MH: How has the shift to offer more care away from the hospital impacted your IT planning?
Arora: We've developed a robust telemedicine program and an infrastructure around it. We want to deliver care to the patients in schools, at home, and in rural areas across the state and through our tele-NICU and tele-ER programs.
We're in over 100 schools today. We also have telemedicine going into the social work aspects. So not only from a school nurse standpoint but we are also meeting the emotional needs of that child.
It's really key to our strategy and we believe that we need to help children in wellness as well as when they're sick within the walls of our hospital.
MH: When you say that you're in 100 schools, is that clinicians based in the school, telemedicine or a combination of the two?
Arora: It's telemedicine into the schools. I think that's very key because we're basically leveraging the infrastructure that's within our community to be able to reach those children so that they can leverage our specialty skill sets when they're needed.
MH: What are the conversations like with the rest of the C-suite and board about reaching deeper into the community?
Arora: They've been incredibly supportive. It's mainstream technology, so we're very confident in its reliability.
There are other aspects of the technology when we connect with small physician practices—one- and two-doc practices—where in some cases the security hasn't been at the level that we'd like it to be. In those instances, we have partnered with our small physician practices to work with them to find security solutions that … can scale to their needs at a price point that suits them.
There's a program called CyberAid. We've partnered with a vendor that, for the price of a cup of coffee a day, was able to provide monitoring and services to address the malware that was coming into these small doc practices. In some cases, we were hosting some of those physician practices on our EHR and it created a better environment, not only for those physician practices but across the whole continuum of care, as far as that data flow.
Those are areas where we try to get creative.
MH: Part of this is also interoperability. Talk a little bit about data exchange with those pediatric providers.
Arora: We believe in the importance of delivering information and we sign up to any method of sharing that we can. For example, we share information around disability determination with the Social Security Administration and, while that's a small subset of our patient population, that actually helps them get reimbursed much more quickly and it saves us administration costs.
That's one example, but we plug into a number of different exchanges and we leverage the interoperability capabilities of our EHR. We find that it's very capable of sharing records. But even when you're doing that, there are still challenges with interoperability between different systems.
I'm going to give you a couple of examples. So a simple one with babies and naming conventions. If you have information like the (parent's) email address and the phone number, your ability to match a baby, to make sure that you're certain that you're matching the record appropriately, is increased by 10%. But many times, the standards don't require that you have an email address or a phone number.
From a lab standpoint, there is currently no standard way to differentiate the type of lab result. So for example, there could be a radiology result or a microbiology result. Both of them are sent in a (consolidated-clinical document architecture) document. If the C-CDA specifications were to differentiate between the various types of results, vendors, let's say Epic, Cerner or Allscripts, could better integrate outside data into the patient's chart, giving an overall better experience to the clinicians and the patients. Without the specification, it's difficult to know what type of results are being sent … and clinicians are forced to look at all results together without categorizing them, sorting them or filtering them, and when they intermingle them, they can get confused.