Building Bridges

At the core, CIOs and CMIOs face a welter of options in this area, with no simple “silver bullet” solutions. A small minority have implemented the same EMR for inpatient and outpatient, but even those organizations need to create outside access to their system; and most organizations use core inpatient and outpatient systems from different vendors, which requires both back-end interfacing/interoperability work, along with an access bridge or mechanism of some sort. In most cases, this is a physician portal, though it can also be a single-sign-on mechanism.

And then there is the HIE option, which many organizations are beginning to develop. At the same time, hospitals and health systems are also dealing with a diversity of physician relationships along a spectrum from salaried physicians in “captive” medical groups to affiliated physicians with staff privileges and beyond, to community-based physicians who might occasionally refer individual patients for inpatient care. And then, of course, some hospitals are standalone facilities, while other organizations are multi-hospital systems of various types, all with individual demographic, geographic, and cultural situations.

THE PROBLEM IS THAT THE CENTERS AREN'T PROVIDING PHYSICIANS WITH ANY INTEROPERABILITY SOLUTIONS. WE REALLY WANT THEM TO BE A PART OF OUR COMMUNITY, TETHERED TO A FULLY INTEROPERABLE SYSTEM.-PAUL CONOCENTI

Given all this, it should come as no surprise that there is no single “automatic” answer to the question of how to optimize the physician navigability issue. But CIOs and CMIOs from diverse organizations are moving forward on physician connectivity through various approaches. For example:

At Parkview Medical Center, a freestanding, 350-bed community hospital in Pueblo, Colo., Vice President and CIO Steve Shirley and IT Director Paula Oreskovich have outsourced all the interfacing/interoperability work involved in connecting the hospital's affiliated physicians with the facility to the Warminster, Pa.-based MobileMD, which offers interoperability and HIE solutions. From his perspective, Shirley says, outsourcing the interfacing/interoperability work to an outside vendor has averted the need to hire at least two full-time employees to his very small IT staff, particularly as his organization makes the shift in the next couple of years from an older version of the core EMR from the Westwood, Mass.-based Meditech to a newer one.

At the Worcester, Mass.-based UMass Memorial Health Care, a seven-campus integrated health system, Senior Vice President and CIO George Brenckle, Ph.D., has focused his efforts on the ongoing development of a dashboard that allows all types of physicians, whether from among the system's 1,500 salaried physician organization, or from among about 1,000 community-based physicians, to view the entire patient record across multiple systems. These include the Malvern, Pa.-based Siemens Healthcare's Soarian system (inpatient), and the Chicago-based Allscripts’ system (outpatient). Brenckle and his colleagues are using the Chicago-based Initiate Systems and the Pittsburgh-based dbMotion, which have developed a community-wide dashboard for patient information for physicians, for that capability. Working with all those vendors together in a collaborative fashion, Brenckle says, “We've created what we call a connected healthcare community.”

At the Anne Arundel Health System, a 350-bed community hospital organization in Annapolis, Md., Vice President and CIO Doug Abel has led the creation of a Web-accessible, single-platform, community-wide EMR (founded on the core EMR from Epic). Rather than a portal per se, Abel explains that his organization's platform allows direct dial-in to the EMR, in a community in which no more than about 20 percent of affiliated physicians have their own office-based EMRs.