November 30, 2009
Three Colorado hospitals have tied themselves in an information exchange, sharing medical records to improve patient care and reduce unnecessary redundant tests.
The program unites the Children's Hospital, Exempla Healthcare, and Kaiser Permanente Colorado, to share complete medical records, including medications, discharge results, lab results, radiology reports, and more. All three hospitals use EMR software from Epic Systems, which simplifies the process. "They've standardized the content so we can exchange and have interoperability with health records," said Mary Anne Leach, vice president and CIO of the Children's Hospital. "Eventually, we will be able to exchange information with other vendors." The exchange started in June with portions of the three healthcare providers, and went live in phases until it is now in full production. The exchange is a first step toward creating a statewide Health Information Exchange, as prescribed in the U.S. American Recovery and Reinvestment Act of 2009 (ARRA), which set aside $19 billion toward implementing e-health records nationwide, said David Pecoraro, senior vice resident and CIO of Exempla Healthcare. The three organizations are working with the Colorado Regional Health Information Organization (CORHIO) to contribute their work toward building a health information exchange, said Lynn Fischer, vice president and business information officer for Kaiser. The three-hospital exchange gives physicians and clinicians access to complete records on patients, so they don't have to re-order lab tests or re-image patients, Leach said. "They're making better clinical decisions, and it's reducing the cost of care to the community by not repeating tests and procedures," she said. Previously, health data was exchanged with faxes, e-mails, and charts being hand-carried from one healthcare provider to another, which was inefficient and not timely. "Patients were literally handed paper and told to take it to their doctors," Pecoraro said. The biggest problem setting up the exchange wasn't technical; it was setting up a process to get patient consent to share records. This required training healthcare provider staff and educating the community. "Patients appreciate overall continuity of care, and in order to do that, people ahve to be more cognizant of the consent process," Pecoraro said. Leach said parents can see the benefits, "Parents don't have to have their children stuck again for lab tests, or exposed to radiation again for another X-Ray," she said. But parents also want to know that their privacy is protected. " We have to assure them that all of this is HIPAA-compliant, private, and secure," Leach said. The healthcare providers made obtaining consent part of the initial registration process. At first they were concerned it might be too time-consuming, but they found it could be made efficient by training admissions personnel and giving them good scripts to follow. E-health record sharing has to be embedded in the physicians' workflow to get them to use it, Leach said. "If you ask them to sign out and sign in to another application, they don't have time for that. But if you have another tab or link in their EHR, they'll use it. As we move forward on CORHIO, we'll use that knowledge." The project was funded internally, with no government grants. All three organizations had made significant investments in implementing Epic EMR, adding a server to allow information sharing cost $50,000 for the server at each healthcare provider, plus about 1,000 staff hours from each organization to implement. The healthcare providers are working on quantifying the benefits. "It's hard to quantify the benefits of improved clinical decisions," Leach said. "This is something we struggle with in the industry, to quantify the ROI of electronic health records. But when we see physicians saying they're making better clinical decisions, and families saying they're getting better care, the value proposition is evident." Using EHRs internally, even without sharing, brought financial benefits to Exempla, said Pecoraro. For example, the healthcare provider used to spend $3 million t $4 million annually transcribing dictated notes. Instead, they now use voice recognition to replace dictation and transcription. InformationWeek has published an in-depth report on e-health and the federal stimulus package. Download the report here (registration required).
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