Recognizing early the need to share patient data between non-affiliated providers, officials at Berkshire Health System reached out to other providers in the Pittsfield, Mass., area, about three years ago to try and get everyone on the same EHR.
"But people were in different stages of the game and most wanted to do their own thing," says Berkshire Health System CMIO Mark Snowise, MD. The mid-sized community (population 130,000) ended up with a total of nine different EHR systems among local providers. Berkshire Health System itself ultimately decided to run two EHR platforms; MEDITECH on the inpatient side and Allscripts for many of the owned and affiliated physicians.
So Berkshire Health System officials began to consider a health information exchange solution to meet the community's data-sharing needs. "The ultimate goal was to have all the data on the patients in the community to be accessible from whatever record you're in," says Dr. Snowise.
When considering HIE solutions, Dr. Snowise and other executives from the health system were looking for a system that would provide more than a simple C-CDA exchange — something that would allow providers to share clinical notes and other unstructured data. They also wanted an HIE that would eventually be able to connect to other regional exchanges and the Mass HIway, the statewide HIE. After considering several options, officials decided on dbMotion from Allscripts.
The HIE go-live is happening in two phases — first data is being entered into the system and then it will become available for users. The HIE project began in February 2013 and Berkshire Health System's inpatient EHR has been feeding data into the HIE since March. Data from the health system's physicians' EHR and cancer center just began flowing to the HIE. "The plan was to have the system up and running for three months [before connecting other users], so in three months we'll release it to users," says Dr. Snowise.
The implementation process has not been without its challenges. In the middle of the HIE implementation, the health system's EHRs needed updates to meet meaningful use stage 2 requirements, forcing staff to split their attention during the upgrade. The health system staff also spent a lot of time customizing the HIE user interface to help the solution fit better into providers' workflows. "We didn't want them to open dbMotion and see a very different view" than they saw in their EHRs, says Dr. Snowise.
One of the most helpful steps taken during the HIE implementation was to visit Pittsburgh-based UPMC and see a similar HIE in action, says Dr. Snowise. "It was so helpful, we got to see the good and the challenges," he says, and he came away with best practices about data mapping and display. The health system also ran internal pilots with clinical users to see how the data mapped from the EHR to the HIE, which let Dr. Snowise and his team make adjustments before completing the build.
Berkshire Health System is also preparing for challenges that will crop up after the HIE goes live. Once it is being used and relied upon by providers, the HIE will need around-the-clock technical support, which will require significant staff resources.
Patient consent is also likely to be an issue. "We'd love it if you're on the HIE unless you opt out, but unfortunately Massachusetts says you're out unless you opt in," says Dr. Snowise. Collecting this patient consent will become more complex as the HIE grows and possibly connects to other exchanges. A governance structure is currently being set up to convene stakeholders to handle this and other logistical issues as the HIE expands beyond Berkshire Health System.
Despite these looming challenges, Dr. Snowise is confident the HIE will be a boon for Berkshire Health System, neighboring providers and the patients they serve. "This will become an essential tool for us," he says. "We'll really be able to coordinate care."
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