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Eastern Maine Healthcare Systems promotes a vision of shared clinical data—even with its competitors.

The information technology goal at Eastern Maine Healthcare Systems seems simple enough: a single, unified patient record across the enterprise. Attaining that endpoint, however, has been a complex undertaking for the seven-hospital integrated delivery system based in Bangor.

Nevertheless, spurred on by a revamped governance model, EMHS is accomplishing what remains for many health systems an elusive vision. By the end of this year, all seven of its hospitals will be running on a common platform of core IT systems. These systems will handle the bulk of clinical, financial, administrative, and image archiving functions. Moreover, EMHS is driving clinical quality through the use of real-time information tools and patient safety enablers, such as computerized physician order entry. "No matter where one of our patients seeks care, their information is accessible," says Cathy Bruno, vice president and chief information officer.

In what it calls the "Together Project," EMHS is rolling out a set of applications that have been in place at its flagship hospital, 370-staffed-bed Eastern Maine Medical Center. Since mid-2005, the health system has been transitioning its affiliated hospitals to a suite of applications from its key vendor partners: Cerner (for clinical documentation), Lawson (for financials), Agfa (for image archiving), and Siemens (for patient accounting and billing). By this October, each of EMHS' facilities—which range from a 14-bed rural facility to a 100-bed behavioral health hospital—will be up on the core systems.

"Many of our smaller hospitals refer patients to our flagship, so the Together Project made sense for the continuity of patient care," says Bruno. "In addition, we realized economies of scale. The marginal cost to add new systems is lower compared to the hospitals' buying individual systems."

A common IT platform—EMHS has multiple data feeds connecting its core applications—fits with the organization's centralized approach to project management and business operations. The system, for example, runs a centralized billing office, which handles payer transactions for four of its hospitals. A centralized help desk addresses IT problems.

The approach has been driven in part by the widespread geographic locale of the system's affiliates. Despite consolidation, the health system has tried to avoid a "top down" culture, in which directives emanate from the flagship hospital. It has devised a representative governance structure for technology projects, a necessity when working with multiple medical staffs, observes C. Eric Hartz, MD, Eastern Maine Medical Center's chief medical information officer.

For example, instituting a standard formulary for use in its computerized physician order entry system requires political sensitivity, Hartz says. "Smaller institutions are concerned about being told what to do," he says.

The shared governance model was borne out of necessity, Bruno concedes. "We had rolled out two hospitals on the Together Project," she says, recalling deployments that took place in mid-2005. "But we realized we had no structure to set priorities. So we created our IS governance committee." The IS leadership group, composed of affiliate hospital CEOs, the chief medical officer, and clinical representatives from affiliate hospitals, took shape at the end of 2006.

Since then, the group has helped steer the Together Project, which otherwise could have foundered given the almost limitless number of decisions facing the healthcare system. The governance committee, for example, established remote ICU monitoring as a top priority. It postponed the introduction of CPOE—now firmly established at its flagship—into several of the system's smaller hospitals, limiting the immediate expansion of order entry to the behavioral health facility. "The behavioral hospital has fewer orders," explains Bruno. "Putting in CPOE at the other hospitals was too much to do at once."

Hartz got an object lesson during Eastern Maine Medical Center's rollout of CPOE, which took place in fall 2007. To win medical staff approval of order entry, Hartz added a log on the hospital's intranet that kept the medical staff abreast of all the issues—and their resolution—with the new system. "We identified 2,100 issues with the new system," he says. "Everything from the simple, such as adding a new dosage to the system, to the complex, such as our process around cardiac catheterization orders, which we needed 50 people to address." Publicly listing all the problems and the eventual technology fixes helped win the medical staff's confidence in the electronic order system, which now accounts for 90 percent of orders placed at the flagship hospital, Hartz says.

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