State officials reversed course in mid-June and cleared construction of a $267 million children's hospital in Orlando, Fla., after twice rejecting the bid from the Nemours Foundation.
The pediatric provider's latest, successful attempt hinged on newly developed plans for joint research and education efforts with the University of Central Florida and the Burnham Institute for Medical Research; a guarantee of access for low-income patients; and Nemours' electronic medical-record system, according to certificate-of-need approval documents.
The Florida Agency for Health Care Administration cleared the 95-bed hospital after a demonstration of Nemours' EMR system, but with 10 conditions, including a pledge that at least 54% of its patient days be care for patients covered by Medicaid plans or charity care. Regulators gave the contentious project the go-ahead despite little evidence that Orlando needs another hospital. Nemours "has not demonstrated that this hospital is needed because of access issues of future bed availability," the agency wrote in its approval. "Further, the project will impact existing providers." However, officials said Nemours' EMRs would likely boost quality and its access guarantees would benefit low-income patients.
"While some hospitals and physician offices offer advanced electronic patient record and tracking systems, Nemours has demonstrated that its integrated EMR has superior features and has been time-tested," regulators wrote.
Dean Montgomery, a director of the American Health Planning Association, said certificate-of-need criteria don't typically deal with EMRs when considering how projects will meet demand and access for care, but regulators may consider how such systems may address questions of efficiency or outcomes when weighing the benefits of development.
Fernando Senra, a spokesman for the Florida regulatory agency, declined to comment on the CON approval but said "each application is different and receives a very thorough review when undergoing consideration," in an e-mail. "There may be factors in an application that make it more of what is best for the community, and this process is intended to select the best of the proposals presented."
Major opponents to the project, Orlando Regional Healthcare and 1,767-bed Florida Hospital, Orlando, have a 28-day window to appeal, but agreed to enter into state mediation to avoid an appeal.
David Milov, Nemours' chief of clinical information systems, said Florida AHCA officials visited Nemours' 174-bed Alfred I. duPont Hospital for Children in Wilmington, Del., for a demonstration of its EMR system after rejecting the planned Orlando hospital for a second time. Milov said the pediatric provider, which also owns clinics in Delaware and Florida, has invested at least $10 million over 10 years in digital records. Eighty percent of inpatient and all outpatient physician orders are electronic, he said, and the system includes electronic alerts, reminders and evidence-based guidelines tailored to patients' medical care.
Milov said Florida officials focused on pediatric-care supply and demand when considering and rejecting prior bids, but Nemours officials put greater emphasis on its proposed hospital's potential value on the third try. "We didn't tell the story well enough," he said of the failed attempts. "What we improved on is our storytelling."
Joe Brown, an Orlando Regional spokesman, said the three-hospital system first implemented its EMRs in 1997. Nemours and Orlando Regional, which owns the Arnold Palmer Hospital for Children, failed to agree on a joint pediatric project in 2006.
Jayne Bassler, vice president and chief clinical informatics officer for Florida Hospital, said it will begin replacing its existing medical records in the next month and begin electronic physician orders in 2008. Bassler said EMRs are widespread among hospitals in central Florida and elsewhere. "It's basically becoming a requirement of doing business," she said. "We're pretty much in the same places and heading in the same places."
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