A Nebraska Hospital Embarks on HIE

A Three-Pronged Approach Toward MUWhen Fremont Area Medical Center (FAMC) in Fremont, Neb., pondered its journey toward meaningful use, their central goal was health information exchange (HIE) in and around its county, Dodge County. In addition to its 202-bed hospital, FAMC employs one physician practice and has several other independent, affiliated practices.FAMC has a three-pronged approach to achieve meaningful use. First, its leaders are seeking to add computerized physician order entry (CPOE) to their Cerner Millennium clinical information system (from the Kansas City-based Cerner Corporation). The next step is to bring six physician practices online with their ambulatory EMR systems; and finally, FAMC plans to link up all the facilities with a community HIE. Ken Pitz, M.D., FAMC’sCMIO, says his organization seeks to link up about 50 physicians, and then eventually have up to 70 total medical staff involved in the HIE as time goes on.“Our first pilot [practice] is up on the practice management side, and they will be going up on the clinical side this fall,” says Pitz. “We have a second pilot [practice] that will be going live with their practice management in about two weeks and live with their clinical EMR four weeks from now.”Pitz adds a third pilot practice will be fully functional by October, with three more practices going up by the end of the year or early next year.

Ken Pitz, M.D.“There may be one or two other small practices that may not go electronic, but we probably would still offer them some type of Web-based interface with the HIE,” says Pitz. Eventually, FAMC hopes to get all interested practices onboard next summer or fall. And further down the line, FAMC will connect with the Nebraska Health Information Initiative (NeHII), the statewide health information exchange. The Nuts and BoltsFAMC opted to use a central repository for its HIE in order to facilitate community health reporting. “When we looked at Axolotl—that’s what the state of Nebraska has—it’s a non-federated model, and that was not quite the direction we wanted to go with for our community,” says Richard Beran, FAMC’s director of information services, referring to the San Jose, Calif.-basedAxolotl Corporation. FAMC is partnering with the St. Paul, Minn.-based Lawson instead, which purchased Dallas-based integration and application technology company HealthVision this January.FAMC has the basics out of the way, but still has a lot of action items left to address in order to make the health information exchange a reality. Namely, what’s left is to figure out a governing structure that has the right balance of physician and hospital administration input. Other next steps include defining what facilities will be able to participate; figuring out how the HIE will share data and build a database; and addressing the necessary privacy and security issues.FAMC intends to initially fund startup costs, and thereafter charge an annual subscription fee for physicians to participate. This is how Pitz and Beran intend to drive sustainability. “Our goal as a community is to exchange and share health information, and the use of the information exchange I think will drive the sustainability,” says Beran. “People will see the value.”

Richard Beran Obstacles and SolutionsFAMC’s initial challenges are familiar to those of many fledgling HIEs—the lack of proven models in the industry and the struggle to get physicians on board. “It’s been a challenge to get people to understand that this is a necessary step for the future of medicine in this country,” says Pitz. “Obviously, we can’t keep going the way we’re going; it’s just too expensive.”Beran is realistic about FAMC’s ambitious endeavor, pointing out that information exchanges are only as good as their data. “Until we can get the hospital information system complete, where we have everything we need to share, allergies, problem lists, ect., an exchange doesn’t do much good,” says Beran. “And same on the ambulatory side, we need to have our physician practices adopt an EMR and use it, so that data can be brought into the exchange.”Pitz sees the only way to succeed in the HIE business is to embark on talks with all major stakeholders early in the game. “If you bring someone in too late, it’s just going to cause problems and delays,” he says. “You need all that input because not one group or the other can drive this. It’s got to be a collaborative effort, and that takes time.”