Prepare and Share:The Community Hospital’s Path to NHIN

March 1, 2006

Now is the time for community hospitals to plan for a future with nationwide interoperability.

As the United States lays a foundation for connecting healthcare communities, initially through individual hospital initiatives, next through regional health information organizations (RHIOs) and eventually through a national health information network (NHIN), what can and should community hospitals do to be part of this process? With the majority of healthcare in the U.S. delivered through community hospitals (generally hospitals with less than 200 beds), these organizations must play an integral role in the connected community fabric.

Now is the time for community hospitals to plan for a future with nationwide interoperability.

Jonathan Leviss, M.D., is medical director and Robert Seliger is CEO of Sentillion Inc., Andover, Mass. Contact them at [email protected] and [email protected] respectively.

As the United States lays a foundation for connecting healthcare communities, initially through individual hospital initiatives, next through regional health information organizations (RHIOs) and eventually through a national health information network (NHIN), what can and should community hospitals do to be part of this process? With the majority of healthcare in the U.S. delivered through community hospitals (generally hospitals with less than 200 beds), these organizations must play an integral role in the connected community fabric.

Most community hospitals, however, have limited resources and appropriately focus on the day-to-day caring for patients, not on leading the charge to connectivity. Nevertheless there are potent practical steps that community hospitals can take today to strategically position for inevitable connectivity. In particular, a two-pronged strategy exists that will enable an organization to operationally prepare for participation in a connected healthcare community, while also becoming “emotionally ready” as an organization to share with other organizations the responsibility for caring for a common community of people.

Prepare for the Years Ahead
Different technical paths to connecting provider organizations are being explored nationally, and several viable models will likely emerge. Federated messaging systems, centralized databases and hybrids of the two, will all have one thing in common—dependence on computer-based, rather than paper-based, information sharing. Moving now to the pervasive use of computers as a replacement for paper in any and eventually all aspects of the care delivery process will prepare a hospital for community connectivity whichever RHIO architecture is implemented in a hospital’s community. Once computerized, the technical potential to exchange information is at least feasible, certainly when compared to paper.

An essential step for connectivity across a community is to increase connectivity within an individual hospital. This can be achieved by maximizing the use of existing information systems and continuing to implement health information technology as part of a local hospital strategy toward a complete electronic health record (EHR) within the hospital. However, it would be prudent for community hospitals to adapt their local strategy to be consistent with community-based or regional initiatives.

If a RHIO is exploring a statewide EHR deployment, focus on medication management solutions and defer a decision about ambulatory EHRs pending the RHIO-sponsored option. Participate in discussions and committees for such communitywide projects and advocate for hospital needs. Most modern information systems vendors will create ways to be compliant with evolving standards for data exchange, or the market will not support their continued existence. Therefore, when selecting technologies for a hospital, focus on the value of a project over the next two to five years, not whether it will be compliant with a standard five to 10 years from now.

Put computers everywhere in order to enable caregivers to become accustomed to using computers as an alternative to paper whenever information is retrieved, and ultimately, whenever information is recorded. If computers are not pervasive and advantageous, then caregivers will continue to rely on paper as the most accessible medium. Enable your IT help desk to effectively support the expanded computer use and dependence. For example, a help desk that learns to quickly address a pharmacist’s problems using e-mail will be better prepared for the later physician needs of an immediate fix to a medication ordering process.

Do whatever is possible to make information accessible to caregivers who are remote from your facilities; provide computer-based access to information, from phone numbers to medication formularies to lab results. Access to electronic information enables a physician to immediately end old, inefficient routines, such as calling a nurses’ station for test results. Physicians accustomed to changing such processes outside of the hospital will be more comfortable accommodating changes inside the hospital.

Additionally, the process of computerizing basic processes prepares an organization emotionally for the complex cultural transformation involved in connected healthcare communities. Clinician discussions in committees and in the hallway about how to cope with receiving test results faster and more efficiently within the hospital will minimize, if not completely avoid, the shock that would otherwise be associated with suddenly becoming part of a larger connected world where such information is shared between hospitals.

Involve patients in projects to put online information and services that would be of use to them. As with caregivers, the idea is to make patients comfortable with the use of computers as a vehicle for constructively interacting with a hospital and health system, whether to find directions to an MRI facility or educational material about managing diabetes. Similarly, involve caregivers, including affiliated physicians, in identifying online content and services that would be of value to them.

Finally, in parallel to the focus on computerization, create a strategy for ensuring the security of systems and safeguarding the privacy of patients. Implementing these capabilities after computerized systems have been deployed is too risky, expensive and potentially infeasible. Discussions about the security of e-mail or physician credentialing systems will provide important experience for the later development of policies for exchanging people’s health data between independent hospitals. Starting with a solid IT security and privacy foundation will enable a wide variety of information and services to be made available to your caregivers and patients.

Adopt Sharing as a Mindset
Even if all of the technical challenges in connecting communities could be resolved with the magical wave of a hand, many healthcare organizations do not yet possess the “sharing” gene. For competitive as well as historical reasons, healthcare organizations have not had many compelling reasons to collaborate, much less share information about their own patients. The cultural evolution needed to make sharing a feasible practice cannot be achieved overnight. Instead, it must be nurtured and developed at all levels of an organization.

Starting now to share case studies, best practices, processes, services, ideas, aspirations, and even technologies can establish a culture in which sharing becomes the norm. Speak with the business managers at other organizations in a community to see if there is buying leverage by partnering for common services from vendors, be it food suppliers or technology providers; cosponsor an educational forum on cancer prevention. By working together, especially on initiatives that are not core to a hospital’s business, organizations can learn to trust each other and develop business relationships that are mutually beneficial, diminishing if not eliminating barriers to further collaboration.

As another example, identify several patients in your community who receive or have received treatment at more than one organization in the community, especially if these are community leaders who are willing to serve as information sources. Collaboratively interview these people to learn how their healthcare experiences, and perhaps even their outcomes, could have been changed or improved if the treating providers and hospitals worked together seamlessly. When hospitals, clinics, imaging centers and labs are able to interoperate, patient expectations—before, during and after a healthcare episode or experience—will be more paramount than they already are today.

Identify and explore patients’ concerns about having multiple hospitals share access to their health information. With an understanding of how to improve the experiences of patients via sharing of information or services with other organizations, identify a practical, cost-effective pilot project and implement it. Pay close attention to not only the impact that the pilot has on patients, but also to the impact it has on caregivers.

Community hospitals do not have to lead the charge to connecting healthcare communities in order to prevent winding up in the “back seat” as communities become connected. By applying a discipline to prepare and share, community hospitals will be better equipped to face the future and able to practically and effectively participate when the time comes. For some communities, the time may come sooner than for others, but it is inevitable that the universal accessibility of healthcare information will be a fundamental component of healthcare delivery practices across the U.S. In so doing, we will all move dramatically closer to the vision of completely informed care where and when it is needed.

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