In Douglas County, as in most communities, when a patient walks into a doctor's office and needs a diagnosis, the first thing a physician needs is information. For example: What medications is the patient taking? Has he been to the emergency room in the past? And has he received treatment for previous conditions at other healthcare providers?
The good news is this data is usually available. But the bad news is the data is usually scattered in dozens of computer systems at different healthcare organizations.
We felt compelled to resolve that challenge and help our physicians cope with the changing landscape of healthcare delivery. When we considered some of the industry drivers, such as EHR adoption, interoperability, quality improvement mechanisms, and pay-for-performance trends, it was clear that DCIPA members needed an integrated EHR and practice management system that functioned on a community-wide basis. And most importantly, the EHR system needed to gather data from many disparate data systems and put the right person's details into the right record.
We began developing a vision of how healthcare could be delivered to better serve the county's residents, while at the same time complying with the federal government's mandate for an electronic health record solution with interoperable systems.
Challenge: enterprise data sharing
DCIPA includes nearly 98 percent of all healthcare providers in Oregon's Douglas County. These 145 physicians serve the health needs of roughly 105,000 citizens throughout the county. The goal was to integrate more than 60 individual practice management systems and other disparate health and clinical information sources across the single-chart electronic health record enterprise.
To accomplish this, DCIPA started building a regional health record network in which each of Douglas County's residents would have a single record that could be accessed, shared, and updated by all DCIPA physicians. DCIPA named this community-wide health information network "UmpquaOneChart."
When we started this project, our physicians were open to the idea but were very vocal about the need for data integration among practices. If they could not share information with other primary care doctors and specialists within the community, the value of a decentralized EHR would be greatly diminished. Physicians also wanted to be able to easily access and share information at the hospital and other service arenas to enhance the continuity of care in Douglas County.
DCIPA chose GE Centricity Physician Office Electronic Medical Record and Practice Management software for its enterprise-wide EHR. The next piece of the puzzle was to implement the concept of Enterprise Master Patient Index (EMPI). While this sounds complex, the concept is simple and well-designed. The EMPI indexes the places that data resides for any given individual. Then, those databases are queried using Service Oriented Architecture (SOA) to update the EHR patient history in real-time.
From the perspective of the healthcare professional, this approach gives a current and comprehensive picture of a patient: Did the emergency room prescribe medication for the patient last week? And what was the medication? This approach was clearly better than relying on patient memory or using batch data updates that can lag behind the times by hours or days.
Getting the index system right
Making the system work meant finding the right solution for the EMPI. Our selection was based on the software being secure, reliable, and able to share accurate information across the DCIPA community. One of the most important things about UmpquaOneChart was being able to access the right information, on the right patient, at the right time at the point of care. We placed a lot of value on patient identification. In mid-2006, we selected Initiate Identity Hub software based on those criteria and, in large part, due to Initiate Systems' breadth of healthcare customer experience. Now that the Initiate Hub is deployed, we are integrating more than 80 disparate databases on more than 30 separate server subsystems to create a single, complete and accurate patient view for each person. The result has been enhanced patient safety and improved operational efficiency throughout the organization.
Regardless of where the patient receives care in the DCIPA community, the information is entered into the system. The Identity Hub uses high-level algorithms to validate the patient identity and deliver the information to the correct patient chart within the EHR. Patient identification is a step that, if you don't get it right, can cause a lot of problems downstream. The EMPI takes all of the data streams, identifies the patient associated with that information, and gets the information into the right medical record in real time.
We're getting a lot of value from the software because it enables us to manage disparate data sources. We take data sources that aren't necessarily like our own and manage them through the Hub.
Enabling technology for a single EMR
The EMPI is an enabling technology for our system, and it makes EHR adoption much easier for our physicians. Now, when a patient is entered into the UmpquaOneChart, all of that information is available to any other physician or provider in our network.
To DCIPA physicians, the portability and on-demand access of patient information through a Web interface has also been a hit. For example, when a doctor goes on vacation, he or she is able to authorize prescription refills from their laptop regardless of their location. When it comes to sharing chart notes, viewing lab results, and more, we're truly realizing the vision of a connected medical community.