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Easing the Migration Strain

June 6, 2011
by Mark Hagland
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The Lahey Clinic integrated health system finds solutions in migrating its MDs to its EHR

The Lahey Clinic is a fully integrated health system that encompasses a flagship, 317-bed hospital facility (Lahey Clinical Medical Center) in Burlington, Mass., a smaller hospital, Lahey Clinic Medical Center, North Shore, in Peabody (with 800 outpatient visits a day and 10 inpatient beds), and two physician groups with over 500 physicians in 18 community group practices, logging 1.2 million clinic visits a year, across its service.

The Lahey Clinic is a fully integrated health system that encompasses a flagship, 317-bed hospital facility (Lahey Clinical Medical Center) in Burlington, Mass., a smaller hospital, Lahey Clinic Medical Center, North Shore, in Peabody (with 800 outpatient visits a day and 10 inpatient beds), and two physician groups with over 500 physicians in 18 community group practices, logging 1.2 million clinic visits a year, across its service area in eastern Massachusetts.

The ongoing rollout of the organization’s electronic health record (EHR) organization-wide continues to ramp up over time. (The Lahey organization uses the Chicago-based Allscripts solution outpatient, and the Atlanta-based Eclipsys system—now part of the merged Allscripts-Eclipsys organization—inpatient.) One of the major challenges of the ongoing rollout across so many locations and physician practices, says Lori Jayne, director of health information management and privacy officer for the integrated Lahey Clinic organization, has been creating image-on-demand availability and managing the storage aspects of imaging informatics. Jayne and her colleagues turned to the Boston-based Iron Mountain Incorporated to help manage storage and image availability issues.

Jayne spoke recently with HCI Editor-in-Chief Mark Hagland regarding the ongoing change process taking place within the Lahey Clinic integrated organization. Below are excerpts from that interview.

Please tell us about the background to your current implementation and image and data management work.
We used to have traditional paper and dictation transcription and front-end and back-end voice recognition, but we needed to jump into the EHR. And so we went from clinic to clinic to clinic; and with that, we have a content management system—a CMS—and we revamped all our forms for current care. Then we developed chart notes, everything, for the EHR; but there was definitely a gap in terms of how we got away from the tethered record. Image on demand is about transforming paper and getting away from that tethered paper record.

It’s challenging for [providers] to abstract old, archived information from paper charts; and we have 1.3 million active records. So Iron Mountain assisted me. We needed to identify how to assist the clinicians at the point of care to migrate on the electronic record. So we sat down and developed an archive-assisted record. We went to anesthesia and said, you used to pull a couple of hundred paper records a week. Now, Iron Mountain pulls that for them, but abstracts certain forms required for patient care. So Iron Mountain is maintaining the paper records. In the old days, I had 7,000-9,000 paper records moving around every day, several years ago. We’ve been digitally converting information as we can, but also with their assistance, we’re going into those old archive records, and we’ve developed record sets, and they scan on demand. So for anesthesia, they want the anesthesia note, the last operation (op) note. So we worked to develop those archived, abstracted record sets. We’ve been doing this now for nearly two years.

And it’s gone well?
Yes, it’s gone very well.

And the physician satisfaction has been high?
Most definitely, because they’re only working in one environment now. So Dr. Smith will ask for an old record, and we’ll already know what Dr. Smith wants. And I can scan the entire record, or a more comprehensive abstract, or just go with their traditional abstract, and then physicians can request more, if they don’t see what they want. It takes less than 24 hours. But [health information management] can turn something around to me within two hours, if it’s urgent. In the old days, that would have meant pulling it, throwing it on the truck, delivering it here and getting it to the units, and it could potentially take a day. It’s typically taking within 24 hours.

The advantage is that you’re not circulating tons of paper records anymore, correct?
Exactly; and it’s the elimination of the touch time for all the people in the chain as well, that is another advantage, and we’re allowing physicians to access the right information at the right time. In the past, some of the clinics had clinic staff, and some of my staff as well, coming in two hours before clinic opening just to prep charts. Now, there will be some records that will never be able to be digitized, just because of the intensity of the form or the type of information. So there will always be a need to scan.

What would your advice be for healthcare IT leaders when thinking about these kinds of opportunities?
Obviously, what are important are the accessibility of the information, and assisting clinicians in migrating from the paper to the electronic world. A lot of organizations stay in that dual world for a long time, and it’s very frustrating. Additionally, for certain types of records, such as transplant services—any area where there’s lifelong need—we might scan the entire record as a matter of course. But once you digitize things, then the mining of that information changes. And anything digital, like all the dictated notes, we can data-mine; anything from radiology, including data and images in PACS and RIS systems [picture archiving and communications systems and radiology information systems]; we can search on words, meds, anything like that.

What should people think about in terms of the costs, setup, maintenance, support, involved?
The support, once it gets up and running—it’s that you need to eliminate the touch time as much as possible. So whatever capture process you use—you don’t want to stick a piece of paper with no identifiers into a scan, because someone will have to manually abstract and add identifiers such as patient name, etc. If you can automate upfront, that makes you much more efficient upfront. So whether you use barcode stickers, or in our case, every form comes out of the CMS, for standardization. So on all my forms, they tap into my master patient index for the correct name, correct date, all the patient identifiers, for it to be automatically indexed into the EHR.

Do you have anything else you’d like to add?
We have an internal process, but because we were very efficient, we were able to collaborate with vendors to bridge that gap even further.


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