Better Information Access

Major technology projects are challenging enough in a healthcare network with several hospitals and clinics united under a single corporate parent. But getting multiple independent hospitals to agree on a master health information technology (HIT) solution serving all of them might seem impossible.

 Recently, all 16 hospitals within the Western North Carolina Health Network (WNCHN) completed the transition to an HIT umbrella solution, designed to streamline patient identification and generate more accurate, electronic patient health records in a standardized format. The member hospitals range in size from 25 to 740 beds and are spread throughout 15 western North Carolina cities and towns. The project was possible because of the hospitals’ longstanding supportive relationships with each other. They have a long history of collaboration through group purchasing, quality and wellness initiatives, even though some hospitals compete with others for patients in nearby markets.

Duplicate and Outdated Records
Over the years, and for a variety of reasons, patients visited multiple hospitals in the region for treatment. Perhaps they relocated from one town to another or received emergency care in a facility other than their “home” hospital. In such cases, their medical histories had to follow them, typically by fax, from one facility to the other.

Duplicate or outdated records became a natural byproduct of this paper-intensive system (common to hospitals and healthcare networks across the country). In addition, small oversights by healthcare providers or admissions personnel, such as forgetting to enter a patient’s middle initial, could cause confusion down the line. In a worst-case treatment scenario, especially in the emergency department, the discrepancy might cause one patient to be mistaken for someone else.

Could the WNCHN hospitals collaborate to devise a more accurate, efficient way to streamline the exchange of patient data, increase its accuracy and, in so doing, improve patient care for every WNCHN patient?

The Standards-based Approach
Through years of ongoing efforts, the WNCHN obtained $2.5 million in federal funds and $1 million from The Duke Endowment to achieve that vision. What followed the funding was the articulation of two overarching objectives for the project: 1) In the shorter term, develop a secure exchange of electronic patient information among WNCHN hospitals; and, 2) The long-term goal is to allow every patient to have a longitudinal electronic medical record (EMR) that can be accessed and updated in real time by any authorized provider.

The ability to accurately associate all historical records for a particular patient helps caregivers become more aware of all past patient healthcare experiences, providing important knowledge for devising the best care plan possible.

Perhaps the biggest practical hurdle to overcome was the fact that each hospital had its own patient-identification system. A work group—composed of representatives from the member hospitals—was assigned to research various options including enterprise master patient index (EMPI) solutions that weed out patient ID errors. The EMPI technology was evaluated, but judged too expensive and time-consuming to install. The work group realized that whatever solution was ultimately employed had to integrate seamlessly in a “vendor-neutral” fashion with each hospital’s existing health information system.

It was also essential for each hospital to retain control over its own EMRs, therefore, they could not be commingled with other hospitals’ EMRs in a central data repository. This step would help ensure the hospitals that the system remained compliant with HIPAA privacy regulations while meeting the highest security standards.

Another chief consideration was deciding which hospital personnel would have access to the EMRs. Would it be physicians only, or some combination of physicians, nurses and specialists like certified nurse anesthetists? Beyond settling that question, we also needed to address levels of access within each patient history. Would all healthcare providers be able to see every detail or would we restrict access in some way? These kinds of questions created more discussion than the IT issues that arose.

Small oversights by healthcare providers or admissions personnel, such as forgetting to enter a patient’s middle initial, could cause confusion down the line. In a worst-case treatment scenario, especially in the emergency department, the discrepancy might cause one patient to be mistaken for someone else.

Yet another potential obstacle was patient approval for record-sharing among hospitals. Should we ask patients to “opt in” to the system by having them sign a document giving each hospital permission to exchange patient data as needed? Ultimately, we rejected this method.

Steering us in this direction was the familiar HIPAA disclosure form that all hospital patients sign. It already cleared the hospitals to fax or otherwise send medical information electronically to appropriate caregivers. The hospitals concurred that patients would, therefore, need to “opt out” of our system by signing a different form.

Through a standard RFP process, WNCHN evaluated more than 20 different vendor proposals before settling on a short list of three. From this, the work group unanimously selected MEDSEEK’s Clinical Web Portal solution and overall project management from IBM. We dubbed our system “WNC Data Link.”

In addition to aggregating clinical information from disparate systems and geographically dispersed healthcare providers, it uses advanced probabilistic matching algorithms to help care providers work more efficiently. Among other things, its calculations determine whether separate electronic records for the same patient exist within the system’s master patient index (MPI), so that duplicate records can be consolidated into one patient account under a unique medical record number.

The ability to accurately associate all historical records for a particular patient helps caregivers become more aware of all past patient healthcare experiences, providing important knowledge for devising the best care plan possible. Such consolidation also provides hospital billing departments with accurate data on which to base patient charges and efficiently respond to inquiries from health insurers regarding covered benefits, co-pays and deductibles.

WNC Data Link was ready for its first go-live in January 2006, and subsequent go-lives proceeded smoothly thereafter. From the start, the system allowed authorized physicians and clinicians to view patient electronic records across all WNCHN hospital systems. Upon request, WNC Data Link searches each affiliated hospital’s information system for patient records and collates them in a standardized format in real time. Clinicians can access the records through any Internet-connected device.

When users log on to WNC Data Link, they can pull the following information related to the patients: demographics, lab results, microbiology results, medications, radiology reports, discharge summaries, histories and physicals, and allergies.

We granted full access to physicians with staff privileges at one of the 16 hospitals. We gave more restrictive access to other users, including physician office staff, emergency department clinicians, health department employees and hospital-employed case managers.

Significant Savings
Eliminating duplicate medical records, which can help us improve patient care, is a long-term priority for our network hospitals. In future phases, authorized users will be able to access electronic records from physician offices, health departments, clinics and other healthcare providers to create a longitudinal view of every patient’s medical history.

Given the number of patients that pass through the 16 hospitals each year, we believe this system has enormous potential. Implementing WNC Data Link was relatively simple because we were able to use our existing patient indexing systems and did not have to spend valuable hours retraining staff on new clinical and administrative procedures. It has already helped us realize substantial cost savings.

This has occurred, in part, because Data Link can display a discharge summary that shows whether the patient experienced a post-acute adverse drug event in the hospital. The report can be given to after-care providers, such as in-home nurses and hospice care workers, so they can avoid administering the same drug that caused the original problem. (In some cases, the new dosing is serious enough to cause a hospital readmission.) Total savings in this area alone are estimated at about $1 million annually.

Another chief consideration was deciding which hospital personnel would have access to the EMRs. Would it be physicians only, or some combination of physicians, nurses and specialists like certified nurse anesthetists?

We are realizing additional efficiencies through EMR transfers between hospitals. Instead of personnel taking time to fax and receive paper-based medical histories, full automation has become the new standard. The estimated annual savings for these processes come to $400,000. We have yet to quantify the long-term return that Data Link could yield by finding and verifying duplicate and faulty patient records.

We do, however, assume the savings realized through accurate records management will be large—especially if Data Link can assist our physicians in eliminating the ordering of redundant tests, which we believe it can. In this scenario, the hospital saves time and money by not conducting the test, while the insurance company (and sometimes the patient) saves the money that would pay for them. Combined savings through the improved procedures could total as much as $3 million to $5 million a year.

But solid numbers are only part of the Data Link story. We believe the system has already helped to accomplish a major feat: measurably improving healthcare for patients in western North Carolina.

Gary Bowers is executive director of the Western North Carolina Health Network. Contact him at [email protected].