Scaling Down Health Information Exchange to Step Up Efficiency, Referrals

In November 2011, Beth Israel Medical Center in New York began using an interoperability service that allows it to send patients' radiology test results directly to the electronic health records of a group of its referring physicians. This service strengthened the hospital's relationship with this group — the Manhattan's Physician Group — increased efficiency and provided a health information exchange platform. This automatic filing of results into a physician's EHR may be only the beginning, however. The system can connect with other hospitals, labs and physicians and may be able to transfer other types of information, such as images, in the future.

Strengthening relationships
Beth Israel Medical Center uses the interoperability service with Manhattan's Physician Group, a multispecialty independent practice that refers many of its patients to Beth Israel. The hospital established the service to meet the needs of the physician group, because waiting for a fax or email of test results was inefficient. The new service eliminates the need for the hospital to manually send the results and the need for physicians to hunt down their patients' results. "We have at least the assurance that the report is in the patient's file," says Michael Abiri, MD, chairman of radiology at Beth Israel Medical Center. "That was the most advantageous part for us."

Providing this service thus strengthens the relationship between the referring physicians and the hospital because they have a guarantee they will quickly receive their patients' radiology results, which improves the physicians' efficiency. The technology is "a platform for a relationship between the physicians and hospital," says Mike Gaeta, vice president of business development at CriticalKey, the company that provides the interoperability service. "It's an investment in the future to keep these physicians close to the institution." In fact, Mr. Gaeta suggests this local health information exchange could support an accountable care organization. If a hospital and physician group decide to follow this model, an existing HIE could facilitate the transition to integrated care. "The structure is there, the platform for a relationship is there. They're already connected," he says.

Rising above the competition

The efficiency derived from the HIE between Beth Israel Medical Center and the physician group gives the hospital a competitive edge over other hospitals building a referral network. Dr. Abiri says having a service that sends radiology results directly into physicians' EHR differentiates the hospital from competitors. When Manhattan's Physician Group put pressure on Beth Israel to develop this service, the hospital complied because it risked losing a base of referring physicians. Providing efficient communication of results may also incentivize other physicians to refer patients to Beth Israel.

In addition, Mr. Gaeta says some hospitals have adopted the interoperability service to compete with local imaging centers. "It's a competitive marketplace. It definitely gives a hospital an edge when competing with its neighbors," he says. This edge can translate into increased revenue for the hospital from an increase in patient referrals.

Looking to the future
In the future, the interoperability service may provide a sustainable model for a statewide HIE. Unlike statewide HIEs, which are generally funded by grants, the local HIE is paid for by the hospital. The local HIEs can also connect with each other to form a larger HIE that may be more cost-efficient than the traditional statewide model, Mr. Gaeta says.

Dr. Abiri says Beth Israel is considering expanding the interoperability service to other departments, such as the emergency department, and expanding its capabilities. Beth Israel aims to use the interoperability platform to facilitate patient scheduling, which is currently done over the phone or by fax. With an interoperable scheduling capability, referring physicians could access the hospital's schedule and directly add patient appointments, eliminating the need for the patient to contact the hospital for an appointment and granting the primary physician more control over when the patient is seen. In addition, the service currently sends written results to physicians. Dr. Abiri says directly sending images from patients' X-rays and other tests to the physicians' EHR would also improve efficiency.

More Articles on Interoperability:

9 Leading Hospital, Health System CIOs Share Top Goals
7 Best Practices for Hospitals Implementing a Health Information Exchange

ONC Reduces Optionality to Support Interoperable Health Information Exchange

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