In 2007, St. Luke's Health System, Kansas City, Mo., had a physician alignment problem: Its affiliated physicians were unhappy about the amount of paper received from the health system.
Laboratory results, discharge summaries, reports and more were delivered in hard copy. Solving this business problem would strengthen the provider's relationships with its physicians. Also, information technology leadership correctly suspected that the solution would have significant benefits beyond the reduction of paper. St. Luke's launched a health information exchange initiative that allows sharing of clinical data at the community level and beyond.
In an online connectivity solution named St. Luke CareLink, St. Luke's uses a combination of e-health technologies to enable two-way communication: secure messaging, e-prescribing, clinical results delivery and automated personal health records. This e-connectivity is accomplished using a software-as-a-service network platform and supplier-hosted rapid deployment methodology that allows flexibility and extensibility to connect outward. The exchange requires minimal staffing resources and eliminates the need for infrastructure beyond access to the Internet, eliminating large capital outlays.
With 31% of the American Recovery and Reinvestment Act's meaningful-use guidelines related to health information exchange, hospitals seeking stimulus funds must embrace exchange. The St. Luke's approach provides the ability to adhere to the stimulus guidelines and the agility to connect to other exchanges that develop in its region.
St. Luke's also developed a physician alliance program, which offers a discounted price for bundled electronic medical record and connectivity solutions to help strengthen relationships with its physicians and position them to qualify for stimulus funds. Under the stimulus law, the states of Missouri and Kansas combined have applied for $22 million in federal stimulus money to design and implement a plan to support statewide health information exchange.
The St. Luke's exchange improves quality of care management, continuity and collaboration for its extensive physician and patient communities. The exchange connects 316 enrolled doctors, a 39% increase. Nearly 24,135 self-registered patients—a 231% growth since the launch—communicate online with their providers and staff. Physicians engage in online exchange with their patients as evidenced by a 40% growth in provider-initiated messages. Last year, physicians and their staff and patients exchanged 3,273 secure messages monthly or an estimated 104,746 total. As of December 2009, physician e-prescribing transactions totaled 70,048—up 61% since 2007.
More than 1 million result transactions—laboratory and radiology reports and transcribed documents—are processed over the exchange to coordinate patient-care delivery. An additional 1 million subset of results are being routed from hospitals to physician practices' EMRs, totaling 2.6 million transactions. Consequently, physicians and their practices are more tightly aligned in receiving and sharing timely orders that are systematically streamlined and recorded to the patient's online PHR.
The exchange has also helped ensure timely reporting of laboratory reports. St. Luke's has seen a 47% improvement in timely release of information.
Approximately 24,000 of the 180,000-plus PHRs created and populated with the more than 2 million test results are actively used by patients and their providers.
Two major exchange challenges we conquered were establishing comfort in busy practices and addressing privacy issues. St. Luke's proved to doctors that using e-connectivity to promote delivery management and contribution to the health information repository were not going to add steps or disrupt processes. Some physicians voiced concerns over having patients enter their own PHR data and that online communication would put them at liability risk. St. Luke's demonstrated the Health Insurance Portability and Accountability Act-complaint exchange delivers authentication, data encryption, message integrity and a permanent audit trail.
The exchange has improved physician-patient relations and family life/work balance. Jennifer Bequette, a physician at St. Luke's Multi-Specialty Clinic, appreciates having her patients' current medical information and the ability to update her young children's PHRs at her fingertips. For Bequette and others, the exchange provides a newfound sense of flexibility and control in answering patients' messages in a timely fashion at the home, office or other Internet-enabled location.
Deborah Gash is vice president and chief information officer at St. Luke's Health System, Kansas City, Mo.
