Clinical data exchange: One effort

Comprehensive electronic medical records have become a reality, helping physicians and healthcare organizations reduce costs and promote exceptional healthcare to their patients. A "true" electronic medical record is a collection of patient centric, healthcare information, available across providers and care settings. Integrating the information gathered in a physician's office with data captured during a hospital encounter minimizes the potential for medication errors and improves the treatment of patients.

Eliminating illegible prescriptions, flagging allergic reactions and reducing the amount of duplicate procedures performed ultimately enhance patient care.

One of the most compelling reasons why interest is surging is that physicians and hospitals are under pressure to improve patient safety while containing costs. Current data posted by the Institute of Medicine and the Markle Foundation shows that:

- Between, 44,000 and 98,000 Americans die in hospitals each year because of medical errors. About 7,000 of those people die from medication errors alone.

- Approximately 770,000 people are injured due to adverse drug events each year, and up to 70 percent of those incidents are avoidable.

- Medical errors cost the U.S. an estimated $37.6 billion annually, and $17 billion of those costs are associated with preventable errors.

Despite these findings, fewer than 5 percent of U.S. physicians prescribe medications electronically. Only a third of U.S. hospitals have computerized physician order-entry systems. Of those, only 4.9 percent require their use. And just 5 percent of clinicians and 19 percent of healthcare provider organizations use operational electronic medical records systems.

President Bush has decided to push the creation of a national health information record over the next 10 years, pressuring providers to embrace electronic medical record technology.

Several initiatives have focused on the creation of local health information networks that will exchange clinical information among community-based physicians, hospitals, health systems and some radiology groups

Consistent with some of the large-scale efforts going on around the country, St. Joseph's Regional Medical Center (SJRMC) in Paterson, N.J., realizes the benefit of sharing hospital-based clinical information with its employed physicians in the community, as well as its large network of private attending staff.

St. Joseph's is a 640-bed urban medical center, in the process of installing the Allscripts Touchworks suite of electronic medical record software with several integration points to our hospital information system. Our data exchange goal is to provide hospital-based lab, radiology and outside-transcribed results from our Siemens Lifetime Clinical Record (LCR) to our physician offices that use the Touchworks EMR. LCR is a clinical repository that provides a longitudinal view of a patient's lifetime clinical information from various encounters and sources. In addition to sending clinical data to the physician practices, we plan to engineer the transfer of practice-based visit information from Touchworks to the hospital LCR.

Currently, SJRMC is in Phase I of a three-phased approach. Phase I involves a family practice office in our network of employed physicians. The practice is using wireless HP tablets to electronically chart their patient encounters using the Touchworks applications. Encounters are charted using structured, problem-focused templates built by the chairman of the Department of Family Practice and champion of the EMR effort at the hospital, Dr. Michael DeLisi. Once the patient has been charted, an electronic prescription transaction is sent to either a printer in the office or directly to the pharmacy. "A completely legible and formulary checked prescription is a real time saver and refills are now simply a few clicks away," Dr. DeLisi notes.

Phase II will provide the ability to print a physician order and have the patient go to SJRMC (or participating lab) for the study (lab, radiology, cardiology, etc.).

Once the study is completed and posted to the medical center's LCR, an interface will send the results back to the Touchworks EMR. Physicians using the EMR will then get a series of physician specific tasks associated with how they would like to see the result and what they would do with it.

Also being initiated in Phase II is the ability to submit electronic charges to the hospital (Siemens Invision) and practice management system (athenahealth's athenaNet). Once a physician completes his note in Touchworks, a screen will pop up recommending the level of service to be charged. At that point, a physician has the opportunity to agree with the recommendation or evaluate if other critical factors would contribute to his changing the recommended codes. An interface would then submit the transaction to the appropriate system(s) listed previously.

Phase III will complete the circle, providing full data exchange between the patient's visit and allergy information captured in Touchworks, which will then be interfaced to SJRMC's LCR.

Preliminary findings in Phase I have shown that large intricate notes are much easier to chart electronically. Pharmacy scripts are legible and precise reducing the risk of medication errors and finally, the printed abstracts (kept in a paper chart) are easy to read.

Unfortunately, there are still a few things that would be better served on paper. Short visits associated with a PPD reading or even wart removals were initially easier to chart and less time consuming on paper (modifications to customized text templates have recently corrected this issue). The learning curve is very steep in the beginning. Even the most computer literate physician will require a significant investment of time early on in order to get comfortable with the new workflow.

According to the large number of physicians we support, the practice of medicine is changing and technology is providing a means for better healthcare. Sharing clinical information will help our affiliated physicians make better decisions and improve patient care.

Over the next two years, SJRMC plans to expand our pilot by adding 10 to 20 practices. The Foundation for eHealth Initiatives has already distributed $2 million dollars to organizations trying to share clinical data and reduce medical errors. As our pilot and future rollout expands, the medical center is positioning itself to apply for grants made available to healthcare organizations similar in size and scope to ours.

Tom Gregorio is Director of IT for physician and ancillary systems at St. Joseph's Regional Medical Center. Prior to joining St. Joseph's, he was a consultant with PricewaterhouseCoopers for over seven years in its Healthcare Consulting Practice. E-mail: gregorit@sjhmc.org.