It isn't to "rip and replace" all of the ambulatory care EHRs with a single enterprise system. "That would create standardization, but it would also consume more capital than we have at a time when Meaningful Use Stage 2, ICD-10, and compliance requirements have already committed all available IT resources," he pointed out in a recent blog post.
Instead, he favors a modular approach that he calls "affiliation planning." This involves figuring out the workflows that the healthcare organization needs to support and then building upon the existing applications and infrastructure to automate those processes in ways that improve quality, safety and efficiency.
[ For more on the challenge of EHR interoperability, see Sharing Electronic Medical Records Still Too Hard. ]
Among the technical means available to connect healthcare providers so they can coordinate care, he said, are Web-based viewers, health information exchange, registries/repositories, master patient indexes, and secure e-mail. None of these technologies is revolutionary, Halamka acknowledges, but together they can be used to build the connectivity needed to share key data.
Instead of simply working on each new project piecemeal -- an impossible task, considering the pace of change -- he suggested that organizations plan how they're going to integrate all of these systems ahead of time. At BIDMC, he said, his team is planning to take the following steps:
-- Have IT infrastructure and application managers list the services they had been asked to provide in the past when BIDMC formed new practice affiliations.
-- Get feedback from existing and new affiliated practices about their IT experience when they transitioned to BIDMC.
-- Create templates for affiliations, mergers and acquisitions. These templates should aid the IT department in rapidly developing staffing, capital and operating budget requests.
This rough-and-ready approach might serve as a Band-Aid in the current environment, but it meets only a small part of the challenge, observed Doug Hires, executive VP, sales, marketing and strategic services, for Santa Rosa Consulting, in an interview with InformationWeek Healthcare. "Halamka is advocating an approach that would solve some of the problems but doesn't solve the issue," he said.
That issue, which many CIOs are grappling with today, is how to share data across disparate systems within the clinical workflow. The best way to do that, in the view of Hires and other experts, is to construct an enterprise data warehouse capable of aggregating and normalizing discrete data from EHRs and other sources. Then the combined data can be fed back to physicians so they can view it in their EHRs.
One problem with Halamka's approach, Hires noted, is that it requires doctors to leave their workflow to get information. "We know that physicians hate having to hop over to a portal to look up specific clinical information," he pointed out. "When they do that, they have to write it down or print it out and go back to their own EHR."
He agreed with Halamka, however, that most organizations don't want to try to get all of the affiliated practices on their enterprise system. Not only would that be very expensive -- hospitals can provide up to 80% of the cost of EHR software to independent physicians, under the Stark rules -- but it would also run the risk of upsetting doctors who are happy with their current EHRs, he said.