Bridging the EHR Divide

Since all of UPMC’s employed physicians use Epic’s EHR, true interoperability between Epic and Cerner was achieved by installing a semantic interoperability solution provided by Pittsburgh-based dbMotion Inc., Venturella says. This allows all data captured and stored in each system to be harmonized and readily retrievable by any clinician, he notes. The interoperability solution also allows UPMC to participate in a nine-hospital HIE which started pushing data last summer, he says.

Karen Thomas, vice president and CIO of Main Line Health in Bryn Mawr, Pa., is working toward total interoperability as well, but is not quite there yet. With a medical staff of 2,200 and non-employed physicians numbering about 1,900, Main Line is currently working on a bidirectional interface so that physician practices can send orders electronically to any one of Main Line’s six hospitals.

To facilitate that process, Thomas says her organization also plans to begin using continuity of care documents (CCDs). CCD is a relatively new standard developed jointly by ASTM International, West Conshohocken, Pa. and Health Level Seven International. It allows for the exchange of reports and clinical data in the original format.

Main Line’s core inpatient EHR is Soarian Clinicals, supplied by Siemens Healthcare, Malvern, Pa. It was chosen because it is scalable and has an integrated database between EHR and practice management functions, she says. The ambulatory EHR for employed physicians is supplied by NextGen Healthcare, Horsham, Pa.

Donald Cope, Jr.

Community physicians who are not employed by Main Line use an EHR supplied by eClinicalWorks, Westborough, Mass. To increase the EHR adoption rate among community physician practices, Thomas says Main Line offers a loan program that covers eClinicalWorks. “We bought the licenses and if they get meaningful use dollars, they pay us back,” she says.

Main Line has partnered with Siemens to provide its MobileMD solution to establish an operational link between these varied EHRs, Thomas says, adding that this allows harmonized data to be sent to a physician practice’s EHR so that the physician can select the data he or she wants. Thomas also notes that Main Line is planning to become part of a regional HIE; and she says she’s confident that the MobileMD platform will be able to handle the interoperability demands of multiple links.

THE HIE CONNECTIVITY FACTOR

Hoag Memorial Hospital Presbyterian, located in Newport Beach, Calif., has been part of a private, three-hospital HIE for two years, according to Tim Moore, senior vice president and CIO. To achieve the necessary connectivity to the HIE, Hoag chose Salt Lake City, Utah-based Medicity. Although the hospital’s core EHR is Allscripts Sunrise Clinical Manager, the EHRs being used by physician practices run the gamut from Allscripts to NextGen to eClinicalWorks, he says.

Moore says that until three years ago, Hoag had in place a program through which it helped subsidize a practice’s purchase of an EHR from one of those three vendors. But when the health system began to seriously consider joining an HIE, that program was discontinued.

Kieran Murphy, Hoag’s director of health information exchange, notes that Hoag has approximately 1,500 affiliated physicians, not all of whom have an EHR. Some are still using paper charts and fax machines, he says. Still, the emphasis on an HIE, which was primarily physician-driven because the hospital’s CEO is a physician, has paved the way for increased EHR interoperability, resulting in the connection of 825 physicians. “Medicity is our HIE platform. Now it’s our intercommunity communication,” he notes.

Not yet part of an HIE, Newman Regional Health adhered to a best-of-breed strategy until a few years ago, says the health system’s director of information services, Donald Cope, Jr. In 2010, there were three separate systems and no interfaces, he recalls. “The old systems weren’t robust, but each system suited the specialists,” he says. Instead of updating the modules, Newman Regional decided to look for one system that offers seamless integration. A hosted Magic Health Care Information System, supplied by MEDITECH, Westwood, Mass., was chosen for the 53-bed hospital. Each of the five clinics owned by Newman Regional rolled out NextGen Healthcare’s EHR. An interface engine resides in the hospital, Cope notes, and acts as a translator so that harmonized data can be sent from one system to the other.

BREAKING DOWN BARRIERS

Cope says that achieving interoperability between systems is the biggest challenge he has encountered. Even though the interface engine uses HL7, “There is a big difference between interfacing and integration. The challenge was in the translation of data,” he says.

Venturella agrees that achieving true interoperability can be problematic, especially since vendors are slow in developing cross-platform standards that would make it easier to integrate disparate EHRs. As a result, systems need to be reconfigured and a middleware solution needs to be employed. The problem of harmonizing data is magnified when a healthcare delivery system becomes part of an HIE, he says.

There are now a number of integration platforms that essentially act as middleware, according to Aspen Advisors’ Cervenak. But getting all types of data into a form that meets the criteria for semantic interoperability is still a major hurdle. For example, there is no one code for allergies, she says, and lab values vary widely from test to test.