BayCare's HIE Blueprint

By Ken Congdon, Editor In Chief, Health IT Outcomes

Realizing that effective HIE starts within its own network, BayCare Health System has put a plan in motion that will allow its hospitals, affiliated practices, and homehealth agencies to seamlessly share patient data.

A lot of mixed messages have surfaced about HIE in recent months. On the one hand, you have widespread reports questioning the long-term sustainability of statewide HIEs and RHIOs (Regional Health Information Organizations) once federal funding for these programs runs dry. On the other, you have reports from groups like Chilmark Research that show impressive growth (more than 40%) for HIE in 2011 and continued promise for the sector going forward. So, what reports should you believe? It’s probably safe to believe both. If a statewide HIE or RHIO is constructed so that it depends on federal funds, then it is likely to fail. At the same time, HIE will continue to prosper. You don’t have to dig too deep into the Chilmark study to find that the majority of the growth in the market is stemming from enterprise applications of HIE technology. This will not only continue, but explode as healthcare institutions move into the post-EHR era. Electronic health data will do little good if it can’t be shared securely among key stakeholders in the care of a patient — both within a healthcare facility and externally. BayCare Health System is one organization that realizes this and is taking control of its own HIE destiny.

Disparate EHRs Cause Integration Headaches

Composed of 11 not-for-profit hospitals, nearly 600 affiliated physicians, outpatient facilities, and services such as laboratory, imaging, behavioral health, and homehealth, BayCare Health System is a leading community- based health system in the Tampa Bay area. Over the past several years, BayCare has been busy getting all of its inpatient operations up and running on a Cerner EHR. However, the health system’s affiliated PCPs (primary care physicians) and specialists run on a potpourri of different ambulatory EHR systems including GE Centricity, McKesson Practice Partner, eClinicalWorks, and others. Some physicians in BayCare’s network don’t even have an EHR yet. A clear challenge presented itself — how to get all these disparate systems to integrate in a manner that facilitates two-way communication between BayCare’s hospitals and its physician network.

“We needed to evolve to the point where there was a better flow of information from entity to entity within BayCare,” says Tim Thompson, CIO of BayCare Health System. “For example, we had a huge business need to push hospital information, such as lab and imaging results, down to the physician level. At the same time, we wanted to give physicians the ability to enter orders for these tests directly into Cerner from their disparate EHR interfaces. We didn’t think we’d get much value out of joining an RHIO or our state HIE until we could exchange health information effectively internally.”

Rather than waiting until its Cerner deployment was complete, BayCare decided to tackle its EHR and HIE initiatives in parallel. The health system evaluated several HIE vendors, but ultimately selected Medicity based on references from other hospitals that also used Cerner’s EHR, a proof of concept, and the proven track record the vendor had with other health systems, as well as state HIEs and RHIOs.

“The tough part in the vendor selection process was getting consensus from all stakeholders within the organization that the HIE platform we chose was going to meet all of our needs,” adds Thompson. “We got several team members involved in the decision-making process — the CMIO, clinical teams, physicians, even homecare representatives — to ensure they were comfortable with the proposed solution.”

Control Is Crucial In HIE Deployments

Once the HIE vendor was selected, the next step was deciding where to start the implementation. BayCare believed it could see the most immediate impact by using the HIE technology to establish a delivery mechanism that would allow BayCare to push hospital information (e.g. lab results, radiology results, discharge summaries, physician notes, etc.) electronically (and securely) into the disparate EHR systems in use at its affiliated physicians’ offices.

“We focused on pushing results to physicians first because it was an easier aspect of HIE for us to control,” says Thompson. “Since we controlled the information we were trying to deliver at the hospital level, we felt we’d have a better chance of success with the technology out of the gate.”

In just over a year’s time, BayCare was able to push hospital results directly into physician EHR systems. In instances where a physician’s office doesn’t have an EHR, BayCare’s HIE allows this data to be delivered electronically to the practice via Medicity’s “dropbox” functionality, which establishes an electronic repository for the practice that is accessible via a standard Web browser.

The logical next step for BayCare was to leverage the HIE technology to provide a means for its affiliated physicians to enter orders directly into Cerner via their disparate ambulatory EHR systems. To date, BayCare has more than 60 of its affiliated physicians entering orders in this fashion using Medicity’s physician portal.

HIE Improves Data Accuracy, Timeliness, & Compliance

The ability for BayCare hospitals and physicians to share data electronically has provided numerous benefits to the health system. One of the biggest benefits has been the timeliness of information to the physicians. Plus, since the solution pushes this data directly to practice EHRs or dropboxes, doctors don’t even have to request the information. Ultimately, the HIE solution allows the clinicians to be more productive and to administer care to patients more quickly. The data accuracy improvements that result from system-to-system communication have also been notable. Secure electronic delivery of results (rather than relying on fax) has also helped to reduce BayCare’s exposure to HIPAA violations.

“On the order entry side, allowing our affiliated physicians to enter a BayCare lab order from their offices directly into Cerner has been huge for us,” says Thompson. “That level of automation is what our physicians are looking for and allows us to compete with the big independent labs like LabCorp and Quest Diagnostics.”

The next phase for BayCare’s HIE will be to bring all affiliated physician data into the system so that it can be shared physician to physician. This phase will allow specialists to query a database to access an electronic patient record from a PCP (and vice versa) instead of having to call the doctor to request the chart. Beyond that, BayCare is currently incorporating home care data into the HIE and is working to connect its system to pharmacy databases (e.g. CVS, Walgreens, etc.) to enable clinicians to access outside drug histories