When NorthShore University HealthSystem in Illinois installed its electronic medical record in 2003, "we thought the main advantage would be patient safety, such as eliminating errors from hand-writing prescriptions," says CIO Tom Smith. Now, after seven years of use, Mr. Smith thinks the main advantage is really an improvement in operations.
One database, shared by all clinicians, he says, has enormously enhanced the way care can be delivered at NorthShore and across the country. For example, it has cut out unnecessary tests. In the old paper system, test results weren't inaccessible; they were just too hard to find, Mr. Smith says. Physicians didn't have the time to wait, so they simply ordered a new test.
Mr. Smith, more than just about any CIO around, can see into healthcare IT's future because NorthShore is already there. Last year, the Healthcare Information and Management Systems Society designated NorthShore as one of just two health systems in the nation to have has reached HIMSS Stage 7, its highest stage of EMR adoption. This year several more health systems reached Stage 7, which requires being paperless, having a complete PAC system for medical imaging, having a reliable back-up system in case the system crashes, being able to share data with other organizations, and having an elaborate data warehouse.
Spreading health information everywhere
How things have changed in healthcare. Mr. Smith says the technological breakthrough at the beginning of last century was the paper chart. All clinical information on the patient was finally in one place, easy to consult. The problem, however, was it was not anywhere else. You had to go somewhere to read it, or have it fetched to you. Now along comes the electronic medical record and, suddenly, the chart is available everywhere. At Northshore and a growing number of other organizations, "the doctor can view the chart in his office, in his home or while away at conferences," Mr. Smith says. The doctor can do anything, anywhere, except talk to or touch the patient.
Getting to this point, however, involves a very difficult transition. Switching from paper to computer is a traumatic experience, Mr. Smith acknowledges. "I have never had to make as big a change in my day-to-day work as physicians do when you implement an EMR," he says. But the 2003 transition at NorthShore was relatively smooth because physicians were required to take training beforehand.
Faced with this daunting change, some hospitals take half-steps, such as moving to a combination of paper and electronic records. "They have not introduced electronic documentation by nurses and physicians or they have not yet started computerized physician order entry," Mr. Smith says. He predicts these half-steps will become less satisfactory as the rest of the world races ahead with EMR.
As hospitals move up the ladder of HIMMS stages, one significant breakthrough is Stage 5, achieving "closed-loop medication." Right on the floor, nurses scan the bar code on a medication to see if it matches the prescription. "This is a significant safety step," Mr. Smith says. "Despite all the other safety checks before this step, we still stop an occasional error this way."
Federal payments to hospitals
Federal health information technology payments to hospitals and practices under the stimulus bill are expected to set off a new wave of healthcare IT implementation. Mr. Smith says the typical 500-bed hospital would get around $10 million in federal HIT funding. While that won’t cover the massive outlays hospitals have to make to qualify for the money, hospitals have another incentive to move forward. Within five years, CMS will start cutting reimbursements for hospitals that do not meet HIT criteria. Mr. Smith says there are ways for hospitals to get up to speed with spending a lot of money. For example, a hospital can buy a turnkey EMR system that costs a great deal less than a customized system.
Even without federal incentives, "EMRs are becoming essential," Mr. Smith says. Hospitals without EMR are simply less efficient. "Sharing data through an EMR speeds up processes," he says. "At NorthShore, a physician can see a patient in the morning, get lab results by noon and refer that patient to a specialist in the afternoon."
IT is a great way for hospitals to align with their physicians. Every physician on staff has access to the NorthShore EMR at its hospitals and 650 employed physicians in NorthShore University HealthSystem Medical Group have EMR in their offices, but most independent physicians do not, Mr. Smith says. Of almost 1,500 independent doctors on staff, about 70 have EMR in their office and 20 more will be added by the end of the year.
Getting physicians into the loop
Mr. Smith hopes HIT funding will incent independent physicians to adopt EMR. The maximum $44,000 in HIT money available to each physician could can all EMR start-up cost. Hospitals can sweeten the pot by selling their EMR systems to physicians for use in their offices at a deep discount. The federal government allows discounts of as much as 85 percent for the software as long as practices buy their own PCs, do the wiring and create connectivity, he says.
The rewards to a hospital of helping physicians bring EMR into their offices far outweigh the costs. NorthShore already is adding more than 1 million office visits to its system each year, giving it a rich repository of outpatient data. For example, the system now has a full record on 65 percent of the patients who come into its EDs. This is revolutionizing work in the ED, when physicians traditionally have no clinical information on walk-ins. Now, with clinical data on two out of three walk-ins, ED physicians don’t have to order new tests and are aware of drug interactions, allergies and previous illnesses.
Patient portals
As more health systems enter HIMSS Stage 7, NorthShore is now looking ahead to a possible Stage 8, which Mr. Smith hopes might include an internet-based patient portal like his system's NorthShoreConnect. "We think a patient portal should be a criterion for the next stage," he says. "We are very happy with ours." This secure site has signed up 125,000 patients, and as many as one-third of them use it in a month because it has so many uses for them. Patients can look up their lab results, send an e-mail message to their doctor, make a doctor's appointment, cancel an appointment, request a medication refill, pay a bill and even change insurance coverage.
NorthShoreConnect is now beginning to allow patients to enter their own healthcare information. It is starting with 800 patients with diabetes who use the site to record their own home testing scores. "We've proven the technology will work and we want to apply it to other patients," Mr. Smith says.
ACOs and healthcare IT
The next frontier for healthcare IT may be the healthcare reform law's accountable care organizations, which link hospitals with physicians and other outpatient providers to deliver the full continuum of care. This means hospitals must move beyond electronically linking up with physicians and also link with dialysis centers, nursing homes, rehabilitation centers, surgery centers and other outpatient units. "Regulations for ACOs are still being developed, but it is hard to imagine them without a very elaborate computer system," Mr. Smith says. "An ACO needs to share data, develop data on costs and move data around."
At this point, he says NorthShore is not yet ready for an ACO. "One open area is the ability to share data with other organizations," he says. HIT monies for organizations that achieve federal standards are not available to anyone besides hospitals and practices. But these entities need to adopt EMR to take part in ACOs, Mr. Smith says.
Meanwhile, hospitals and other healthcare organizations are creating information exchanges in each state to help share information. Mr. Smith says the Illinois exchange, organized by the Metropolitan Chicago Hospital Council and the State of Illinois plans to be up and running around September of next year.
Hospitals that are on the sidelines as these rapid changes take place will fall further behind, Mr. Smith predicts. "Without EMR," he says, "it will be difficult for them to compete."
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