Provisioning EHR to small hospitals and clinics puts connected, improved care within reach

There’s a way around this disconnect for both the IT haves and have-nots, to their mutual benefit.
09:11 AM
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Healthcare systems with well-functioning electronic health record (EHR) systems often find that smaller hospitals and clinics in their service area are in no such shape, hard-pressed to afford and operate a top-shelf EHR that would immensely improve care and enable them to mesh digitally with larger referral systems. But there’s a way around this disconnect for both the IT haves and have-nots, to their mutual benefit.

Organizations with EHR technical and operational acumen are extending their capabilities out to community or rural facilities through a program called provisioning. For example, UnityPoint Health, from its base in Des Moines, has connected its Epic EHR system to 18 hospitals and 62 clinics, while Providence St. Joseph Health, based in Renton, Washington, has provisioned 13 hospitals and 37 physician practices to date.

For organizations seeking to expand their reach, provisioning is giving critical access and other resource-limited care facilities a reason to affiliate, said Brian Moreau, director of UnityPoint’s Community Connect unit, which packages the health system’s Epic EHR and related services for resale to others. Moreau called it “a big part of our growth strategy” and cited “a direct connection” between its success and “the growth of our community network of rural hospitals.” Several rural hospitals became affiliates specifically because they wanted to participate in the Epic Community Connect program, he said.

Enhanced expertise, technology

A dedicated team was set up to reorient everything from implementation to workflow around the needs of critical access hospitals. This has brought not only the particulars of EHR operation but also the evidence-based practices, quality improvement initiatives and analytics of a large system to rural providers via applications and tools that would be unaffordable for the small facilities that Epic does not target.

“Sharing of best practices and elevating quality is the vision,” Moreau said, a vision that includes opportunities to network with other hospitals and to benefit from the more than 600 IT staff in UnityPoint’s employ, all working to improve access to data on patients shared by multiple providers and strengthening population health efforts. 

Providence, also an Epic EHR user, bills the costs of licenses, third-party applications, the work of analysts and other services as a “pass-through” to affiliates, at no markup, to further the program’s affordability for largely rural, outlying facilities, said Sherry Maughan, vice president of the Community Connect program. The Providence St. Joseph program, which is accredited by Epic, has grown over the past several years and includes a breadth of services such as account management, operational support for contracting, invoicing and purchase order management.

Physicians at affiliated rural practices and hospitals see the same record and user interface as clinicians working within the Providence St. Joseph Health organization, which includes Swedish Medical Center and Providence St. Joseph Health locations in western Washington and Kadlec Regional Medical Center in southeastern Washington and neighboring states. It makes for a seamless experience whether a patient is at a rural clinic or seeing a specialist in a Providence facility, said Rob Watilo, chief strategy officer for Providence St. Joseph Health, Southeast Washington service area.

Seamless, efficient access

When bringing provisioned doctors and hospitals into the existing Epic EHR system, from a patient clinical information standpoint, “it’s like that patient in the outlying community was seeing one of our primary care physicians or specialists ― it’s that seamless as far as access to information,” said Watilo.

If a patient has to leave the community for additional care, it’s a much cleaner referral ― all medication lists, history and clinical information from the smaller hospital’s EHR are a touch away instead of scattered in faxes and scanned documents, he said. The family doctor can see specifics of what was done and any changes in medical picture after the patient returns home.

Small hospitals gain information access and efficiencies in clinical care they could not have managed on their own, said Katie Heldt, chief nursing executive of Greene County Medical Center, a UnityPoint affiliate in Jefferson, Iowa. “We are very fortunate as a rural facility to have Epic as our electronic medical record; it helps us to be able to share patient information in a protected way, a consistent way that everybody understands.”

At a Des Moines facility or an urgent care center, a doctor can seek a Greene County patient’s record and “it’s all right there,” Heldt said. “It saves time, it saves money, it’s efficient and reduces variability.” Best practices and standardization through Community Connect have improved outcomes in quality, which has bolstered clinician acceptance. Physicians still have the ability “to use their knowledge and think on their feet, but it does provide some guidelines for patient care, and it’s truly appreciated.”