Integrating A Private HIE With Myriad EMRs

Compiled by Cindy Dubin, contributing editor

Becoming part of a national public HIE is fraught with challenges. One facility has opted to implement a private HIE for more standardized sharing of patient information.

According to the 2012 State of the Health Information Exchange Industry report released by Black Book Rankings, 98% of healthcare providers with HIE strategies in place will focus on private community or regional exchanges for the foreseeable future rather than national health record exchange initiatives. For many, the decision to do so comes from the arduous process that has surrounded the build out of a public HIE.

In 2010, the federal government appropriated $548 million to launch public HIEs, and in 2012, many were still embroiled in the process of developing a sustainable model. Thus, many providers began to look to private exchanges to address their needs. By investing in a private HIE solution, hospitals and physician organizations have control over the design and implementation of their HIE and can facilitate interoperability between the systems in their location.

But establishing a private HIE is no walk in the park, as Rebecca Weber, senior vice president and CIO of Meridian Health, explains. The New Jersey-based not-forprofit healthcare organization is composed of five acute care hospitals, 2,500 owned and affiliated physicians, and numerous Meridian partner companies that include home health services, skilled nursing and rehabilitation centers, ambulatory care facilities, ambulance services, and outpatient centers. As Weber explains, the process of establishing a private HIE and integrating it within Meridian’s vast network has been a daunting task but one that she is determined to see come to fruition.

Q: Why did you choose to leverage enterprise HIE technology?

Weber: We had two reasons. One is, at the time, we had merged with two other facilities. They were on different systems, and we wanted to bring the data together until we had the opportunity to standardize all the systems. Second, we’re a community health system, and we felt that it could improve the quality and safety of the services provided to our community patients to combine their clinical data with data from non-Meridian facilities. We worked with Informatics Corporation of America (ICA) to use its CareAlign HIE. ICA provided the technology and infrastructure for a multicounty regional HIE that serves more than 250,000 people in Monmouth and Ocean counties. The result was the creation of our Monmouth Ocean HIE.

Q: Did you leverage your enterprise HIE with a public HIE?

Weber: There was discussion that we would leverage it to integrate it with whatever the state came up with. There is a benefit to doing this, and we are awaiting the development of a state exchange that is currently being developed. The benefit of a state exchange is continuity of care for the patients in the State of New Jersey. Currently, only Meridian has integrated data into the Monmouth Ocean HIE. The other local hospitals decided it was too costly or too soon or decided to go in a different direction and back out. If they were going to come on board, they would need to make an investment to cover their portion of the costs, as there was no grant money for this exchange from the state or federal government. All funding for the technology has been directly from Meridian Health.

Q: How are clinicians and physicians actually interfacing with the HIE?

Weber: It’s a separate Web-based system they access to look at patient information across the continuum. We’re in the midst of several pilots to integrate continuity of care documents (CCDs) between the HIE, which is already fed by all the health system data and the doctors’ offices. What that means is the doctor in the office EMR can see the latest results on a patient, pharmacy profile, allergies, etc. They can send their own information up through the exchange as well.

That process has begun, but it’s been a long and drawn out endeavor. Nothing is easy. The issue is that every EMR vendor has its own way of doing things, which has made the process painful. Interfacing the EMR with the HIE requires significant interface programming, cooperation between both the EMR and HIE vendor, and understanding that what may work today with the EMR vendor may change tomorrow because of an upgrade to the EMR or HIE system. I am hearing throughout the country that it’s taking longer and it’s more difficult than anyone ever anticipated.

Q: What other systems or applications are you connecting with the enterprise HIE?

Weber: We have integrated with our HIS (including integrating Surescripts data), so we can tell if patients are refilling their drugs and to alert us to drug-drug interactions. So, if a patient comes in to our trauma center and she is in a coma, we have as much information as possible to give her the best possible care. All of that information is stored in the HIE.

Q: What benefits have you realized as a result of an enterprise HIE?

Weber: From a user standpoint, there is considerable use among our emergency department as the ER physicians use the system extensively. However, in the standard physician office scenario, there’s not a lot of use because it’s a separate Web-based system at the moment. Once its data is fully integrated with the physician office systems — and that’s where we’re going right now — I think we will see the benefit greatly increase.

We have pilots going on right now to integrate multiple EMRs with the HIE — with two-way integration. One vendor is ready to go live, and the second one should be done in about one month. We have more than 2,500 individual physicians’ offices. Among those offices, about 20 different EMRs are in use, and they are using different software versions of those EMRs, which adds to the difficulty of interfacing. And interfaces are different based on the software. Some EMRs are only capable of importing/ exporting PDF documents (not discrete data), while others are capable of sending and receiving discrete data.

Q: Why would you recommend other healthcare organizations use an enterprise HIE?

Weber: The advantage is to have a single repository of data that can be used in many ways for access and for data mining and research. It provides a platform to integrate data into other healthcare entities’ systems in a more simple way than doing individual systems.

Q: What best practice advice would you offer to others leveraging an enterprise HIE?

Weber: Don’t underestimate the difficulty and the project management that you will need to bring all the entities together. Make sure you work with an HIE vendor that partners with you. And lastly, however long you think it will take, make sure your time frames are realistic. We started two and a half years ago. First EMR integration started 18 months ago. Our first live data was to have been transmitted last week — now delayed another week due to privacy paperwork issues.

The most difficult part of our private HIE has been dealing with the multiple EMRs in everyone’s offices and different ideas on how to handle data. Some vendors want to send a PDF file for all patient information to sit in a lump in a record. In the long run, that’s not helpful. We need to have data that can trend and match. Having all the lab results in one place for a patient, in chronological order, helps trend and track the health of the patient.