At a time when provider organizations are collectively—but also individually—embarking on their complex interoperability journeys, one local health system in Virginia is doing its best to keep it simple, operating under one basic premise: making it about the patient by helping physicians access the patient data they need when they need it.
Of course, healthcare interoperability is more complicated than that, but Centra Health System, a Lynchburg, Va.-based healthcare system comprised of six hospitals, centers and medical groups, and 53 ambulatory practices, has taken the challenge head on with the help of strong leadership centered around physician engagement. Centra began its interoperability journey in 1995; initially, it began building inpatient medical records that were made available to all providers and staff with patients within the organization’s system. By 2007, Centra was utilizing the Alpharetta, Ga.-based McKesson’s RelayHealth network to build out the local health information exchange (HIE).
With the help of RelayHealth—the McKesson business unit that focuses on improving clinical connectivity—Centra has succeeded with more than 33,000 orders accessed by more than 400 providers and 37,000 patients, with a more recent focus on creating a consolidated clinical document architecture (C-CDA), says John-Paul Jones, M.D., chief medical informatics officer (CMIO) at Centra, and also a practicing emergency room (ER) physician, family doctor, and local medical examiner. “We have always taken a community view that the information be centered around the patient; that’s our medical group slogan,” Jones says. When rolling out the HIE, that’s come to the forefront even more. The data must be patient-centric, wherever or whenever that encounter or that information is collected—be it a pneumonia vaccination at CVS or a critical care ICU stay. It’s all important,” Jones attests.
Centra’s inpatient acute care EHR is McKesson, while the organization uses Allscripts in the emergency department, and throughout all of its ambulatory practices, there is a mix of systems, Jones says. “You have a big variety. Expanding out even more, in Virginia, many hospitals are on Epic, but we see Cerner as well. It really depends how far you go out, and you don’t have to go out very far to get a big mix. For RelayHealth, our primary focus has been local, for developing an accountable care organization (ACO), for communication, for patient engagement, and for the patient. The majority of care will be with providers in the immediate community. We are connecting, or interconnecting with a variety of practices, with the priority being local,” he says.
John-Paul Jones, M.D.
Being a provider himself, Jones fully understands that most physicians want their tools to be bigger, better, faster, and stronger, as well as having them integrate better into their workflows. “I’m a physician, and all I want is everything,” Jones jokes. “For providers, I have what I call a two-second rule. If it takes more than two seconds for a page to come up to access the information, then we will move on, look elsewhere, or just fill in the blanks. The dirty little secret of providers is that we will use what’s accessible—but easily accessible. If it takes too many steps, too many clicks, and too much time, we will kind of have to move on,” Jones says.
To this end, providers have an array of challenges when it comes to accessing information in their technology systems. One such issue is perceived completeness, meaning that sometimes the information is there, but it’s like finding needle in a haystack. Oftentimes it requires some digging, and that’s tied into the response time and accessibility of the data,” Jones says. What’s more, another challenge for providers is relevance to the encounter, as Jones puts it. “So as an ER doc, there are bits of information that are important. That’s completely different than when I am a family practitioner, and different still than when I am wearing the hat of a local medical examiner,” he explains.
“[Can a system bring up] a particular type of encounter for a particular specialty, and tell me what’s important and what’s not important? That’s hard to do, as in most health systems, most EHRs default to just having everything in there and have the provider figure it out. EHRs 3.0 will start developing the ability to filter things for more defined roles such as an anesthesiologist vs. a general surgeon vs. a coder vs. an ER doctor. I think part of the level of dissatisfaction is not being able to identify what is important to that particular provider,” Jones says.
Indeed, Jones says that the “easiest” challenge of health information exchange is the technical aspect, while the next tier up is time and money. The biggest barrier by far though, is physician engagement, buy-in and the willingness to allow data exchange to happen, he says. “We have had an open policy regarding access to our inpatient EHR ever since it was enacted. Now with the HIE rolling out, there has been some resistance from places about sending data out of their EHRs. They are happy to take it in, but not send it out. We were surprised by that,” Jones says.