Banner Health, a large nonprofit healthcare system based in Phoenix, Ariz., embarked on a strategic initiative last year to connect its 23 hospitals in Alaska, Arizona, California, Colorado, Nebraska, Nevada, and Wyoming, with its 150 ambulatory locations, and to ultimately make business within the system easier.
“Our first interest was to allow the hospitals to communicate with our ambulatory physicians in a way that we had not previously able to,” says Gregory Raglow, M.D., medical informatics director for Banner Health.
Like multi-system or statewide health information exchanges (HIEs), organizational health system HIEs like Banner Health’s have to come to a consensus on how to make communication flow easier among all constituents. For Banner Health, that meant all its hospitals operating on an electronic health record (EHR) from a single vendor. “Most of our applications on the inpatient side belong under Cerner [based in Kansas City, Mo.] as our vendor as a deliberate vision of our [Senior Vice President and] CIO Mike Warden who saw that standardization was the only way we were going to deploy and maintain a robust solution across our enterprise,” says Raglow. The system is also three-fourths of the way in deploying computerized physician order entry (CPOE).
Gregory Raglow, M.D.
Banner Health has started two prongs of its information exchange. Its first phase is building the pipeline from the hospitals to its ambulatory practices, the Banner Medical Group, to connect its 800 employed-physicians. Currently, hospitals share discharge summaries, ER/hospital admission notifications, operative and radiology reports back to the primary care provider.
Like its vision for a unified inpatient EHR, Banner Medical Group is halfway through rolling out a unified EHR solution provided by NextGen Health Information Exchange to its ambulatory practices. Raglow says this standardization will allow all Banner Medical Group practices to act as one entity for ease of patient care. The next phase of the information exchange is building a connection from the ambulatory side to the hospitals, which will likely start this summer and enable ambulatory practices to share patient data like medications, allergies, and problem lists through NextGen [Health Information Exchange]. “Were looking at using either the portal functionality of our NextGen Health Information Exchange, or possibly, routing that information directly into Cerner via an MPage [a tab in PowerChart], so we don’t have to go outside the native systems to view that information,” says Raglow.
A third piece of the information exchange will be linking non-employed physicians—NextGen Health Information Exchange clients first—to hospitals via portal access. Eventually Raglows says Banner Health plans to directly interface with physicians’ EHRs, while acknowledging that even the smallest interruption to physician workflow can be a significant barrier to use.
The exchange operates on a central repository model. Initially, the hospitals had reservations about security within the exchange, but leadership assuaged those fears by creating a centralized security policy, and coordinating as a system, so decisions are made in concert with all hospital leadership. To help align Banner Health with state directives, Warden sits on the board of the non-profit, public-private partnership Arizona Health-e Connection that establishes the state's e-health infrastructure.
Another challenge Banner Health is facing with its system-wide exchange is with data standardization. Currently, Banner Health hospitals employ an Enterprise Master Patient Index (EMPI) over several applications, and in 2012 it will expand to ambulatory data sources. Another effort on this front is standardizing the registration process on the inpatient and ambulatory side, which Raglow says has led to a drop in patient mismatches. Raglow adds that much hard work done remains to be done around mapping and building manual interfaces to transmit laboratory orders between the lab application in Cerner and NextGen Health Information Exchange.