Health Information Exchanges Hometown heroes
Small-town Doylestown Hospital has earned distinction for implementing a successful HIE. By Richard D. Lang
ith roots in Colonial America and bucolic Bucks County, Pa., Doylestown is quintes- sential small-town America. Thirty miles north of Philadelphia, the town of 8,600 is also home to Doylestown Hospital, which serves its county- wide population of 620,000 and has earned distinction for implementing a successful health information exchange (HIE).
Doylestown Hospital, the only U.S. hospital founded and still operated by a women’s club (the Village Improvement Association), serves as a hub for 400-plus independent physi- cians practicing 42 specialties at more than 100 practices in the region. So, it was a natural move to launch the Doylestown Clinical Network (DCN) HIE in 2007.
The DCN HIE has become a common link among the hospital’s medical staff. The HIE has helped community phy- sicians improve care and reduce costs – and it has propelled Doylestown Hospital to the ranks of Thomson Reuters 100 Top Hospitals and 50 Top Cardio Hospitals for 2012. To date, community providers have accessed the HIE more than 2.5 million times for the electronic records of about 350,000 patients. Of the HIE accesses, 1.3 million were then downloaded to physician electronic health records (EHRs); 1 million of those data retrievals have been medication associ- ated, 100,000 have been for allergies and another 100,000 for problem lists. However, achieving the level of physician acceptance and sustainable network traffic required for a successful HIE did not occur overnight.
If you build it
As states, communities and health systems plan and imple- ment HIEs, many healthcare leaders assume that physicians will access the data simply because it is finally available. Doylestown Hospital has discovered launching an HIE that connects independent, office-based physicians and a hospital does not in itself automatically translate to clinician accep- tance and usage. Collaborative policies and seamless data integration are critical. To put it another way: Clinicians must be engaged in a “cultural interface” as well as a user interface. Doylestown’s healthcare community is inherently col- laborative. At the time of Y2K, for instance, local physicians
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approached the hospi- tal for help selecting an EHR platform that would bring them as a collective group into the 21st century. As a result, about eight in 10 doctors in the community now share the same EHR system as the hospital. Given the common platform, it was only a matter of time before doctors wanted to share patient data like demograph- ics, laboratory results, allergies and medications. It was a logical next step to facilitate this information sharing through NextGen Healthcare’s HIE. The hospital was able to build interfaces to connect the few physician offices on disparate EHR platforms, and launched the HIE initially as a portal.
Richard D. Lang, Ed.D, PMP, FHIMSS, is VP and CIO at Doylestown Hospital. For more on NextGen Healthcare: www.rsleads.com/210ht-209
Single point of entry
When DCN first was launched, accessing HIE information required physicians to leave their practice EHR systems and log into a portal. This extra step represented a disruption to physician workflow and negatively impacted usage. IT surveys at the time, in fact, revealed the surprising truth that after initial enthusiasm, HIE usage dropped off. That was when Doylestown realized that data from an HIE must be seam- lessly integrated into the patient’s electronic record prior to an encounter in order to obtain maximum usage. Doylestown worked with the hospital’s HIE/EHR tech- nology vendor and its own information technology staff to ensure that updated data were automatically pushed to the patient record. Now, when a patient arrives in the hospital’s emergency department or any DCN-linked practice, the most current data has already been uploaded into the record. Physicians do not need to remember to request the updated information or manually reconcile the chart. The integration was so effective that physicians now do not realize they are using an HIE because it does not add extra steps to a physi- cian’s workflow.
Not hospital-centric Achieving physician buy-in and adoption of an HIE is a multidimensional process. At Doylestown, it began with
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