When Henry David Thoreau wrote The Maine Woods in the mid-1800s, he described a wilderness environment already threatened by advancing American civilization. Today, Maine has retained much of its wilderness quality and American civilization is advancing in the form of a statewide regional health information organization initiative. Its still largely rural environment, however, means the RHIO, dubbed HealthInfoNet, must necessarily spring from a single local health care provider because there usually isn’t more than one in most areas of the state.
As virtually the only health care network in central Maine’s Kennebec River Valley, Augusta-based MaineGeneral Health is the de facto community health information network in that part of the state. And, as it rolls out its ambulatory electronic medical record, it also launches a critical segment of HealthInfoNet. How MaineGeneral goes, so goes the state’s RHIO, at least in central Maine.
It’s a dual role welcomed by MaineGeneral executives. “We’re developing a mini-RHIO that will play into the larger state RHIO,” says Kash Basavappa, senior vice president of MaineGeneral Health and CIO of MaineGeneral Medical Center, which has hospitals in Augusta and Waterville. A communitywide health record is an integral component of delivering the highest quality care to both providers and patients in the region, Basavappa says. “Step one is to provide seamless access to our care providers. Step two is to enable our patients to access their records across the region. We’re very cognizant of the patient’s right to the medical record.”
Elbow Room
Recent relaxation of Stark rules as well as a three-year, $1.5-million AHRQ grant that MaineGeneral Health received two years ago to fund implementation of an interoperable EMR in the Kennebec County area have helped it connect its own facilities and independent physician practices in the area. The region,140 miles north and south and 70 miles east and west, covers seven rural counties with 140,000 patients--about 11 percent of the state’s population.
With two hospitals, imaging centers, laboratories, behavioral health clinics and extended care facilities, MaineGeneral Health is the third-largest health system in the state. MaineGeneral Health is also a partner in a physician hospital organization, Kennebec Regional Health Alliance, which links it closely to the 250 physicians practicing in the region.
“We cover much of the central region of Maine,” says Dan Mingle, M.D., assistant medical director at MaineGeneral Medical Center and principal investigator for the AHRQ grant. “We saw the value of sharing information and wanted to roll out a system that provides every person with a single chart on one platform so we don’t have to wait for national interoperability standards to be finalized.” That’s why the six-year EMR project required software vendors to demonstrate that they could keep up with evolving standards. The organization ultimately selected Allscripts.
Using the Web and a thin client that puts the burden of heavy computing on a central server, clinicians anywhere and anytime will be able to register their patients and, after the system confirms a patient’s identity, retrieve in real time key components of the patient’s medical record: allergies, problem list, active and previous medication lists, personal and family history, imaging and lab results, and progress notes. Currently 100 doctors participate in the system, generating 13,000 electronic orders a week.
Like any clinical IT initiative, however, MaineGeneral Health’s ambulatory EMR rollout has hit snags not unfamiliar to more urban academic medical centers. “We ran into difficulties because technical staff lacked clinical backgrounds,” says Barbara Crowley, M.D., president of both Kennebec Regional Health Alliance and MaineGeneral Health Associates, a non-profit MGH subsidiary and umbrella organization for primary care and specialty practices in Greater Kennebec Valley.
As a result, Crowley identified physician super users to help design clinical templates with drop-down menus for the Allscripts ambulatory system, which comes in modules that enable physicians to electronically transmit prescriptions or dictate information.
Platform for Growth
CIO Basavappa says clinicians like what’s available so far. “It’s caught on with our local physicians,” he says, and it can provide a demonstration of how HealthInfoNet can work statewide. That’s important because both Basavappa and Mingle are involved in planning and implementation of HealthInfoNet, and MaineGeneral is one of the major participating institutions in the statewide RHIO initiative.
“The vision of interoperability requires that we make sure we connect on the basis of standards, including HL7 for data exchange and the CCR,” he says. The CCR, or the continuity-of-care record, is a standardized format for retrieval of certain clinical information. According to Basavappa, MaineGeneral is interpreting the revised Stark rules to suggest that a provider organization can pay for all software licenses for physicians minus 15 percent of cost, which must be borne by those doctors. That does not include additional support services like training.
“With this single platform, whether standards happen 10, 15 or 25 years from now, we can still be interoperable,” Mingle says. “When I look at care, it’s almost always local, and at least 60 percent of the data that makes a difference is standardized today.”
After 14 years of experience as a family practice physician, Mingle returned to school and earned a master of science degree at Dartmouth’s Center for Evaluative Clinical Sciences, working with its Microsystems Group to explore the characteristics of high-performing health care organizations. “IS was the common denominator. I believe a good information system is foundational to improvements in accessibility, quality, safety and cost of care,” he says.
Adds Basavappa: “The EMR [and ultimate linkage into HealthInfoNet] is really for the benefit of our patients. We don’t expect to make any money—it’s cost neutral from our standpoint. We see the key value from being able to deliver quality care. MaineGeneral wants to be a leader.”
Chuck Appleby is a freelance writer specializing in health care and technology.
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This article first appeared on November 29, 2006 in HHN's Magazine online site.
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