Not-So-Easy Integration

For her part, Gash stands on the other side of the data exchange aisle. Gash would love to share data feeds to the hundreds of affiliated physicians who treat patients at Saint Luke's 11 hospitals. Most of the groups still use paper records, which is one reason Gash is considering taking advantage of the relaxed Stark guidelines, which now would facilitate hospital sponsorship of affiliation physician EHRs. But even connecting to physician groups that have deployed EHR technology has proven to be difficult for Saint Luke's, she says.

Case in point: Saint Luke's took six months to create an interface between its hospital information system from McKesson with a large cardiology group practice running a NextGen EHR. The project became resource intensive, Gash reports, and left Saint Luke's own internal interface engine—software that distributes data across a network—in peril. "The physician group does not run 24/7," she notes. "So if something happened to the connection, it would put our own inpatient and outpatient activities at risk."

Gash wound up working with RelayHealth, a subsidiary of McKesson, to tailor its patient portal and e-messaging technology to feed data to the cardiology group. "It populates the NextGen EMR with discrete data," she says. In addition, the set-up sets the stage for data sharing with group practices that may deploy EHRs. "Our hope is for the fully integrated health record. We want a longitudinal record from the ambulatory setting to the inpatient. That way, providers could have a seamless view."

—Gary Baldwin

Healthcare organizations must sometimes choose which applications to integrate into their core clinical system. Here are the "yea" and "nay" decisions from two organizations both running ample IT.

Name: Saint Luke's Health System, Kansas City, MO
Technology: Echocardiograph
Resolution: Integrated the results with its McKesson system
Reason: Physicians identified ease of result retrieval as critical

Name: Springfield (IL) Clinic
Technology: Vital signs monitor
Resolution: Has postponed direct data feeds to EHR, despite vendor capability
Reason: Would require a major change in workflow and purchasing of monitors for every exam room

One reason that Deborah Gash, vice president and chief information officer at Saint Luke's Health System, has avoided the "best of breed" approach to software is the difficulty it poses in linking systems. "Some data is difficult to match, and HL7 [a data exchange standards group] does not always fill the need," she says. As a result, Gash has opted to deploy its clinical information technology primarily from McKesson. Yet even the software giant has fallen short on occasion. Saint Luke's rolled out McKesson's nursing documentation module, which trapped progress notes and other vital signs. However, the system did not enable nurses to maintain electronic plans of care. Gash leaned on McKesson to develop a new module, working on the new product with the vendor. "They did not have the functionality before the development work began," she says. "We were not the only hospital clamoring for it.