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Saying Yes to Integration

December 19, 2012
by Gabriel Perna
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Looking at how leading CIOs are connecting disparate systems

Across the country, IT leaders of hospitals and health systems are recognizing the importance of integration in the new healthcare environment. While some have bought into the idea of a Chief Integration Officer, others are looking at alternate paths to assimilating different electronic medical records (EMRs) and other clinical IT systems.

For the longest time, when someone asked Jim Murry, CIO of UC Irvine Healthcare, an academic medical center based in Irvine, Calif., if they could integrate various technologies, his answer would typically be, “no.” Even HL7 protocols, he says, are “very limiting.”

This changed when Allscripts opened up its EMR platform, reports Murry. He adds he found this open platform was a great opportunity to invest in those “open” tools and do some of the things that his users have been asking them to do for so long, but had either been impossible or required enormous energy and resources.  

According to Murry, the platform gives him and his colleagues the ability to integrate applications, either home grown or from a third party, seamlessly into the EMR, so much so the user doesn’t even realize it’s outside of Allscripts. He says it gives them the power to access data and logic that might not be in the EMR.

“If I have some kind of data in the EMR, but the user wants to access some other kind of data with it and view that together or act on that combined data, we can now do that through these APIs [application programming interfaces], it give them views they’ve never seen before, or logic in their workflows that they’ve never had access to before,” Murry says.

Being Realistic

At Sharp HealthCare,  a San Diego-based regional integrated health system with four acute-care hospitals, three specialty hospitals, two affiliated medical groups, a health plan, and a number of other various provider settings, vendor integration is not only something that is necessary, but it’s the very foundation for a continuum of care. So says Bill Spooner, the CIO of Sharp HealthCare and the reigning CIO of the Year by the College of Healthcare Information Management Executives (CHIME) and Healthcare Information and Management Systems Society (HIMSS).

Bill Spooner

Spooner’s belief in integration dates back 20 or so years, when a master patient index was created as a single identifier. Over the years, he says, various other elements such as integrating analytics into EMRs, have evolved within the system, but overall the idea remains a continuous challenge.

When it comes down to EMRs alone, Sharp’s various provider settings all use different systems, Spooner says. The hospitals use Cerner (Kansas City), the medical groups uses Allscripts (Chicago), and the community-based physicians are “using various other EMR products.” And at the end of the day, while a single vendor system would have its advantages, he knows it’s just not that realistic.

“The single platform option is pretty lacking,” Spooner says. “I don’t think there’s a long-term future in that. I think on top of that, putting all of your eggs in one basket, relying on a single product to support all of your needs, is a little bit risky in terms of the growth of that company, its stability, and development. Is the single company really going to provide all of the innovation you need?”

Integration Investments

To achieve interoperability between these vendors, which Spooner admits at Sharp are still “not perfectly connected,” he has looked at two different investments. He’s used a context management system, which gives them the ability to put the patient’s hospital record and his physician record from a medical group on the same screen.

Along with the context management system, he has invested in a health information exchange (HIE), from dbMotion (Pittsburgh), which partners with Allscripts. The advantage to the information exchange, Spooner says, is it can grab patient summaries from different, outside networks, whereas the context exchange can only grab summaries on the same network.

Spooner says this kind of product is where he believes the future of integration is at, at least within his own health system. He also likes the idea of patient engagement systems integrated across the continuum of care, as it “represents the sweet spot because it’s an opportunity get the patient directly involved with their health information.” Already, Sharp’s medical groups have nearly 100,000 patients signed up for their portal, and he wants to figure out a way to get the patient to look at their information “across the community.”

Voice Recognition and More

Like Spooner, UC Irvine’s Murry, has also invested in the dbMotion HIE/EMR integrated product. He says for users sitting in UC Irvine’s EMR, there is now a tab they can hit that will seamlessly look for any outside data on that patient. He adds, the hospital is looking to expand beyond this capability, where “they don’t even need in a tab,” and any outside data just shows up as an alert of some type. He also says UC Irvine is working with M*Modal (Franklin, Tenn.), to integrate voice recognition and natural language processing (NLP) within the EMR.

Jim Murry

“At the desktop, this is allowing us to integrate two types of voice with EMR,” Murry says. “One is the user can navigate the EMR through voice. The other part is I can speak to boxes into the EMR.  I can speak to the box in the EMR, which Dragon can do that today. You can click on a free text box and speak to it.  But with the API integration we’re working on with M*Modal and Allscripts, you can then take that free text after the physician has just spoken and use a natural language processing engine to go through that text and then populate structured elements in the EMR.”

Both Murry and Spooner seem to feel good about possibilities when it comes to integrated data. Murry mentioned a number of other integrated projects within his hospital, such as moving data from pre-operation to the operating room, and moving data in house between specialists.

It’s all about tying pieces across the care continuum, Spooner says. He wants integrated technologies to identify where the patient is at any given point and where the “optimal next step” should take them in their care. He also adds these technologies will be used from a population health standpoint.  

When advising those who wish to embark on a similar mission, Spooner recommends making sure it aligns closely with an organization’s business strategy and recognize that it’s an evolutionary process. “There’s that old saying, ‘Rome wasn’t built in a day,’ and I think that really applies here,” he says.

For Murry, he says as a CIO, he would push his vendor to give them the type of open platform he has been provided. “When you look at the demands that are coming at us with health reform to do what we have to do and to be competitive in the market, we are going to have to move a lot faster than we move today. This gives us the capability to move faster,” he says.

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