As the acute and ambulatory settings become more intertwined, satisfying admitting physicians means offering them a view into the hospital enterprise. In the hospital of today, that means remote access to patient information, anytime, anywhere for physicians. But can hospitals handle the IT challenges of this new paradigm?

For many hospitals, this IT transition to physician mobility begins with the implementation of an EMR. “Once you move to an EMR, physicians rely on the computer for information,” says Ken Lawonn, senior vice president and CIO of nine-hospital Alegent Health in Nebraska and southwestern Iowa.

But once physicians are computer-reliant, they need to be mobile as well, and that means implementing a physician information system. “There's no greater mobile workforce than physicians,” says Lawonn. “And mobility has to extend beyond the hospital.”

Physician information systems can cover a wide range of functions, including charge capture for more efficient billing. When integrated with the physician practice, many incorporate practice management components.

Many hospitals have a mixed bag of functions available for physicians on the go. Most give the ability to view lab results, vital signs, allergies and medications, and sign off on certain procedures, usually through a variety of mobile devices like PDAs and Smartphones. Portal-based Web access is the industry standard.

Currently, according to Orem, Utah-based KLAS, the two market leaders in the space are Toronto-based Thomson Healthcare (which purchased MercuryMD in 2006) and Boston-based PatientKeeper — though they're not the only solutions in town. Many hospitals utilize mobile components offered by their EMR vendors, such as Meditech or Cerner.

But with different vendor systems, hardware and software available, what features are the most important to physicians?

When Jeff Cash, CIO at 370-bed Mercy Medical Center in Cedar Rapids, Iowa, began investigating a physician information system, he says he got tremendous push-back from his doctors, who felt the hospital's technology was too outdated. “We asked, ‘What would it take?’” he says. The physicians wanted a portal that was intuitive, designed for physicians, with the ability for some level of customization. They also wanted it to be Web-based and deployable from a PDA or Smartphone.

Mercy is live with PatientKeeper, which integrates with the hospital's Meditech system and is accessed by the physicians through a portal. “The docs never log into Meditech anymore,” Cash says. “They don't even think they're using Meditech, they think they're using PatientKeeper.”

Mercy's physician information system has two access methods — the Web portal and a separate product that supports a mobile phone interface. It's a PDA feature that also works on cell phones running a Windows mobile version. At Mercy, the doctors use it as they're rounding, but not all of them.

“Lots of doctors find it easier to use a desktop,” says Cash. “The PDA isn't for everyone.” Results can be viewed in the physician office in real time by logging on to the Web. “They're not ordering tests through the system yet, but they're signing off on their documentation.”

But what if a hospital has yet to go wireless? Lianne Stevens, vice president of information technology and CIO at The Nebraska Medical Center (NMC) found the Thomson product, which utilizes synching stations for mobile devices, a good fit with the hospital's GE Centricity EMR.

“The reality is that there are not enough workstations in the units for the physicians,” she says, making anytime access impossible. Stevens says she chose the Thomson synching solution because, “We wanted something that could be implemented quickly and that was not too complex.”

The synching stations download information from GE Centricity onto mobile devices. “Right now, we have 26 synching devices throughout the hospital,” Stevens says. She says once the hospital transfers to wireless capability, the physicians will be able to synch from anywhere. They will be able to use the same device whether they want to cradle-synch or use wireless.

At Alegent, Ken Lawonn took a different route as he began implementation of the Siemens Soarian clinical EMR. “One of our primary goals was to capture information as close to the point of care as possible and give the caregiver the most appropriate tools to do that,” he says.

Most agree there's a greater degree of accuracy with one entry, rather than writing it down and transferring it later. “We were a Siemens shop and, as we built and deployed Soarian, our physicians were very involved. One thing they said was they wanted access from anywhere — the office, home, out of town. We focused on trying to give them that.”

Alegent's Soarian clinical access is Web-based. The hospital system also uses document imaging that can be accessed remotely for progress notes and orders.

And the wireless device used in the hospital? “We like the C5 from Motion Computing (Austin, Texas),” says Lawonn. “It's a tablet that has the ability to scan.”

Lawonn says Alegent has begun the implementation of Atlanta-based NextGen's ambulatory EMR system for its employed physician group. “And we're offering it to independent physicians that leverage the changes in the Stark law.” (see Tech Trend on EMR underwriting, page 50) He says information will flow from one EMR to another. “The cool integration is a physician can be in the hospital working in Soarian and click a NextGen icon and then access the patient.”

There was an important lesson Lawonn says he learned in offering this solution. “We found about 80 percent of the physicians wanted the practice management component as well, so we had to circle back to give them that too.”

In the end, many believe these types of systems give hospitals a competitive edge in attracting admitting physicians. But competition is not always first on everyone's list.

Cash at Mercy had a different take, though his principal competitor is only six blocks away. Rather than provide an exclusive solution, Cash felt collaboration was more important. “One of the reasons we chose PatientKeeper was that it is a third party that the other hospital could adopt too.” (PatientKeeper is agnostic and interfaces with Mercy's competitor hospital, which runs GE IDX.)

Cash says the collaboration was driven by a desire to satisfy his doctors. “Our docs tell us that, ‘Both you guys (Mercy and its competitor) continue to invest in technology, but you will always do it differently. Can't you make it easier for us? We don't want to learn all these passwords and applications.’”

Mercy now shares a high-speed imaging network and joint ordering system with its competitor. “All the physicians can place their orders in both hospitals in this system. A doc in the community can see clinical results independent of which hospital the patient is in.”

But what about the bottom line? “I use the term competitive collaboration,” Cash says. He believes the physicians are not going to choose the hospital they admit to based on the user interface. “They're going to steer patients to you based on your clinical care, on the level of technology you offer, on the nursing care. So let's make the playing field even.”

Cash says he could have encouraged the other hospital not to get PatientKeeper. “But at the end of the day, we should all think about how we can create reproducible solutions.”

Lawonn agrees that other factors are more important than attracting physicians. “The ability to integrate what the physicians are doing in their offices will breed some loyalty. More importantly, we think if we understand the workflow and understand the needs and apply this technology properly, it will make life easier for the clinicians, and we believe we'll see better outcomes with our patients. And that's where we're going to be judged going forward.”