital Marketplace predicted that ambulatory EHR use will increase from less than 25 percent adoption in 2009 to over 80 percent by 2016. With adoption on the rise, hospitals and medical groups are making a concerted effort to achieve total interoperability between their systems.
Getting to that point means having to overcome some basic challenges, according to a survey conducted by the Washington, D.C.-based Bipartisan Policy Center and Doctors Helping Doctors. Results of the survey, published in October, showed that 71 percent of clinicians cite lack of EHR interoperability and information exchange infrastructure as major barriers to the exchange of health information. In addition, 69 percent say the cost of creating and maintaining interfaces is a major problem.
Also, more than half of the respondents say they want critical data pushed to them electronically, but prefer to selectively retrieve other, less critical information. The desire to cherry-pick data comes as no surprise to Jody Cervenak, a principal at the Pittsburgh-based consulting firm Aspen Advisors. “Each physician has a need for very specific data,” she says. “Each wants a different slice of the electronic health record.” The kind of data being accessed will largely depend upon that physician’s specialty, she adds.
Donald Cope, Jr., director of information systems and security officer at Newman Regional Health in Emporia, Kan., notes that mobile technology has streamlined data capture and complicated issues of interoperability as well. “Clinicians want data sent to their cell phones, but they don’t want all the results,” he says. “They want the system to think for them—to alert them.”
Among the reasons for the lack of integration between a hospital’s EHR and those of its affiliated practices are the historically slow adoption rate of EHRs by physicians, and the variety of available best-of-breed systems, says Cervenak. “Many decisions were made before vendors had a solution for both sides,” she says. “Hospitals also may have acquired physicians and gotten their systems.” Additionally, organizations may not be inclined, because of time or cost, to replace these older systems with a single, integrated system, she notes.
Traditionally, getting disparate systems to communicate with each other has only required an interface engine based on an industry standard such as HL7 (from the standards organization Health Level Seven International, Ann Arbor, Mich.). But that may not be enough when all kinds of data need to travel from multiple departments in a hospital to the hospital’s core EHR and then to numerous physician practices. Likewise, physicians need to send orders and data from their EHR back to the hospital, so a bidirectional solution is needed.
In order to achieve that kind of high-level interoperability, a separate integration system needs to be installed, Cervenak says. Essentially “middleware,” that system is able to collect and “harmonize” data—converting it into an understandable, cross-platform format while maintaining the original meaning of the data.
ESTABLISHING THE LINK
While the meaningful use program offers financial incentives for physicians to purchase and use EHRs—and will eventually penalize those who don’t—a number of large hospitals have found it advantageous for themselves and their physician practices to offer their own form of monetary assistance.
Jim Venturella, CIO for physician and hospital services at the University of Pittsburgh Medical Center (UPMC) in Pittsburgh, Pa., has been working with his colleagues to provide connectivity to the organization’s more than 3,200 employed physicians and 2,000 non-employed, affiliated physicians.
UPMC’s inpatient EHR is from the Kansas City, Mo.-based Cerner Corporation, and was implemented in the late 1990s. On the outpatient side, Venturella notes that affiliated practices are offered several options when it comes to outpatient EHR adoption. The health system’s choice for its employed physicians is the EHR solution from the Verona, Wis.-based Epic Systems Corporation; non-employed, affiliated physicians may choose either Epic or the Chicago-based Allscripts; high admitters, he notes, tend to pick Epic. For those practices that already have their own EHR, UPMC offers a connection back to the hospital’s core EHR via a customized platform provided by MedLink, a self-developed solution at UPMC.