“The clinics are going up as we speak,” Carlson said. “So, next March, we will roll out with three facilities and the rest in May 2014.”
Hospitals and hospital systems, especially those that have purchased physician practices and expanded their ambulatory-care outpatient clinics, are facing a growing need to follow patients continuously no matter where they are receiving care. Interoperability between EHRs has become key to successful integration of their operations. But many of the hospitals and clinics being knit together have legacy systems with multiple and often non-communicative EHRs. That is forcing many to consider switching from their existing systems to more comprehensive EHR vendors that can serve all their facilities.
“I think we do well with all of our quality metrics, fabulously, actually,” Carlson said, “but … we ended up needing something that crossed over to all areas.”
Currently, clinicians at the hospital are primarily served by a Siemens EHR for inpatient and NextGen for ambulatory care. “We have a lot of different ancillary services that have their own programs as well,” Carlson said. For example, discrete, “best-of-breed” EHRs for the emergency department and another for obstetrics. Communication between them was “inconvenient,” she said.
“If you had an OB patient that ended up on another floor, the nurses on another ward wouldn't have access to the OB system. A few years ago, they did figure out how to have the OB record flow into one spot of our (main inpatient) system, but it was more like looking at a PDF. That gave us real-time information. We didn't have that before … Using Epic will eliminate that,” she said.
Epic competes with more than 30 vendors of complete EHR systems for inpatient use by hospitals. Its 20% market share gives it the leading position among vendors who have had customers get paid as “meaningful users” of health information technology under the federal Medicare EHR incentive payment program, according to CMS data. Epic also leads in the incentive payment pack of more than 400 health IT vendors of complete EHRs for ambulatory care, with 22% of that niche market, CMS data show.
All vendors must develop methods to help their customers meet the interoperability criteria in Stage 2 of the meaningful-use requirements, which begins for eligible hospitals Oct. 1 and for physicians and other eligible professionals Jan. 1, 2014.
Could this pressing need for interoperability finally drive a stake through the heart of the “best of breed” strategy used by so many healthcare organizations in the past? Best of breed refers to the assembly of a complete EHR from component parts—noted for excellence in their particular spheres or specialties, such as emergency departments or labs—and tied together with interfaces or so-called “integration engines.” According to CMS data, 88 different vendors of so-called “modular” EHR systems have at least one client that has used its software to meet its Medicare meaningful-use targets under the EHR incentive payment program.
Dr. Michael Sheinberg thinks so. Sheinberg is an OB/GYN at Lehigh Valley Hospital in Allenton, Pa., and the associate medical direct of its 800-physician medical group. He and a contingent of about a dozen people from Lehigh Valley came to the Verona meeting in preparation for their switch to an Epic EHR. Sheinberg said Lehigh Valley clinicians had been using a different EHR for about a decade.
“We were probably king of best of breed,” Sheinberg said. “But it was at a time when that was the best of what you could get.” Individual systems for specialty areas, such as ED, made sense. Since then, according to Sheinberg, developers of enterprise systems like Epic have greatly improved their specialty modules while the specialty systems seem to have reached a development plateau.
“We sort of maximized out the best of breed concept,” Sheinberg said. “We sort of outgrew it. Most of us did. You can only get so far with efficiency with the best of one system.”
When it comes to expending the effort to achieve interoperability, “you have to think of the bigger picture,” and that's improved patient care, said Jennifer Greene, an application analyst at 640-bed Lancaster (Penn.) General Hospital. About a year ago, after four months of effort, Lancaster, using its Epic EHR, had achieved interoperability with May-Grant Associates, a large, independent OB/GYN group practice, which uses an EHR from Greenway Medical Technologies.
So far, in a year, the hospital and the group have exchanged more than 11,000 documents, Greene said, “and that increases monthly. It might have taken four months, but the benefit you get in return is worth it.”
Follow Joseph Conn on Twitter: @MHJConn