Is There Value in EHR Investment for HIEs?
By Chris Stevens, product manager, Orion Health, January 2010
The importance of electronic health records increases exponentially when made available throughout the healthcare community.
The delivery of healthcare relies on accurate, up-to-date patient information. Unfortunately, much of that information resides in individual stores of paper, electronic records, databases and files scattered across all of the systems of numerous stakeholders. This is where electronic health records (EHRs) and health-information exchanges (HIEs) shine, and why so much of the national discussion now under way about the need to cut costs and increase care focuses on the meaningful use of EHRs within and among providers.The portal now enables clinicians to search for patients by name, medical record number, hospital room, floor and appointment, or under the category of recent patients.
For hospitals and doctors' practices, HIEs reduce costs by saving staff the time they spend administering, reducing redundant tests, and handling lab and radiology results. More often than not, these savings equate to a significant return on investment. For patients, the benefits include improved overall care, fewer tests and time saved with unnecessary tests and visits. For an idea of the return an HIE can bring to a community, look no further than Lahey Clinic in Burlington, Mass.
Lahey Clinic offers patients access to clinical trials of new therapies for diseases, including cancer, diabetes, heart disease and cataracts. Its research programs encompass more than 200 clinical-trial protocols, as well as participation in numerous national and international studies. This nonprofit, multispecialty group practice has about 500 physicians providing care in its area of operations, with hospitals in Burlington and Peabody, Mass. The clinic's practices provide patient access to physicians from virtually every medical specialty, and here physicians collaborate to develop personalized treatment plans.
Because each physician lacked a holistic view of patient information throughout all the various healthcare touch points, providing multidisciplinary treatment was more difficult than necessary. Physicians at the clinic, for example, used about a dozen systems to gather clinical data, including disparate lab, cardiology, pathology, radiology, dictation, admissions and registration applications.
The result was a work day that included multiple and cumbersome logon credentials, and disparate paper and digital patient data that made finding the right data when needed overly time consuming, costly and difficult. Also, staff had to physically transport records among locations. While every physician dictated notes, there was no easy way to retrieve and review them. The staff would have to print records every day for the physicians. Additionally, the disparate systems made exchanging patient information with referring physicians inefficient.
Patient Information Portal
The clinic decided to build an information-rich Web portal that would pull data from all of its disparate systems for a unified display of patient information. The ultimate goal is for the portal to be at the center of a community health-information exchange — where patient data is available wherever and whenever needed by authorized caregivers.
Using this portal, caregivers can update and access data from each individual system and store it in a common clinical data repository. The portal acts as the user front end to the repository and to some individual IT systems within the clinic, such as its document-management system.
The portal now enables clinicians to search for patients by name, medical record number, hospital room, floor and appointment, or under the category of recent patients. Once they find the patient's record, the portal gives them access to see the following information: demographic data; appointments; hospital admissions; referring providers; chart notes about the patient, which can be sorted by date and author; laboratory information (EKGs in both text and wave forms, microbiology results, color-coded abnormal results, and radiology reports with embedded links to PACs images); a list of diagnoses and procedures to comply with the Joint Commission regulations; and scanned paper documents, including documents that patients bring in from other institutions, signed consent forms for surgery, and audiology and ophthalmology reports.
Lahey Clinic assembled an advisory committee of experts and stakeholders in the new system: physicians, ancillary system owners and information services. This team reviewed the design, layout and clinical decisions. To ensure the systems value from the start, three years of converted data were incorporated into the system. Training was crucial to ensure success, so the clinic trained users through departmental presentations and provided both online manuals and training videos, while special-training Web pages were made available to non-Lahey providers.
Another consideration was the system had to have the ability to scale and integrate capabilities so that the portal could grow into an HIE.
Remaining compliant and protecting privacy was also crucial. Although all Lahey Clinic providers can access all patient data, except for confidential psychiatric records, the clinic restricts access for non-Lahey providers to patients with whom the provider has a relationship. When a referring physician sends a patient to Lahey Clinic, that physician is added to a provider table in the Lahey system, which indicates what patients that healthcare provider is able to view online. Once non-Lahey providers enter the system, they see a home page that lists all of their patients who have had clinical activity at Lahey Clinic.
For emergency room physicians who do not have a prior relationship with the patient, the portal requires that physicians enter the patient's name and date of birth. The providers then must fill in a clinical-use screen requiring them to acknowledge they are using the information to deliver care. Lahey audits use of the system to monitor which providers have accessed patient information. This ensures that providers have access to a patient's medical record but that they use that access only when they need it to provide medical care.
This is how Lahey Clinic has created a successful balance between patient privacy and system usability.
Reaching Out to the Community
The portal streamlines the flow of patient information and saves time through simplified access to many medical systems. Lahey staff says the portal has strengthened the relationship with referring providers and sees the portal as a way of getting clinicians comfortable with the idea of using EHRs. To increase the value of the system even more, Lahey Clinic is in the process of rolling out the system to non-Lahey providers, beginning with the groups that make the most-frequent referrals.
The clinic is in the process of deploying a full-fledged EHR for both in-patient and clinical settings. When the EHR is available, the portal will be able to access such information as patient medications and allergies. Lahey also is in ongoing discussions with other healthcare institutions and is encouraging them to create their own clinical data repositories and share their information with the clinic.
Ultimately, it would like to be able to display both Lahey and non-Lahey data on the same screen, while allowing each site to retain its own data. By offering the ability for local community clinics and hospitals to integrate with the solution, Lahey has ensured that at the appropriate time the clinic will be able to integrate to a statewide HIE.
Today, the portal serves 5,800 registered users, with more than 1,000 unique users signing on daily. The system is improving care and work-flow efficiency of care providers in the clinic. Because Lahey built a portal that could scale to include other providers in the area, all of those quality-of-care improvements and lower costs associated with greater access to data, improved efficiency and productivity, and reduction of redundant services can grow and be shared throughout the greater healthcare community in the region.
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