One of the oft-repeated reasons healthcare organizations are advised to implement an enterprise master patient index, or EMPI, touches on the fear of a worst-case scenario, such as an unconscious patient admitted to an emergency room away from his or her hometown and regular healthcare providers. Yet, one technology industry executive says a far more common market motivator is becoming important in driving the EMPI market.
"In the last six to 12 months, the customer satisfaction issue is becoming more prominent," says Lorraine Fernandes, senior vice president of healthcare practices at EMPI vendor Initiate Systems, Chicago. "People recognize it's a competitive market, and people have a choice in competition. So you need to treat them right when they come in the front door. Don't ask them to fill out a form 12 times because they've hit 12 different touch points of your system over the course of a week's time. That's something fairly new that we're seeing a lot more."
An industry survey released in 2006 by the Chicago-based HIMSS Foundation and the Dorenfest Institute says that EMPI implementation is still in its early stages (www.himss.org/DorenfestInstitute/docs/ClinicalSystemsHospitalMarket.pdf), with 1,048 hospitals — 26 percent of the survey's overall sample — reporting they are either currently running or contracted to install an EMPI. This is the lowest installation rate of 12 clinical IT systems included in the survey.
However, a number of experts say sharing patients' demographic data across organizations, plus IT-dependent financial incentives, will drive the EMPI market just as compellingly as customer satisfaction and patient safety issues. These factors will also mandate that provider organizations extend the reach of their EMPI technology beyond the walls of acute-care facilities.
EMPI & P4P
"The short term driver now is to allow the small- to medium-sized practices to participate in pay-for-performance," says Stephen Carson, M.D., chief medical officer of the San Diego County Medical Society Foundation, which recently installed EMPI technology for its regional health information organization (RHIO), the San Diego Medical Information Network Exchange (SD-MINE). Carson says physicians in small and medium-sized practices fear that large groups have gotten a leg up in technology implementation enabling pay-for-performance premiums, and want to reduce the disparity.
Barry Hieb, M.D., research director for Gartner Inc., Stamford, Conn., says the EMPI market is maturing. "There's no question that anybody who is serious about exchanging data needs to get one," he says, adding that one of the technology's most likely customer bases, the RHIO market, is hampered by unclear business models.
"I think every IDN, every RHIO, would buy one if they didn't have to spend real money to get one," Hieb says. "RHIOs are particularly a problem, because all of them, with maybe two exceptions, are grant funded."
The quicker the better
RHIOs are still investing in EMPI technology despite their uncertain futures. One possible avenue toward cost-effective EMPI deployment, says Joann Kern, vice president of clinical strategy for consulting and technology firm Healthvision, Irving, Texas, is to adopt a modular architecture and shorter timeframe for deployment and payoff.
"The next (learning) curve is how to turn 12- to 18-month EMPI implementations into a three-month implementation," Kern says. "There's not a lot of money supporting the RHIO initiatives and a 12- to 24- month return on investment is not going to be acceptable."
The SD-MINE initiative is powered by a SeeBeyond eIndex EMPI from Sun Microsystems, Santa Clara, Calif. And according to Carson, the first data in the EMPI is indeed based on the sort of incremental principles Kern recommends.
"The one EMPI system that is truly interoperable around the community is our San Diego immunization registry," Carson says. "We already have 800,000 discrete and distinct immunization records stored in the registry, and we've decided to build incrementally off that registry, because immunization records are one thing people don't get overly concerned about being private, and it's functional. Multiple hospitals and physicians around the county are accessing it. That incremental approach is pretty cost-effective."
Vermont's sole RHIO, Vermont Information Technology Leaders (VITL), Montpelier, will count on the already cooperative nature of the state's provider community to smooth deployment (at press time, VITL was in the final stage of choosing an EMPI vendor). VITL President Greg Farnum says the state's small population (600,000), precludes the need for physician groups or hospitals to buy an EMPI, yet the benefits of a central EMPI accessible to all providers is considered critical in next-generation networks.
"It's a bit of a foreign concept, because we are dealing with so many small practices that don't necessarily need the sophistication of an EMPI in their daily workflow," Farnum says. "Once we enable this in a central location and start showing folks the benefits of an EMPI and what it can do to help reduce duplication and waste and improve workflow, it's truly something that will be demanded just because of the efficiency benefits."
Gartner analyst Hieb suggests one possible way to combat the high cost of EMPI technology in the nascent RHIO setting is to have vendors offer it as a service, on a per-transaction basis. "Ultimately, you might argue that will be the model that will be most profitable over the long term," he says.
Greg Goth is a freelance writer based in Oakville, Conn.