Taking the Lead

Only a small percentage of physician practices have implemented electronic medical records. The percentage varies from about 11% to about 20%, depending on the survey. I would wager that if you only looked at solo practices or smaller physician groups the percentage might be even lower. Cost, disruption of workflow, skepticism of the technology, and security issues are just a few of the obstacles impeding the widespread adoption of EMRs. Yet there are some community hospitals and physicians who are looking for ways to bring this technology to their communities and share patient information. Here is an example of how one community hospital is sharing its hospital's lab results, radiology reports, patient histories and discharge summaries, among other items, with area physicians—regardless of which EMR vendor the doctor uses, if any at all.

Charles Vargo, executive director of the Washington Physician Hospital Organization, which is comprised of about 100 practices—33 of which already have some sort of EMR—says that physicians were coming to The Washington (PA) Hospital and requesting an interface between their EMR and the hospital's lab system. But creating—and maintaining—individual interfaces to roughly 33 practices using about 15 different EMR vendors was too difficult for the 256-bed standalone hospital to manage. And standardizing to a single vendor wasn't an option. "We couldn't tell people to turn their back on their investment and start over," Vargo says.

So the hospital, which is located about 30 miles south of Pittsburgh, collaborated with the physician organization to develop the Washington Health Information Network. The network uses MobileMD's health information exchange and enterprise access application, which enables physicians to electronically access all of the hospital's health information systems from a clearinghouse. Physicians now have access to both inpatient and outpatient information in real-time. They can choose what lab results, x-rays, or reports they would like to be "mapped" or automatically recorded in their EMR. And if they don't have an EMR, they can still access the information through a secure Web portal. "We are the largest facility in our county and are the leader of care services here, so we needed to take a lead to move this along," says Rodney Louk, Washington Hospital's vice president of information systems.

Several vendors were considered for the project, but MobileMD was ultimately chosen because of its ability to interface with a multitude of medical records systems, along with its Web portal application. In addition, the vendor also offered ongoing support for all of the interfaces. "MobileMD was the only company that took responsibility for maintaining the interface between the clearinghouse and the physician vendor," Louk says. Neither the PHO nor the hospital had the resources in-house to manage all the physician interfaces.

From what I have heard about hospital partnerships, success often hinges on whether both parties have some skin in the game. Louk agrees with that sentiment. One of the reasons that the network, which began implementation in September 2007, has been successful is because both organizations are helping to fund the project, he says. The hospital is paying for all of the technical pieces and the ongoing licensing fees for the clearinghouse. In addition, the hospital will pay for 85% of the cost of the health information exchange component for the physician practices. The PHO helped fund the initial setup of the clearinghouse, and is paying the ongoing subscriptions for the physician portal, which is offered to doctors free of charge. The hope is that the free offering will aid in the adoption of the technology, says Vargo. "When they see the value, it may help push the issue of return on investment. A lot of people are in the paralysis by analysis phase where they are looking to see if it's worth their while to make the investment," he says.

The project is also viewed as a physician initiative rather than a hospital initiative because the PHO is spearheading the effort, which has helped the network garner a lot of acceptance. "The only way the hospital is going to see a benefit to this is if the masses go there," says Louk. "So that is the thought behind how we are organizing it and rolling it out."