Building a Robust, Sustainable Health Information Exchange: Case Study with Northeast Georgia Health System, HealtheConnect
"If the healthcare provider can understand what is going on with a patient that is 100 miles north of them, the patient may not have to be transferred — they could receive care at their home hospital. That ability to understand the patient's situation — to know if they really need to be transferred to a tertiary care facility or to know, if the patient does come, what they need when they get there — is invaluable," says James Bailey, MD, chief medical informatics officer and chief quality officer of Northeast Georgia Health System in Gainesville, Ga.
Unfortunately, not all HIEs are implemented or optimized effectively to achieve interoperability or beneficial outcomes, such as eliminating unnecessary patient travel or duplicative tests and treatments. For instance, studies on HIE outcomes have found mixed results because of the wide variance in implementation success. Furthermore, one area where many HIEs struggle is the transfer of images — a capability that is paramount in accurate diagnoses.
"There has been an unbelievable sophistication of imaging technology and diagnostic tools. However, the number one cause of patient risk is failure to diagnose. If you consider the broad picture and the incredible benefit imaging can offer — the first element any physician will want in information exchange is the exchange of images. We might doubt each other's diagnoses, but if I can see the images for myself, I am more comfortable with the diagnosis," says Dr. Bailey.
While there are many HIEs in the beginning phases, there are also many that have ceased or failed. In order for HIEs to meet their full potential, hospitals and health systems need to rely on practiced wisdom and benchmarks. Collaborative partners in Northeast Georgia are developing an HIE that is well on its way to benchmark status. Here, Dr. Bailey CMIO and chief quality officer of Northeast Georgia Health System; Allana Cummings, CIO of Northeast Georgia; and Deven Mattheus, chief clinical integration officer for Northeast Georgia, discuss the process, best practices and key outcomes of this service area HIE.
HealtheConnection Health Information Exchange Initiative
Northeast Georgia Health System was approached by the state government to launch a statewide initiative using an HIE connectivity model. The health system partnered with a community health alliance in Gainesville, including Northeast Georgia Medical Center and Northeast Georgia Physicians Group; The Longstreet Clinic, P.C.; Northeast Georgia Diagnostic Clinic; and Northeast Georgia Heart Center, to initially launch an image exchange pilot. Technology solutions like Merge Healthcare's iConnect Access and Share were chosen to aid and add efficiency to the HIE. The collaborative partners began their medical image exchange initiative last summer, and the first site launched last fall. They started using the image exchange in the wider physician community in January 2011.
With a successful image exchange pilot under their belt, an HIE project was launched with the selection of MobileMD from Siemens as the vendor of choice to support the broader 23-county HIE initiative. Over 100 interviews were conducted with providers, administrators and community members to learn about the community's needs throughout the region.
"We wanted to link electronic medical records not only from a provider perspective but from a patient perspective as well. That is when you really start connecting the health information in a way that is meaningful in its use. If it is just an exchange between providers we lose that patient engagement and involvement," says Ms. Cummings.
Northeast Georgia has helped coordinate the engagement regional members of the medical community to develop an effective HIE, which already includes a medical center, two large internal medicine and multispecialty group of physicians. According to Dr. Bailey, these physician groups were the natural partners for discussing what the HIE should include as well as testing the program.
How: 4 best practices
Much of success thus far can be traced back to the systematic process being followed by collaborative partners. Here are four best practices that a hospital or health system should follow to achieve similar outcomes.
1. Begin with discussions. To start, the team engaged community physicians in discussions to understand what would be necessary for optimal benefits. Without information from physicians on what is most critical for treating patients, an HIE cannot prepare the appropriate capabilities. According to Ms. Cummings, the physician feedback revealed two major points: physician interest in an exchange of health data was high and that there was room for a huge impact on patient safety and care.
"When physicians did not have the necessary information, such as images, in critical situations, they would often repeat tests that were unnecessary if they had access to images from other facilities and physicians," said Ms. Cummings.
2. Launch with a pilot before widespread rollout. To begin the HIE implementation, community partners launched a pilot medical image exchange with physicians who had been directly involved with the HIE since the initial planning phases. "I would always recommend a pilot. We did a lot of discovery — what worked and what didn't, what providers found value in etc. I believe the later training mechanisms were more effective as a result," said Mr. Mattheus.
Once Northeast Georgia received feedback from the pilot, including successes and opportunities for improvement, the HIE was rolled out in broader phases. "We launched [iConnect Share] so physicians could start direct exchanges. It worked as a good bridge strategy until physicians decided they wanted to feed images into the exchange for everyone's consumption, which tied into our broader HIE strategy," says Mr. Mattheus.
3. Rely on technologically savvy users to help develop the right training program. In order to develop an HIE training program, Northeast Georgia and participating organizations selected technology friendly users to develop a training model. The individuals in this workgroup also supported the implementation by acting as key contacts. "By utilizing technologically capable individuals who were not afraid of bumps in the road we received candid feedback, which challenged us to reach for higher quality in our training model," says Mr. Mattheus.
In addition, the work group provided insight into the practical applications of the HIE that would be used by the physicians the most often. "This was the biggest learning curve for our team. We would get excited about specific technological features, and the work group reminded us to be practical and keep things simple. Instead of getting caught up on the bells and whistles of the HIE and its software, we focused on the most applicable features first," says Ms. Cummings.
4. Utilize "elbow support" for physician training. According to the Northeast Georgia team, the first and best method of training for physicians is "elbow support" because it allows a physician to learn the HIE system in a hands-on format, yet with a support member at their side for questions and troubleshooting. This method of training was useful because physicians did not have time for classroom or formal training, and physicians were less likely to get frustrated and give up when they had easy access to an expert.
"You really can't learn these systems until you can be hands-on and play with them. Similarly, if you are playing with a system and you don't have someone to help you when you mess up; you get frustrated and never want to use it again. Elbow support in the early phases of training is important and can't be over emphasized. Once you get past the beginning stage, you can do other types of education and training," says Dr. Bailey.
"Elbow support was useful because, while the software was fairly intuitive, we didn't just throw physicians into the system with a login and password. We were able to strike a balance. We were training physicians in their workplaces as they were doing their job," says Ms. Cummings.
Why: Benefits and outcomes
The medical image exchange developed and implemented by these community partners has been up and running for less than a year. However, the collaboration participants are already experiencing the benefits of an effective, sustainable and robust HIE.
1. Less time, duplicative tests. The ability to exchange health information, especially images, has allowed Northeast Georgia to save time and eliminates duplicative tests. "Patients can be cleared for surgery through the image exchange rather than having images couriered. This saves time, which is a significant help. Another example would be when patients who have had multiple CT scans in other facilities present in the emergency department, we can see there history more readily and forego another exam," says Dr. Bailey.
2. Unexpected cost-savings. Image exchange users have been able to save money on courier fees to transport images. "When we working on the pilot image exchange implementation, we were totally focused on the patient safety element and overlooked unexpected areas of cost savings. Instead of paying for the hardware and courier fees of burning images to CDs and sending them, we can exchange images electronically at no additional cost beyond our initial exchange investment," says Ms. Cummings.
3. True exchange of data. The image exchange lets physicians exchange images and store them in their own facilities or send them to another system to store in their PACS system. "We try not to duplicate images across the physician community. The image exchange software lets us pull images into our system and push it to another site," says Dr. Bailey. In some HIEs, information is never truly exchanged because the storage of the image remains with the original location. Depending on the situation, this can hinder the use of the images for the patient's diagnosis.
"We are excited to provide a service-area HIE through HealtheConnect that is feature rich in exchanging images and health information between providers and with patients. We believe we must cast the net wide to meet the exchange needs on behalf of our citizens so that health information is available wherever they present for care throughout the region. The idea of being able to demonstrate to other communities how to come together, collaborate and organically grow an HIE is rewarding. We have tried to develop a better, more sustainable HIE model for the long run. It wasn't a vision for Northeast Georgia Health System but a vision for northeast Georgia," says Ms. Cummings.
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