Achieving a Community-Wide Approach to M.D. Connectivity

The issue of physician connectivity is one that is posing challenges—and offering opportunities—for CIOs nationwide. At the Worcester, Mass.-based UMass Memorial Health Care, a seven-campus integrated health system, Senior Vice President and CIO George Brenckle, Ph.D., has focused his efforts in that area and on the ongoing development of a dashboard that allows all types of physicians, whether from among the system’s 1,500 salaried physician organization, or from among about 1,000 community-based physicians, to view the entire patient record, across multiple systems that include the Malvern, Pa.-based Siemens Healthcare’s Soarian system (inpatient), and the Chicago-based Allscripts’ system (outpatient). Brenckle and his colleagues are using the Chicago-based Initiate Systems and the Pittsburgh-based dbMotion, which have developed a community-wide dashboard for patient information for physicians, for that capability. His approach is one of many diverse approaches to physician connectivity being pursued out in the field. Healthcare Informatics will provide a broader look at the subject in its upcoming October cover story.

Brenckle spoke recently on this topic to HCI Editor-in-Chief Mark Hagland. Below are excerpts from that interview.

Healthcare Informatics: Please tell me about your health system.

George Brenckle, Ph.D.: We have seven campuses in our integrated system. In Worcester, we have three campuses that make up UMass Memorial Medical Center. We’re affiliated with UMass Medical School. Our total bed size is about 1,100 beds. And our facilities vary in size from that of the medical center, with 780 beds, to a community hospital with two campuses and around 125 beds, as well as a 42-bed rural hospital.

We’re Allscripts for ambulatory, and are implementing Siemens Soarian for inpatient. And we have a multi-campus medical center in Worcester, and then four member hospitals across central Massachusetts, and a faculty practice that is salaried, and a community medical group that is salaried also.

HCI: How many physicians are in those two groups?

Brenckle: Altogether, we have about 1,500 salaried physicians in our system. We also have about 1,000 independent community physicians who are affiliated with us. They are located throughout central and western Massachusetts, reaching into southern Vermont and New Hampshire and northern Connecticut. And about 30 percent of inpatient admissions come through our affiliated physicians.

HCI: You’ve created a portal for the physicians?

Brenckle: Yes. A lot of places have tried to take a single-vendor approach, with one database, clinical data repository, EMR, etc. That approach has a lot of advantages, but also a lot of disadvantages. One of the things I was confronted with when I got here was, how much do I rip out? We already had a major commitment with Allscripts when I came in 2007. And the Allscripts implementation was well under way. And right when I got here, we were bringing our first pilot sites up live, and the idea of stopping that and reconfiguring; you had to rethink that. Another disadvantage of trying to go with one vendor is that, I don’t care how big you are, you can’t be good at everything. And so by saying, we’re going with one vendor, you have to make some compromises. And the third thing is, if you say, in the future, I’m going to reach out to the community, you’re in a multi-vendor situation inevitably anyway, as you try to integrate with hundreds of community physicians and some community medical centers.

HCI: Tell me about the interfacing between Allscripts and Siemens Soarian?

Brenckle: We have two electronic medical records. And we’ve taken the approach, for a patient being seen here at UMass Memorial, that it is a patient-centric record. So there is one record on the ambulatory side. We’re not being practice-specific, we’re being patient-specific, across primary care and specialists. And that’s taken some work to work through the details of that, particularly in the specialty areas. Now one of the things we’ve got to recognize is that not everyone has an inpatient encounter, and actually a very small proportion of our people have an inpatient encounter. In fact, of all our patients who had an outpatient visit, only 9 percent had an inpatient stay. Then we looked and said, OK, we’ve got a separate record for the inpatient encounter. The ambulatory record is single and longitudinal, and the anchor is ambulatory; everyone has that.

HCI: So then, as a patient, if I’m admitted to UMass Memorial, is a link created?

Brenckle: Yes. When you think about the inpatient encounter, it tends to be very specific: You’re coming in on a certain date, you’re treated for a specific time, and for a specific condition, and you’re released on a specific date. Indeed, inpatient stays are very specific and also very information-intensive. So we recognize this is a different kind of thing, but there’s continuity we want to flow through it. So we want access to the problem list, the medication list, so we can do medication reconciliation upon admission and [see an] allergy list, and we want access to their history, background, etc. So when we create the inpatient record, we will bring across those key pieces of information. And those pieces are populated into the inpatient workflow in an automated way. We’ve been implementing Allscripts, we have about 600 physicians up on Allscripts; we’re in the process of implementing Soarian, but we’re not live yet right now. We are running Meditech, and are moving to Soarian, and will build this capability within Soarian; we go live next summer.

And there’s one more piece of this. There’s that information that comes from the ambulatory setting into the acute-care encounter; and then at the end of that encounter, what goes back? We’re looking at discharge summary, discharge labs, discharge meds, and they will go back and be in the ambulatory record. And what we’re trying to deal with here is, what kind of information is appropriate? What does the referring physician need to know? Probably not my vitals on day two of my inpatient stay. We’re trying to avoid dumping huge amounts of data out there. Because particularly when you’re in an ICU, you’re generating massive amounts of data. So we’ve been having discussions with our physician groups, asking, what kinds of information do you need going in and what kinds going out? And what are the transitions, and what kinds of information need to flow through those transitions? And how do we get to information that we need? So recognizing that we have a dual environment, we created the capability for a sort of a health information exchange/aggregation engine/portal, and we’re using dbMotion for that.

HCI: That’s the element involving the dashboard, correct?

Brenckle: Yes, it’s related to the capability of seeing a composite view of the patient, regardless of the setting of care. We’ve architected this so that when you’re admitted to the hospital, you just need the most basic stuff from outpatient, and to be able to look at it quickly. So when you’re in Soarian, and you’re a hospitalist on the floor, you’ll be able to click on a button and get the dbMotion dashboard; the same thing if you’re an office-based physician in Allscripts. The unifying factor will be the dbMotion dashboard.

Now the thing is, if you start saying, I want to reach out to the community, and I want to make this work for independent physicians out in the community as well as ourselves, and not everyone has Allscripts or Soarian, this approach has enabled us to say, for example, if we’re working with a primary care practice that’s implemented Epic, we can do this for them as well. And we’ve actually done this for a few small practices that are using GE Centricity and eClinicalWorks; we’re talking to community health centers using NextGen; and we’ve done it with a large physician practice using Epic; and we have some pretty good examples.

HCI: So inevitably, you believe this heterodox approach is necessary, because ultimately, not everyone in a community will use the same system?

Brenckle: Absolutely. Now, we do compete for patients and for doctors, with other hospitals in the community. And so, if an independent physician in a two-physician practice wants to automate, and comes to us, what do we do? So we say, we have this great ambulatory EMR we’re implementing with all our docs, and we’ll provide you with that. The bad news is you’re now connected with a big academic medical center. And not everyone is thrilled with that aspect of it. So our emphasis is on the connectivity, not on controlling doctors’ computing.

HCI: But your overall vision is seamless connectivity for physicians?

Brenckle: That’s exactly right. We’ve created what we call a connected healthcare community.