Edward Septimus, M.D., has a busy schedule. Like other physicians, he is not fond of wasting time.
The medical director of infectious diseases, occupational health and pharmacy for Memorial Hermann Healthcare System in Houston, Septimus often begins his day by sitting down at his computer, where he gets the latest information about his patients' lab results and X-rays from the previous day. He also is informed if a patient has been moved to intensive care or transferred to another hospital unit.
If Septimus is at home and needs to send in an order for a lab test or medication for a patient, he can do it by logging onto his computer, typing in a password and requesting the order electronically.
"I know exactly what I want," Septimus says, and he gets the order done right "because I did it. It's more efficient, and I don't have to wait on the phone while someone takes my order."
In a world where multitasking has replaced house calls, physicians are increasingly aware of how they spend their time and when they are wasting it. At the same time, hospitals are trying to find new ways to bring physicians and their patients into their systems.
With the failed experiment of owning physician practices as a backdrop, hospitals across the country are beginning to look for other, less-costly ways to improve their physician relationships and establish ongoing loyaltiesÃsuch as by outsourcing Internet-based, physician-oriented services.
Those services are positioned at the intersection of two of the biggest priorities of healthcare executives: building clinical communication into healthcare delivery systems, and using the Web to restructure the relationship between hospitals and physicians.
The latest Modern Healthcare annual executive survey of information systems trends shows that links to physicians are a top priority for developing an integrated delivery system. Other results throughout the survey reinforce the importance of knitting together a physician community (Modern Healthcare, Feb. 5, p. 66).
With those objectives in mind, a growing number of hospitals are politely prodding physicians to trade in their pencils and notepads for password and portal. And although quantifiable results are scarce, some doctors are reporting that now they can't live without something they never asked for in the first place.
At Memorial Hermann, a 12-hospital not-for-profit system, the strategy has involved outsourcing the development and hosting of a physician-centered intranet through an application service provider called Healthvision. Based in Dallas, Healthvision is a healthcare Internet company that runs Memorial Hermann's and other hospitals' Internet applications from a data center in New Jersey.
Healthvision takes care of the computer equipment, software and staff to oversee the data. As part of a multiple-year contract, the hospital pays an annual fee for the contracted services and hires whatever staff it may need to foster use of the system among physicians. Memorial Hermann and Healthvision have been working on the physician portal since late 1999, and just last August they began using electronic messaging capabilities.
Efficiency for all
"Whenever we think about the five major challenges for our system over the next five years, one of those is physician alignment and collaboration," says David Bradshaw, vice president and chief information officer of Memorial Hermann. He says the goal in creating the physician portal, called Physicianlink, was to try to streamline processes and information flow to support physicians and make it easier for them to work at Memorial Hermann facilities and provide care. "Hopefully it creates efficiencies for them and for us," he says.
Jim Elder, senior vice president of operations for Healthvision, says it should. "We don't think a hospital can afford not to do this," he says. "If Memorial Hermann doesn't invest in a set of Internet applications that make it easier for patients and consumers to do business with them, then someone else is going to do it. We believe a couple of key health systems in each market are going to take advantage of these Internet applications and derive so much value from these applications to their doctors that theyOll build a very loyal customer base and will become a dominant player."
There are about 1,000 participants in Memorial Hermann's network, Bradshaw says. Through the system, physicians who have privileges at Memorial Hermann hospitals can get a password so they can log on to the portal, which they can access from any computer with Internet capabilities.
They then can request or receive lab work, radiology exams and transcriptions. They can access information to facilitate billing or to determine patientsO eligibility for insurance coverage. Physicians also can use the portal to link to various reference libraries that provide a variety of clinical information sources. The system can be customized so physicians quickly can access sites of particular interest or view information in a way that is tailored to their specialty.
Physicians take to the Web
Physicians were not clamoring for the Web-based services they now have, but they are beginning to change their habits based on its availability, says John Vanderzyl, M.D., a family practitioner who sends patients to 886-bed Memorial Hospital Southwest in Houston. "I think physicians are like anybody else," he says. "We're not really demanding it. I'm only 36, but even so, we're kind of set in our ways of doing things. In a sense you don't really embrace things that quickly, but once we do, it will make life so much easier that we will demand it of all the facilities we send patients to."
San Francisco-based Catholic Healthcare West, another not-for-profit system with 47 hospitals, has been working to expand the use of clinical messaging products that link affiliated physicians and deliver clinical information from CHW hospitals and labs. What began as an agreement in March 1999 to work with Axolotl Corp. to create a "clinic without walls" has expanded from one CHW hospital, 275-bed Dominican Hospital in Santa Cruz, Calif., to CHWOs hospitals in the Bay area and the Sacramento region.
"It improves patient care and enhances the close relationship that CHW has with the medical staffs of our hospitals," says George Bo-Linn, M.D., CHWOs senior vice president and chief medical officer.
Bo-Linn would not say how much CHW has spent on the electronic initiative, nor has CHW yet measured its effectiveness, he says. But he indicates that part of its attractiveness is derived from the options it offers physicians. "It's their choice," he says. "They take a look at it and determine whether it brings value to their daily practice."
Ray Scott, president, co-founder and chief technology officer of Mountain View, Calif.-based Axolotl, says his company provides software to allow CHW to pass information along through the Internet: lab results, admissions information, discharges and transfers. Currently 11 CHW hospitals are involved, and there are plans to expand the system to all CHWOs facilities over a three-year period, he says.
Scott estimates that the products save hospitals at least 75 cents for each electronic transaction. With electronic transmission of lab results, for example, there is no courier cost, no paper, no time wasted waiting on the phone and no collating. "When you add all that up, 75 cents per transaction is a conservative estimate," he says.
One of the advantages of the portal approach is that it enables physicians to use a health system's existing and varied computer applications intuitively, just as when they browse the Web, when they actually may be interacting concurrently with several information systems.
Memorial Medical Center in Savannah, Ga., has been involved in a joint venture with McKesson HBOC to develop yet another physician portal that does just that, says Frank Davis, M.D., assistant chief of trauma and surgical critical care. McKesson is marketing the product to other hospitals and systems as a key solution for attracting and retaining physicians.
While information systems departments designed the clinical systems of the past, physicians are designing the more recent products. "A lot of information systems people don't really take care of patients," Davis says. "From the get-go, we said this thing had to be intuitive. Without knowing anything at all, you basically can get into the system with two to three minutes of training and be able to navigate."
Although the availability of the system might not drastically change referral patterns, Davis asserts that a computer system can discourage physicians from referring patients if it is difficult to navigate. "If a physician is in a community and has a choice of a hospital with a good information system and a bad information system and had to make lots of rounds, the good information system could be a deciding factor," he says.
Whatever the doctor wants
One example of the information system's physician orientation is the placement of computer terminals in the Savannah facility. Some physicians like to take notes as they walk when making rounds, while others like to sit at a desk. Still others like to stand and write. To accommodate everyone, the hospital has placed laptops on rolling carts for the walkers, conventional desktop computers for the sitters and computers on countertops at the nursing stations for the standers. "You need to cater to all types of work habits," Davis says.
Designing a portal to overlay a hospital's existing, or "legacy," systems is also far less expensive than redesigning all the systems from scratch, he says. "It's a big bang for the buck, because for several hundred thousand dollars, it gives you a whole new look and feel," he says, "but it preserves the investment you have in your legacy systems."
Steve Stanic, vice president and chief information officer at Memorial, says physicians at the hospital think the portal is the greatest improvement the hospital has ever made from an information systems standpoint. For about $250,000, the hospital has been able to allow physicians to do their jobs more efficiently. "It's very inexpensive, especially for what it does," he says. "It really makes whatever system the physician is in transparent to them."
Physicians who have no desire to be computer experts can double-click on a patient's name and get all the information they need. Training takes about five minutes, he says.
The proliferation of portals is simply a new twist on hospitals' attempts to remain competitive, says Daniel Russler, M.D., vice president of clinical strategy for the information technology business at McKesson. "Ever since hospitals have been competitive, they've worked with physicians in different ways," he says. "What's really new with the Internet is the creation of an electronic community, the opportunity to improve physician relationships by creating a healthcare community."