Starting an ACO with '24 different EMRs'

One CIO offers perspective on making nearly two-dozen different systems talk with each other
By Mike Miliard
05:17 AM
St. Francis Hospital in Hartford, Conn. takes on big EMR change.

It's fair to say that Linda Shanley has a rather full plate these days.

"We're a 600-bed hospital – we're two hospitals, actually: one's a rehab hospital – and right now we're going through an Epic implementation," said Shanley, vice president and chief information officer at Hartford, Conn.-based Saint Francis Hospital.

"We also have a very large PHO, with probably about 800 physicians," she added. "Approximately 200-plus are employed, and the rest are all community physicians. There are two larger groups: One is about 60 doctors and the other is 30; all the rest are of varying sizes, from one or two physicians, up to 10."

Across all those care settings, "we have about 24 different EMRs," said Shanley.

Put mildy, "That's a challenge."

And one more thing, just to add to the fun: At the same time as the hospital's Epic switchover, "We also decided to participate in the Medicare Shared Savings Program," she said.

Long story short, when it comes to aggregation of data for this nascent ACO, "there's a lot going on."

Thankfully, the Epic implementation piece is going well. When we spoke at HIMSS14 in Orlando, Shanley said the go-live was just over a month away, and she felt sufficiently confident the launch would be smooth that she could spare a few days to visit the conference.

"It's refreshing to see how it all comes together," she said. "We're training right now, in the midst of it, and it's really been unbelievable."

As for the ACO, setting up data exchange among so many disparate systems beyond the hospital has been more of a challenge.

"Ultimately we want everybody to be on the same EMR," said Shanley. "That journey is not going to happen overnight."

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In the meantime, St. Francis is getting help from Orion Health, whose Collaborative Care for ACOs suite helps with "aggregating all the data together in a traditional HIE sense," she said.

"We needed to bring more than just (clinical) data together; we needed to bring the claims data in, and we needed to have a mechanism to look at patient data and be able to manage them from a care coordination standpoint," said Shanley.

"That's the whole thing: to be able to bring every piece of data together. A lot of the docs aren't on our EMRs. We have to be able to enter data and bring together lists – and work those lists so we can affect outcomes."

Even with help from the most robust care coordination tools, though, that can be easier said than done. Shanley said one of St. Francis Care's acute challenges is "finding where all the data is.

"A lot of the docs are on all these different EMRs -- and some are still on paper," she said. "Sometimes patients get care outside of the system, that's where the claims data become very useful: If someone goes to, say, CVS to get their flu shot, the doc may never know that. At least you get that in the claims data."

Also, "not all clinicians or users of an EMR document the same way," she said. "And a lot of the EMR vendors are not as giving with their data, as far as being able to extract it out of the systems."

Orion's tool "shows you which data elements you're missing," said Shanley. "You have an exception report so you can go through and see what you have to find; you're not just looking willy-nilly, you know what's out there."

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That data sifting has represented a "huge development project" between St. Francis and Orion, she said. "There have really been growing pains sometimes. You fix this thing, and then something else goes astray. But we made it."

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