By linking hospital systems to referring physicians’ EMRs, a health care system strengthens its relationships with community practices.
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| Ryan Smith | Robert Connely |
Like many hospitals across the United States, Intermountain Healthcare is facing pressure from referring physician practices to connect the health system’s patient record systems with practices’ ambulatory electronic medical records. During the last several years, more than 50 practices and clinics reminded the Salt Lake City system that national reference labs were putting the organization at a competitive disadvantage by providing interfaces that electronically deliver laboratory results directly into practice EMRs.
EMR interfaces from the hospital systems are a physician satisfier. Perhaps even more important, they can improve patient care by enhancing patient data quality and the speed with which it is delivered. From the business perspective, interfaces help practices get more value from their EMR investment by reducing administrative costs—specifically, fewer staffing resources are required to sort, scan, index and enter paper-based patient data into practice EMRs.
For the health care system, exchanging data with practice EMRs offered many benefits, including lowering administrative costs and eliminating privacy concerns created by fax, mail and courier delivery of paper documents. Most important, an effective EMR interface would support one of Intermountain Healthcare’s ongoing primary objectives: strengthening relationships with community physicians.
In late 2006, Intermountain Healthcare began building a proprietary lab interface to a physician practice that referred a high volume of outpatient lab services. The results were mixed. Although the point-to-point interface functioned as expected, it took several months to build and required a great deal of resources to implement and test within the practice. At the end of that process, Intermountain Healthcare had a connection that only delivered lab results to just one vendor’s EMR at a single practice. Moreover, scalability was virtually nonexistent; after extrapolating what would be necessary to expand the program, it became clear that Intermountain Healthcare couldn’t replicate that interface on a sustainable basis.
Setting Higher Expectations
The system’s eBusiness department went back to the drawing board, looking at alternative methods of interfacing with referring practices across a wide spectrum of clinical and administrative information. The organization decided that in addition to delivering lab results, it wanted a tool that would facilitate the distribution of all clinical, administrative and financial patient reports to the referring practices’ ambulatory EMRs.
Rather than building the system internally, Intermountain Healthcare sought a commercial application that would handle the “last mile” of connectivity. However, the organization’s leaders insisted that any adopted system should reduce IT costs and complexity, be scalable, and not divert resources from other major IT projects already underway. A strategic proposal based on these guidelines was approved by senior management, and by late 2007, the board of directors had established a 2008 goal of directly interfacing lab results into the EMRs used by 200 referring physicians.
After expediting the review of the handful of products that met Intermountain Healthcare’s requirements, the virtually unanimous conclusion was to deploy a third-party platform that uses software agents and grids as the mechanism of information exchange. Agents are software “robots” that reside inside the hospital network and continuously collect, filter and distribute results data based on the precise parameters established by the hospital and each practice. Other agents are installed in the affiliated practices’ ambulatory systems, where those practice-based agents receive information that pertains only to each practice’s patients. The patient results data is distributed over a secure Internet-based “grid.”
The platform had several appealing features, including:
- The system is highly scalable at very low cost: The system is designed for the efficient exchange of information, as opposed to the aggregation of data, and is therefore easily and inexpensively scalable. Software agents reside inside the hospital and practice systems, thereby eliminating many hardware- and network-related capacity issues and privacy and security concerns. No matter how far it expands, the system requires only one hospital server and no network expansion or enhancement.
- Little is required from the hospital IT staff: Technology staff worked with the vendor to create interfaces from Intermountain Healthcare’s lab, radiology, transcription, ADT and other systems. Once these interfaces were in place, practices could be linked without consuming network, hardware, security or interface technical resources.
- Interfacing with new EMRs is relatively easy: Once the vendor has created an interface for a particular EMR, that interface can be customized for use by any hospital to connect to practices with that EMR. When the trial deployment began, the vendor had created interfaces with 15 major EMR systems. The vendor is able to quickly establish connectivity to additional systems, including the numerous esoteric EMRs in use in the community, so that number continues to grow.
From Trial to Full Deployment
Because the application and the technology behind it were relatively new to the health care world, Intermountain Healthcare chose to implement the system on a trial basis at a 10-physician multispecialty practice. A particularly IT-savvy practice, this medical group was skeptical that the system would be able to deliver the promised interface functions; Intermountain Healthcare had not been successful in providing an EMR interface in the past. The pilot began with delivery of laboratory results, including microbiology results and anatomical pathology reports. Several months later, it began sending radiology text reports. Almost immediately, the pilot practice fully embraced the new system and expressed nothing but satisfaction with the new capabilities.
The organization has now chosen to deploy the platform across the entire health system. Since Intermountain Healthcare made the decision in July 2007 to deploy the agent-grid platform, the number of other hospitals across the United States using this system has grown to more than 300.
Growing Data Delivery
As for the board’s 2008 goals for interfacing with affiliated physicians, Intermountain Healthcare is on track to meet or exceed its goal by the end of the year. Experience shows that the speed of deploying the EMR interface is largely dependent on the pace at which practices and clinics choose to implement the system. Strong medical leadership—including oversight from the system’s chief medical officer—has been key to the organization’s success with this initiative.
Intermountain Healthcare now has the capability of providing practices with the full range of hospital-generated data. By spring 2009, the organization expects to be electronically delivering full text reports, including radiology transcriptions, surgical notes, discharge summaries, ED reports, history and physical reports, cardiac reports and more, to practices. The system also plans to begin receiving data from practices over the interface system, starting with prenatal records coming from affiliated OB-GYN practices.
Since deploying the interface, Intermountain Healthcare has already seen a 2 percent growth in outreach lab revenues, resulting specifically from offering this solution to referring practices. As additional functionalities roll out, the organization expects to continue to improve service to physicians in the community and see benefits elsewhere in hospital operations.
Ryan Smith is assistant vice president, eBusiness services, at Intermountain Healthcare, Salt Lake City. Robert Connely is chief executive officer for Novo Innovations, Alpharetta, Ga.
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