Case study: Idaho HIE teams with EMR vendors, doc groups to keep costs down
Primary Health Medical Group (PHMG), comprising 11 neighborhood multi-specialty clinics with a total of 45 providers in Southwestern Idaho, is serving as one of Idaho Health Data Exchange’s (IHDE) beta groups to help facilitate the HIE's hub-to-hub functionality.
IHDE's strategy to connect healthcare providers in the state is to partner with EMR vendors. "We strategically went after EMR vendors who have the largest presence in Idaho," said Scott Carrell, executive director. "We can build one connection with a variety of physician groups or clinics that can more easily connect to IHDE rather than build independent connections between each provider and clinic." By leveraging the existing technology, IHDE is able to keep development costs down.
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Clinicians at PHMG, which is one of the largest groups in the state and sees some 200,000 patients yearly, are beta testing access to IHDE, according to Dr. David Peterman, PHMG's president. "This is the first step to begin to see the value of getting patient information," he said. The second phase involves getting the eClinicalWorks-hosted server to transfer real-time information from PHMG to IDHE and having it readable - in other words, in a familiar format - to provider participants.
Currently, primary care physicians (PCP) receive a chart within 24 hours when their patients present to the facility after hours. Once PHMG is connected, PCPs will be able to access real-time information - such as X-rays and lab results - via IDHE. "This has huge implications in terms of continuity of care in the community," Peterman said. After patients visit the emergency department (ED), PCPs have to call to have the summary faxed or access the hospital's system, which oftentimes is complicated. Once connected, PCPs can pull up information on the patient’s encounter. "That kind of real-time access to information is just invaluable."
PHMG, which implemented eClinicalWorks in 2007, was an early adopter of electronic health records (EHRs). "We made a strategic decision early on that we felt that the future of medicine and success is dependent on having data," Peterman said. In order to meet PHMG's goal of improving its performance and being able to demonstrate its value and performance to patients and third-party payers, the medical group had to have meaningful data. "The only way you can get at that is through electronic health records," he said.
In terms of sharing patient information with other healthcare providers, PHMG believes in relying on a trusted entity to be the HIE platform. With so many different EHRs implemented at various hospitals and physician offices, Peterman says trying to exchange information - in its broadest sense - and create a digital interface is "close to impossible." IHDE serves the purpose of being the central data bank with patient information that allows clinicians to exchange information in real time, he said.
PHMG currently has a digital interface for labs with one hospital and a digital interface for reading X-rays with another hospital. Each interface, however, took 12 to 15 months to create, and additional time to debug the interface. In that timeframe, applications are often upgraded to the next version. "If we wait for all the vendors to figure out a way to create interfaces, it's just not going to happen," Peterman points out. "But if we can all agree to send our information to the IHDE we have a solution - a very exciting solution."
"We joined it [IHDE] not only because it's going to make care better for our patients and make our doctors better doctors and more efficient, we wanted to make a statement to the rest of the providers in Idaho," Peterman said. "We're saying for you to practice medicine going forward and to give the best care, you've got to move towards doing this."
Participating in IHDE will help PHMG meet Stage 2 Meaningful Use criteria, which will include the ability to exchange information with another entity, once the final ruling is issued. IHDE will also serve as the platform that enables stakeholders of accountable care organizations (ACOs) to coordinate care through the clinical integration of hospitals, labs, physician offices and other healthcare providers.
"There has to be an IT solution on how to share information, how to access and not duplicate tests," Peterman said. "Instead of painstakingly trying to create a digital interface directly from every hospital, doctor's office, and so on, there's one solution - it's the IHDE. It just makes sense."
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The industry already understands that trying to treat patients episodically is not only costly and a drain on limited resources, but doesn't necessarily deliver the best outcomes. "If you want to follow a patient through the continuum of an illness, which could be five days, five months, five years, you have to have access to that information through that continuum," Peterman said. "IHDE allows for that."
In this era of exchanging patient information, and especially where privacy and security of patient information is concerned, Peterman makes another important case for HIEs: Whatever happens to healthcare organizations, the health exchange is not going to go away and therefore the information will remain on the platform. "If you create a limited interface between two entities and one of the entities goes away, where does the information go?" Peterman said.
A health information exchange that handles patient information is the "most logical and most secure in terms of patient protection," he pointed out. "It's really a win-win."