Healthcare leaders in more than 100 communities across the U.S. are exploring ways to share patient information through regional health information organizations. One way providers in several communities have tried to achieve interoperability is by agreeing on using one main healthcare information technology system to serve their needs, creating what might be called vendor-centric RHIOs.
One of the oldest and most extensive examples of this rare breed is an exchange served by Inland Northwest Health Services, a not-for-profit corporation formed in 1994 by four Spokane, Wash., hospitals looking to collaborate. Today, INHS supplies outsourced IT to 38 hospitals and more than 1,000 office-based physicians in Idaho, Washington, and, most recently, California.
INHS uses as its basic core the enterprise hospital IT system from Medical Information Technology, or Meditech, Westwood, Mass. INHS also supports a physician office electronic health-record system from GE Healthcare, although the service organization will work with a multitude of other software products for its provider clients, according to Thomas Fritz, INHS chief executive officer.
INHS client hospitals range in size from
25 beds to more than 600, all using a central data repository and servers in Spokane that dish the software using an application service provider, or ASP, model.
Using one core IT system isnt a panacea for interoperability, Fritz says. No matter where you are, youre going to have multiple vendors, he says. Were hoping with the setting of interoperability standards, youll be able to use multiple vendors easier. But Fritz says: There is no doubt about it, the fewer vendors the better, because that means fewer interfaces. INHS has 225 employees working in IT and a $35 million IT budget spread across 38 hospitals.
Jay Linney, vice president of state and regional health initiatives for Kansas City, Mo.-based Cerner Corp., says the idea of a vendor-centric RHIO is an interesting premise and logical and valid on its face. Weve also had experiences where health systems have made opposite decisions, where there is not a strong, vested interest in sharing information across the street, and hospitals have chosen not to buy the same IT system as a key competitor, Linney says.
Cerner, already a player in remote data hosting, will be the IT provider for a Web-based, employer-sponsored community health record consortium in the Kansas City area called Healthe Mid-America.
So far, 21 area employers have committed to join Healthe Mid-America, providing free community health records for their 100,000 employees and dependents, according to Jim Hansen, CEO for the consortium. Cerner is scheduled to launch a pilot of the service for its own employees Jan. 31, with rollouts to two or three other employers expected before spring.
The group estimates employer members will save $15.6 million over five years in lower healthcare costs through the system, Hansen says.
What were seeing in the Kansas City employers coming together is where we see the market will evolve, Linney says.
Epic Systems Corp., Verona, Wis., has locked up all of the hospitals and several of the large medical groups in nearby Madison. Working with its Madison customers, Epic is developing a programming package to create an exchange capability for fellow Epic system users, according to Carl Dvorak, chief operating officer.
Dvorak says he doubts vendor-centric RHIOs will dominate the healthcare IT landscape. Most areas have a number of vendors already in place, he said, but, we are seeing in a number of geographical areas where there are enough Epic sites together to give them a jump start to the exchange of data.
The interchange will allow a provider at one Madison hospital or medical group to do a simple request for patient information stored on the IT system of another facility in the community. The first exchanges will be limited to basic information such as medication histories, allergies, immunizations and a summary of recent visits.
Obviously, it isnt going to be the complete medical record, says Peter Strombom, vice president of information services at Meriter Health Service, Madison, a participant in the exchange pilot. Strombom notes that developing a viable business case has been a major hurdle for most RHIOs, but it wont be a problem in Madison. Because its peer-to-peer, we believe we dont need the infrastructure that an independent RHIO requires, he says.
Strombom says the project was launched about six weeks ago during a meeting of Madison-area healthcare IT leaders. We hope to have a test environment up and running by
Jan. 8, he says. Having common vendors makes it easier.
St. Louis-based SSM Health Care, the parent of St. Marys Hospital Medical Center in Madison, didnt pick a vendor for its systemwide clinical IT program until about 15 months agoafter most of the hospitals and major physician groups in Madison had chosen their IT vendor.
There was a complex and thorough evaluation and selection process, says Frank Byrne, the 289-bed hospitals president. But the experience of our key physician partners (at
St. Marys) was certainly one factor, which worked out well with us in Madison because our physician partners at Dean (Health System) had already selected Epic and were already on the way in implementing it. Dean is a 500-physician group practice affiliated with St. Marys.
Like Linney, Byrne says, In traveling about the country, I still encounter the healthcare leader who sees that a proprietary EHR will give them a competitive advantage. According to Byrne, thats the wrong approach. I feel the medical record belongs to the patient. Since were all going to be on the Epic platform, were looking at how we can accelerate the process and improve the care for the people we serve.
But Hoda Sayed-Friel, Meditechs vice president of marketing, is skeptical. No one model of RHIO will dominate, she adds. Everyones definition is different. The stakeholders and the personalities across the country are all different.