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EMR networks connect health care providers statewide

Jessica Briggs, a physician’s assistant at Capital City Family Medicine, speaks with a patient during an appointment. Briggs will enter the patient’s information into the My St. Luke’s, the St. Luke’s Health System’s electronic medical records platform. Once My St. Luke’s is fully implemented, this patient will have the same chart at every St. Luke’s clinic so all providers have access to the same information. Photo by Glenn Landberg.

St. Luke’s Health System is installing a $100 million electronic medical records system that will allow its providers throughout southern Idaho to see the same information for each patient. But if a patient sees a provider outside the St. Luke’s network, staff might have to use a low-tech option like fax or courier to see the patient’s medical records.

That’s where Idaho Health Data Exchange comes in. The exchange’s software translates information from disparate EMR systems and stores it in an online database, allowing providers with EMRs that don’t communicate to access each other’s information digitally. Not only does this save time and paper, but ideally it also reduces mistakes in transferring patient data.

Translation between EMR systems is what prompted St. Luke’s to centralize its patient records under a single EMR platform.

“This is critical information that we need at the point of care as soon as possible,” said Dr. Marc Chasin, chief medical information officer for St. Luke’s Health Systems. Chasin said that in 2010, when St. Luke’s started building its centralized EMR system, it had eight different ambulatory, or outpatient, EMR interfaces, and none of them communicated with each other.

St. Luke’s new EMR system, called My St. Luke’s, runs on the Epic platform. The first group of St. Luke’s physicians went live with My St. Luke’s on Nov. 8, 2011. By January 2013, all St. Luke’s ambulatory operations except in the Magic Valley are slated to be online with My St. Luke’s. Once St. Luke’s adds its inpatient operations to My St. Luke’s, all of its facilities will be able to access the same record for each patient. Ideally, this will reduce errors and unnecessary tests.

“One of the main causes of patient injury … is when you transition care,” Chasin said. For example, when a patient moves from the emergency room to an inpatient facility, the inpatient physician needs to know what medications are in the patient’s system and what procedures were performed in order to provide the best possible care.

But even once St. Luke’s has fully implemented its Epic conversion, its EMR program won’t necessarily be able to communicate with non-St. Luke’s EMR programs. For example, Saint Alphonsus uses a platform called Cerner, and independent practices may use a variety of EMR platforms.

The Idaho Legislature created the IHDE in 2006 to bridge that communication gap.

“We’re trying to remain as the Switzerland of the health care community,” said Scott Carrell, executive director for IHDE. The exchange pulls patient information from its participating health care providers and uses specially developed feeds to translate patient data from a variety of EMR programs into a single interface that’s accessible on the internet, called a virtual health record.

“These are largely driven by business purposes,” Carrell said. Health care providers want to save time and money on requesting information from a patient’s other physicians, and being able to access that patient’s records in a centralized, online database allows them to do that. Additionally, being able to see that the patient recently had a certain procedure, such as an X-ray or MRI, allows the physician to avoid duplicating expensive tests.

Health care providers do have to pay varying fees to use the IHDE service, which are less than $500 per license Carrell said. Providers have two options for using the IHDE.

The first, cheaper option is a view-only option. Providers who select this option are able to look at a patient’s information, but their own EMR system will not use IHDE information to update itself, nor will IHDE use that provider’s EMR system to update its own information.

The second option, which is more expensive, allows providers to submit their EMR information to IHDE, as well as update their EMR information with IHDE’s information.

But not every health provider in the state is connected to IHDE.

“Just the embrace of the technology is one hurdle,” Carrell said. Some physicians question the benefit of EMR systems and view them as a cost burden overall, especially if they aren’t planning on practicing much longer. In addition, some practices have to upgrade their hardware to accommodate EMR systems or communicate with IHDE.

“There’s a lot of internal cost,” he said. “There are some who think it’s a greater headache to go through all that.”

MyChart is a web-based portal patients can use to view their My St. Luke’s chart. Patients can log on with a username and password and update the chart, should they forget to mention a drug allergy or medical procedure during their appointment. Photo by Glenn Landberg.

St. Luke’s had to upgrade its servers and hardware in order to implement Epic across the board.

“We knew that the resource demands were going to be more significant,” Chasin said. The money St. Luke’s used to upgrade its servers and hardware was categorized under organizational capital and was separate from the $100 million price tag for the software and organizational change required to implement My St. Luke’s.

Implementation of the technology, including training providers to use it properly, can be another hurdle.

“It’s a lot of change,” Chasin said. “That’s the hardest part.” St. Luke’s has an entire catalog of training classes available for employees. The training required varies depending on a person’s job, but doctors aim for about 12 hours of training, and nurses aim for about 20 hours. St. Luke’s clinics are advised to reduce their patient load by 50 percent to accommodate the My St. Luke’s learning curve and training.

Carrell said implementing such technologies usually affects a provider’s workload.

“If they don’t have an IT guru in their practice, then they’re going to become one,” he said.

Chasin said that so far, implementation has been running smoothly at St. Luke’s. The process has required organizational growth and change, but people resistant to those changes have been few and far between.

“You’re going to have incremental disagreements, but if you’re moving toward that one goal, those are going to become trivial,” he said.

One of IHDE’s biggest challenges in bringing providers to the table has been a lack of awareness, said Carrell.

“We really are a startup company, in essence,” he said. “Some people didn’t know we existed.” But with members in southwestern and northern Idaho, the exchange is gaining momentum. “We’re trying to reduce the divisions that exist in our state. … It’s slowly but surely happening.”

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