Just Say No to a Single Product … and Hello to a True Community Record
Editor's note: This column was written by Bill Spooner, senior vice president and chief information officer at Sharp HealthCare, San Diego, winner of the 2007 Malcolm Baldrige National Quality Award. In 2009, Spooner was awarded the CHIME-HIMSS John E. Gall, Jr. CIO of the Year Award.
In 2011, as health systems across the country race to earn HITECH incentives for Electronic Health Record adoption in the hospital and ambulatory settings, many will come face to face with the real bogeyman in healthcare today: How will they get their systems to converse with those of all the affiliated and non-affiliated providers in their community, most of whom use technology from a variety of different vendors?
Answering that question is critical, not only to creating accountable care organizations (ACOs), but to improving our healthcare system. You can't increase quality, improve safety and manage costs across a community without seamless handoffs of patient information from one care setting or organization to another. Just one example: If providers in a skilled nursing center can see the test results and treatment plan developed for a patient during their hospital stay, they can more easily avoid expensive duplicate tests and potential problems leading to readmission.
We all agree on the rationale for connecting across communities of healthcare stakeholders. Where we disagree is how to accomplish that goal. The most popular approach today seems to be implementing a single product across all of a health system's properties. The appeal of the single product is undeniable, but short-sighted. What CIO hasn't yearned, at one point or another, to replace the hundreds of applications running in their enterprise with one gleaming -- and very expensive -- throat to choke?
Single-Product Approach: What's the Problem?
The problem with the single-product approach isn't that it's too expensive, assuming you have the money, of course, or too time consuming. It's not even that you can't find a single vendor who can bring together much of your organization.
No, the real problem is that it's unrealistic to believe that such a strategy can extend to every provider in an entire community. Can you imagine getting all the stakeholders in a community to agree on a single product?
In conversations I regularly have with groups of my fellow CIOs, this concern is usually marginalized. Yet I believe every health system with a single IT product risks locking themselves out of the future of healthcare, which will require information systems that interoperate across an entire community of care.
At Sharp, we've taken a different approach to building a seamless patient record, one that I think of as more practical and less expensive and time-consuming than the "rip and replace" strategy required for a single-product solution. Since 2004, Sharp has invested to automate ambulatory records and consolidate inpatient clinical systems as part of The Sharp Experience, our enterprise-wide performance improvement initiative.
Hybrid Approach
While we don't disclose our EHR expenditures, the totals are considerably less than I hear reported by many organizations. The program represents a hybrid approach, with multiple best-of-breed applications complemented by an ambulatory EHR for the 400 multi-specialty physicians of Sharp Rees-Stealy Medical Group, and a unified inpatient EHR from a different vendor (currently in five of our seven hospitals).
One of the biggest reasons we've taken this hybrid approach is that our physicians and other caregivers in and out of the hospital like it. It means they're able to use the IT systems that best meet their needs, which should translate into better outcomes. Why? For one thing, caregivers are more adept at using the applications they like, which means they're more likely to use them.
More importantly, our hybrid approach solves a common complaint about single systems - that caregivers are inundated by extraneous patient information. For instance, our Rees-Stealy physicians don't want to see the 56 hourly glucose readings from their patient's hospital stay in the EHR; they want to be able to quickly spot representative readings, or the last reading before discharge. Physicians want IT systems that not only pull disparate pieces of data from multiple settings but that make sense of the data. Now that we have mountains of information, the challenge is to filter the data so caregivers receive only the right information, at the right time. More about that in a moment.
Along with the benefits of the hybrid and best-of-breed strategy comes one big challenge: interoperability. Over the years our IT department has deployed a range of solutions to create virtual interoperability among the solutions we use. These range from depositing results into the same system, to web-like interoperability, to methods for pulling data out of all the applications and analyzing it in aggregate.
Allscripts (our ambulatory EHR provider) and Cerner (inpatient EHR) deserve a lot of credit for sharing the common goal of tight interoperability and for working with a common group of clients, including Sharp, to deliver tight integration of key clinical information. This ability will be especially important as ACOs emerge in our communities, because physicians, hospitals and other stakeholders are only able to work as a coordinated team to deliver better care more cost effectively when they work from the same shared record.
Interoperability Platform
The best overall solution, I think, is one that we are just about to deploy - a Community Record and Exchange, provided by Allscripts. The interoperability platform is designed to bridge gaps that often exist between hospital-based and office-based care by connecting our acute and ambulatory clinical and financial applications with those from other vendors in the community. It can also help solve the problem of paring down and integrating mountains of data using "semantic interoperability," an approach that preserves the original meaning of data regardless of its format.
The result will be a single community patient record that is available across all care settings -- the cornerstone for a health information exchange, initially comprised of Sharp and its affiliated practices, which will pave the way for efficient connected healthcare in the region.
In the end, that capability is the biggest single justification for the hybrid or best-of-breed strategy. Our goals for clinical excellence can only be met by ensuring that our physicians have access to a comprehensive patient record that reflects meaningfully harmonized data from all care points throughout both the acute and community environments. A single patient record will significantly enhance our ability to provide the best care possible for San Diego area residents.
Thanks to our willingness to just say no to the single-product trend, we're in position to cross that finish line to a true community record, well ahead of the rest of the pack.