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A Chat with Beth Israel's CIO John Halamka, Part II

February 8, 2008
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John Halamka is leading the integration of Beth Israel Medical Center with the docs in its associated IPA.

Not to be outdone by his neighbors at Partners HealthCare, John Halamka, M.D., CIO of Beth Israel Deaconess Medical Center (BIDMC) and Harvard Medical School, is hard at work integrating his acute facility with associated physician practices. The undertaking is a massive one requiring the build out of infrastructure and plans for ongoing support. Recently, Halamka chatted with HCI Editor-in-Chief Anthony Guerra about his plans to electronically ink the acute and ambulatory worlds.

Click here for Part I

AG: Is this a one-way thing? If a doc goes into the Beth Israel Deaconess HIS while in the hospital, can they see information sitting in their eClinicalWorks patient record?

JH: Let me tell you the two things we have done there. So this is sort of an interesting privacy question, in that, it is common for physicians in the community to look into the hospitals’ information systems, but not so common for the hospitals to look into their private practice systems.

So we have two things: the first is we know one level of clinical integration has to be the pay-for-performance and quality-analysis side. Once nice feature of eClinicalWorks 8.0, which is the version we’re rolling out, is that it allows distributed federated queries. This allows the medical director or the physicians' organization to say, ‘I wonder how many diabetics have a hemoglobin A1c throughout these practices.’ They then go out and run a query. That’s one way.

The other way is we have used clinical summary documents that enable the docs in eClinicalWorks to forward a continuity of care document to a physician at the hospital that summarizes the problems with the medication lists, last labs, that sort of thing. So rather than having a doc in the hospital look real time into the private practice system, it’s the private practitioner who pushes out the clinical summary to the doc in the hospital. And that way, from a privacy standpoint, it covers things a little nicer.

AG: And so the physicians in this case don’t feel their information is vulnerable because they decide what to push out?

JH: Exactly. We have tried multiple models in our RHIO. ‘Everyone should see everything. It’s a pull model.’ And the docs say, ‘I have a hard time with that, the patient has certain preferences, I have certain control I want to maintain. But pushing a clinical summary — good, it’s between me and the doc I’m pushing it to.’ Not anyone can look at anything.

AG: When did you first start the conversation with the physician organization that you wanted to move in this direction?

JH: One year ago, we put together this vision, and we recognized it will cost about $4 million to initially execute putting up a hosting center, trying to roll out to our PCPs in the community. So then I had to go to the board, and not only the hospital board, but the physician organization board, and we agreed that we would do a $2 million physician and $2 million hospital contribution. And so building the governance, getting the funding, getting all the contracts done with eClinicalWorks and Concordant took some time. And I also brought in an ethical hacking firm called Third Brigade, and they are ensuring that all the things we’re building are incredibly secure. So all that, and all the planning and the project management, took about a year to do. So we’re now in throes of getting ready to do our pilot of three doctor’s offices between now and June. And once we finish our pilots, then we’ll be rolling out up to 300 docs. So obviously we’re refining cost models, figuring out exactly what it’s going to cost. I’ll know more in a couple of months.

AG: When did you pick eClinicalWorks?

JH: They were chosen early on, and here’s the interesting history on that. This is almost a year ago. In Massachusetts with Mickey Tripathi’s Mass E-Health Collaborative, you had cities getting EHRs and docs in those three cities were offered any of five EMRs. Ninety percent of the docs chose eClinicalWorks. So in our area, the notion of a Web-based, ASP, fully integrated practice management and EHR is what the docs want, and really it’s the only vendor in town for the small practice offering that Web-based ASP model. So a year ago eClinicalWorks was chosen by the whole community, as well as our docs, as the right choice.

AG: And Concordant, when did that get done?

JH: Well, we finished it recently, but for six months we were looking at some really interesting new business models. Concordant has traditionally been the desktop, the doctor’s office. We said, hey, you guys have such expertise in eClinicalWorks, why not host the application in a facility and not only take over the desktop but also the server side. And that’s what they have agreed to do. So we really expanded their capacity and their role in all of this, so that took a couple of months of planning.

AG: So the constituencies and systems in this project include: the medical center, the physicians’ organization, you have your homegrown HIS, eClinicalWorks, Concordant and Third Brigade? Am I missing anyone?

JH: There are two other players that I’m bringing in. The Mass E-Health Collaborative itself with Mickey Tripathi. He has some really great experience in rolling out eClinicalWorks, and so I’m going to seek his organization’s advice in practice implementations.

And in our state, we have the peer review organization MassPro and they do a lot of the CMS demonstration projects for getting EHRs rolled out like DoqIT. So I partnered with those guys to make sure we’re very well plugged in to any CMS demonstrations possibilities, best practices for guidelines and quality measurements. I really want to make sure that not only do I get infrastructure from Concordant, software from ECW, and practice roll out, and implementation from Mass E-Health Collaborative, security from Third Brigade, but I’m very tied into government programs where there’s pay for performance incentives and demonstration projects in CMS.

AG: Are you running this completely or working with a partner on the IPA side?

Part III will be posted in our Web-First section on Tuesday.


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