Ten years ago, IT leaders at Milford Regional Hospital in Massachusetts, a 145-bed, acute-care facility serving a region of 20-plus towns, started to realize that it had a clear technology need: being able to integrate different sources of data, especially as its ambulatory practice was going live with its GE Centricity electronic health record (EHR) at the time.
Indeed, sending all laboratory and radiology results, and other transcribed reports to the practice’s EHR was integral, so the IT team started their search for a vendor to not only do that integration but also to look at all of Milford Regional’s other interfaces and consolidate them as well. They ended up choosing an interface engine product from Summit Healthcare, a Braintree, Mass.-based vendor focused on healthcare integration. Soon after the partnership commenced, Milford Regional went live with six interfaces in a six-week timeframe, says Nicole Heim, the hospital’s CIO. “Initially, we didn’t have an in-house interface team so we leaned on Summit to do the outsourcing of the interface development. So it was a super busy six weeks trying to get everything set up, as you can imagine.”
Nicole Heim
In a recent interview with Healthcare Informatics, Heim discusses that process, how interoperability is progressing at Milford Regional, and what else is top of mind for her as a CIO these days. Below are excerpts of that discussion.
How as the Summit Exchange platform helped your hospital’s interoperability needs?
Well at the time, GE Centricity didn’t have the capability to do all of the customization on their end, so we leveraged [Summit’s] tools to do the customizations that we needed to make the results look the best they could in the GE EHR. Summit’s team helped us make that six-week timeline, and then we went live with it.
From there, we had duplications of admission interfaces and results interfaces between our systems, and mostly at the time it was just between our internal systems, so sending data from one system to another. Then, over the next few years we looked at how we could consolidate those down and reduce maintenance costs, which we were able to realize.
[The platform] operates like a traffic cop, so it could filter out results to go to just this system or this provider, and it can make changes to the way the message is so that it displays better in the resulting system. We had to do that with GE because of the way that system works. We can send one admissions feed, and based on the location of the patient or based on the provider, we can send it to what system it needs to go to internally or what physician’s office it needs to go to on the outside.
Our physician group, the Tri-County Medical Associates, is about 100 physicians now, so we send [transactions] to those offices, and then we have a handful of other facilities that we send information to, like Reliant Medical Group, Partners, who is across the street from us and provides oncology services, and then some other independent physicians. We send a lot more outbound results and to some of those organizations, we send them continuity of care documents (CCDs) too. Inbound, we receive the CCD documents from our physician group when they refer a patient here for services, and from that practice, we receive all lab orders electronically.
That was a good project to highlight this partnership with Summit. We started with this interface engine and I was looking for a new solution to integrate these orders electronically, from the physician’s office; they were complaining that the loop of ordering lab orders and getting results was not closed, that they had to reconcile these orders to results manually, so they wanted a process to automate that.
Are you connected to the Massachusetts statewide HIE (the Mass HIway)?
We are connected and we were the first organization in Massachusetts to send live production messages to the HIway (Massachusetts Health Information Highway). We received a grant a few years back to do some work with two post-acute care facilities—a home care facility and an skilled nursing facility—so we partnered with that grant and sent those facilities continuity of care documents through the highway. So it goes from the Meditech EHR to the HIway, and then over to them. Since then we have expanded that to send the CCD to our physician group, and that goes through the HIway as well.
As a hospital CIO, what else is top of mind for you today? What is most pressing?
Plans are underway for meaningful use Stage 3; we are still in the stage of understanding the objectives, doing a gap analysis, and figuring out if we need to purchase anything to achieve Stage 3. It’s rather frustrating that some of the vendors are not there as far as being able to tell us if they are certifying their existing products for Stage 3—we have found some vendors are not doing that; they’re sunsetting their existing products—and others don’t have a viable solution to show us at this time to meet the measures. Some people think Stage 3 is going away, but we don’t have a lot of time to secure funding, purchase products, and implement it to be ready for January 1 if we don’t move forward with those decisions soon. So our team is spinning their wheels with certain things regarding Stage 3.
And then there is security, too. That’s what keeps me up at night most. It always is security. We recently did a security risk assessment, so there are some risks we need to look at and mitigate. There is constant work with this, and you could be at a point where all your risks are mitigated but then a new risk is introduced.
I do have buy in from leadership as it relates to cybersecurity, so if I bring something forward as a concern about a new product, I do get the support that I need. But adding resources to focus on security is different, as we are a small 145-bed community hospital. We run really lean in our IT staff; I am the HIPAA security officer, and I do have two other resources, but only a fraction of their time is dedicated to security. I don’t have a CISO or a team responsible for it, so it falls on lots of different people.
There’s been talk about if Stage 3 is even worth it at this point. Do you see it as a worthy endeavor?
I don’t know that the industry is ready for the high bar that Stage 3 has set, in a few areas especially. Incorporating patient-generated health data into our EHR is something we are ready to do. That’s a huge amount of data and so much of it might not be pertinent to a hospital stay. Certainty from a population health management standpoint it makes sense, since we know what’s happening after the hospital stayؙ—but it’s not all that pertinent. Another one is secure messaging from a hospital—a few cases make sense but if the bar gets set higher, it doesn’t make as much sense as it does in the ambulatory world.
And then the biggest challenge is incorporating the CCD discrete data into the EHR from the referring facilities, for new patients specifically. We have focused on this a lot as we think it’s by far the most challenging objective. We may be ready to do that, but those facilities referring to us may not be, and we are held accountable because they’re not ready. So if everyone in my region here was ready it would be one thing. You also have to look at the workflow process—who’s going to do that clinical reconciliation of the allergies, problem lists and medications? That’s a huge change in their workflow. It will likely be the physicians but how will they handle the influx of data? Will they trust it? If they get documents from multiple sources, how will they build that into their workflows? I don’t see how they’re ready for that right now.
