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Smoothing the Path to Inpatient/ Outpatient Integration

September 20, 2010
by Mark Hagland
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Interview: Janie Tremlett, Senior Vice President of Strategic and Clinical Consulting, Concordant

Janie Tremlett is senior vice president of strategic and clinical consulting at the Chelmsford, Mass.-based consulting firm Concordant, where she consults on a broad range of issues, including electronic health record (EHR)/electronic medical record (EMR) integration and health information exchange (HIE) development.

Tremlett spoke recently with HCI Editor-in-Chief Mark Hagland regarding the challenges of inpatient/outpatient clinical information systems integration, which will also be discussed in the October HCI cover story. Below are excerpts from their interview.

Healthcare Informatics: Tell us about your recent work in the inpatient-outpatient integration arena.

Janie Tremlett: Concordant, as a company, focuses on the EHR and on ambulatory and clinical information systems; and I head up strategic consulting. So I work with [hospital] CIOs and with physician groups to make this stuff happen. And I recently held a CIO forum on this topic. That gathering came about because five CIOs were calling me with the same kinds of questions, so we ended up holding the meeting on July 15 in Boston. I had about five CIOs. And I asked them for their top three to five issues, and also presented some industry information on where people were at.

HCI: What were the concerns that were brought forward in the meeting?

Tremlett: Among their top issues was the patient master index; and people are really struggling with this now, because the interfaces had been point-to-point, but doing it holistically across the health system is really magnifying the problems. Others were integration of multiple EMR platforms; patient consent; medication integration; the cost of HIE sustainability; and affiliated physician networks. And what we talked about there was governance. And regional versus enterprise, versus statewide HIEs, and who should do what, where. A couple of light topics for breakfast! [laughs]

HCI: What does that list of concerns say to you about the challenges that CIOs are facing broadly in knitting all these systems together?

Tremlett: I think this list of concerns was inevitable. As you know, healthcare has been so siloed in so many ways, in terms of the culture, the technology, the workflow, everything. And everybody’s been fine with that isolation. But now when technology is being leveraged to try to bring this together, initially, the hardest thing is actually getting rid of the cultural and process silos. And changing things across a whole integrated health system is a tremendous challenge. In fact, this list is a subset of the headliner issue, which is the human nature piece of this, of having all these little silos; I said to the CIOs, those are he underlying issues you bang your heads against every day.

HCI: Doesn’t that speak to the need for CIOs to gather all the right people together at the table to begin with—the clinician leaders, clinical informaticists, and the other leaders needed to really make things happen?

Tremlett: Exactly. We talk in depth with CIOs about governance and staffing; and in virtually 100 percent of the organizations we go into, they find they need to change structures around people. We’ve had staffing engagements with people for three years now, where, once they’ve implemented the EHRs, they then find themselves looking for the people who can help create continuity across the continuum of care. So you might have great clinicians who can go out and figure out a practice workflow; but now they need to go out and talk to the lab directors and the long-term care directors, and I think that, there, you need a different skill set.

HCI: Isn’t it a chicken-or-egg problem, in terms of needing clinical informaticists to help to begin to solve these problems to begin with? Yet the reality is that most organizations don’t obtain those informaticists until they’re up against the problems.