Bypassing third-party governance allows Spectrum Health to meet physician-practice needs across three hospital systems.
Bypassing third-party governance allows Spectrum Health to meet physician-practice needs across three hospital systems.
The transition to this unique HIE began with Spectrum Health’s decision to replace faxed lab results and paper-based processes. Though its fax methods had been refined over a period of several years, Spectrum Health found that report distribution remained imperfect. To investigate this, staff asked several practices to compile all the faxes received from Spectrum Health over a two-week period and track when a particular result was expected but not received.
“We compared the sent and received reports, as well as particular practice patterns, and we discovered that even though the system operated as it was designed to, it sometimes sent duplicate results,” says Patrick O’Hare, CIO of Spectrum Health. “We also examined why certain results were not received.”
As a result of this analysis, Spectrum Health decided that instead of further refining its fax processes, it would explore better technologies that would provide the foundation for future HIE initiatives.
Today’s healthcare organizations are under pressure to implement electronic health records (EHRs), engage in e-prescribing, adopt computerized physician order entry (CPOE) and become involved in HIEs to improve patient care and lower the cost of healthcare. Regional health-information organizations (RHIOs) that connect healthcare providers through centralized or federated models are becoming a reality. Another type of HIE is emerging, however, one that is built by local health systems collaborating to exchange basic clinical data, effectively reducing healthcare costs while providing the flexibility and scalability to adapt to future industry standards.
Such an HIE has been launched by three organizations within the medical trading area (MTA) of Grand Rapids, one of nine MTAs in the state of Michigan. The three pioneering healthcare organizations consist of Spectrum Health, Trinity Health and Metro Health.
Spectrum Health wanted the ability to connect with physician practices in an automated manner. Rather than trying to directly interface disparate EHRs deployed by each practice, it sought a solution that could provide the needed interoperability for seamless data exchange.
“There were a number of factors that led us to the implementation of the Medicity Novo Grid technology,” O’Hare explains. “Essentially, we wanted to take the friction out of information exchange by electronically distributing lab results to the physicians’ offices.”
Information Available for EHRs
Novo Grid is an agent-based network that enables healthcare organizations to exchange laboratory results, transcriptions, surgical notes, admission and discharge summaries, and other information directly into an EHR or, for paper-based practices, into an electronic drop box that can be accessed via any Web browser. Physicians also can use the system for ordering laboratory tests and scheduling radiology exams.
“The industry is embracing health information exchange, a movement accelerated by the American Recovery and Reinvestment Act,” O’Hare says. “Although our HIE decision predated the ARRA, we knew we needed a simple HIE solution that would enable us to quickly deploy HIPAA-compliant data exchange with these physician practices. As it turns out, an HIE also allows us to demonstrate meaningful use and qualify for stimulus funding.”
Trinity Health and Metro Health also implemented the Medicity Novo Grid around the same time as Spectrum Health. “We’re now collaborating with Trinity and Metro to distribute results through our common technology,” O’Hare explains. “And we’ve accomplished health data exchange without a separate governing entity as found in a typical HIE.
“This is a bottom-up approach to establishing HIEs,” says O’Hare. “Our organizations are working together to build upon our common business strategies and take advantage of the synergies to share healthcare information in a cost-effective manner to improve patient care.”
A traditional HIE operates under a separate 501(c)3, has its own staff and funds its own administrative services. Spectrum Health’s approach accomplishes the same result without the additional cost burden of creating a separate entity.
“We’re leveraging the staff in our respective healthcare organizations to provide administrative and customer support services, and supplementing with other services from Medicity, as needed,” says O’Hare. “We each set up our preferred routing, dates and content for individual physician offices, so we benefit from both the broad customization and common technology provided by the agent-grid solution.”
For now, Spectrum Health is working exclusively on delivering clinical data, with future plans to incorporate physician-to-physician and hospital-to-hospital referral functionality, which is also available through Novo Grid. When examining long-term strategies, O’Hare expects the collaborative efforts of local hospital systems to deploy the agent-grid technology and encourage area provider participation will drive immediate value. In addition, these actions lay the groundwork for connection to a future state-HIE backbone, other HIEs and the national health-information exchange.
Unique Challenges Addressed
Since Spectrum Health was a development site for Novo Grid, deployment to the hundreds of practices within its medical trading area came with unique challenges. Each physician’s office presented its own set of work-flow variables that O’Hare’s staff had to consider before incorporating the HIE technology into each practice’s system.
The agent-grid solution, for example, was designed to immediately send test results and reports to the ordering physicians. Spectrum Health’s network, however, included an obstetrics (OB) practice that wanted the receipt of certain lab results delayed by three days until other test results could catch up, be grouped together and distributed to the practice as one complete report. This would allow the OB practice to view the complete batch of patient test results at one time. By “retraining” the agents, Spectrum Health was able to adjust the timing to meet the distinct work-flow needs of that practice.
Flexibility is inherent in the agent-grid system, O’Hare says, permitting paper-based practices to EHR-centric practices to benefit from using the grid. By selecting what O’Hare’s staff calls the “easy” button, paper-based practices can print every new report that has arrived since the last time reports were printed. With other practices, physicians might choose to view reports online and decide not to print them. For practices with an EHR, the agent-grid technology provides the appropriate integration to enable test results to go from the hospital system directly into the practice’s EHR for immediate clinician access to the data.
“For disease management, physicians can go into the system, pull a list of pending orders and identify patients where orders had been placed, but the patient didn’t show up for their procedure,” explains O’Hare. “The office staff can then contact the patients to find out why they didn’t have the test performed. This is hard to do in a paper-chart environment.
“The system was not designed to be a clinical viewer where a physician can go in and trend lab results,” he adds. “Our target was really office staff, but physicians are using and appreciating the system, as well.”
Regardless of each practice’s position on the technology adoption curve, they benefit from the solution. “Different health systems have chosen different approaches to deploying the technology,” concludes O’Hare. “With the various combinations of systems and the diversity of medical staff, this tool has provided the adaptability required to meet everyone’s needs.”
From the Catalog
According to www.medicity.com : The Medicity Novo Grid powers health information exchange throughout the healthcare community, electronically connecting hospitals, ancillary service providers, physicians and administrative staff so that all involved in delivering care to a patient have the most up-to-date and accurate information in real time. The Grid forms a secure, intelligent network to distribute and exchange clinical information, such as orders, results, transcribed reports, problems, medications, allergies and demographic data, across acute- and ambulatory-care settings.
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