Part III: Connecting the Docs
While patient care organizations around the country are building electronic medical records (EMR) systems for a variety of reasons, health information exchange (HIE) has emerged as a very compelling rationale for automation, especially among physicians and physician organizations.
One group that could be considered pioneering by nearly any yardstick is the Ann Arbor Area Health Information Exchange (A3HIE), Ann Arbor, Mich., a consortium founded on a mutual vision of sharing patient information through a single community health portal, accessed from the Web.
A3HIE is comprised of 210 physicians and 50 nurse practitioners serving 400,000 patients through one large primary care and three specialty care practices (cardiologists, gastroenterologists, and a multispecialty group).
Carlotta Gabard, a doctor of public health and A3HIE's executive director, explains that the consortium came about because its four participating medical groups were leaders among the group practices in the area that are not directly affiliated with the University of Michigan Health System (Ann Arbor) and its network, but whose leaders were looking to fast-track EMR implementation.
Though there was no initial commitment among all four groups to purchase the same EMR product, all four did eventually choose a solution from the same company, Horsham, Pa.-based NextGen Healthcare Information Systems. The four groups worked out contractual language with NextGen to allow them to communicate with each other: "We wanted to be able, because of the significant referral linkages among the groups, to be able to benefit by sharing information," Gabard explains.
Contracts were signed at the end of 2003, and the cardiology group had implemented its EMR by the end of 2004. By late 2006, all four groups had implemented. Meanwhile, the consortium went live with its community health repository in mid-2005. As a result, Gabard explains, "Anytime a patient presented to any of the four practices, and had a change in one or more of four categories — demographics, medications, allergies, problem lists — those changes were uploaded to the system." To date, she says, 40,000 patients are already in the system.
The fact that the groups were doing both initial EMR implementation and HIE at the same time is something many in healthcare would find astonishing.
"That was interesting," Gabard says. "We had a lot of discussions about it." But the opportunity to make physicians' work lives easier and more efficient, and to improve service to patients, outweighed any trepidation participants might have felt. In fact, she says, "The opportunities have included being able to reduce the cost for interfaces," with regard to connecting the medical groups to local hospitals (primarily St. Joseph Mercy Health System in Ann Arbor), and streamlining referral processes. Now, she notes, "Our referrals are really a lot more integrated."
The A3HIE venture has also overcome one of the key hurdles physician organizations face with regard to EMR.
"Physician practices are not really in the position, unless they're very big, to have the technical staff and to maintain interfaces, and to upgrade systems," Gabard notes. "That has been one of the largest opportunities in all this. AH3 can offer those connections, and provide referral reports back to primary care from specialists, and it can provide that through really one mechanism," one that has smoothed multiple processes for the participating doctors.
Gabard notes that many large organizations are cautious about adopting new technologies. However, she says, CIOs need to be ready to keep pace with physicians. "The physicians here want to move faster."
Mark Hagland is a contributing writer based in Chicago.