Healthcare solutions that streamline operations and make life substantially easier for physicians are rapidly becoming more prevalent in the sector. However, these advances will all come to nothing if the patients are unable to recognize how EHRs improve their care. The medical industry is recognizing this and patients are responding. According to a recent study from the National Partnership for Women and Families, consumers are becoming increasingly aware of EHRs and are beginning to trust the new health IT tools.

Most of the respondents to the survey said they are beginning to accept that EHRs and other similar solutions will improve how doctors manage their care, even though they are still somewhat concerned about data privacy. While this worry is valid, respondents clearly see the potential gains of EHRs as greater than the risks.

The key difference is that the respondents are seeing their physicians use EHR systems. The study found that respondents whose doctors actually use EHR solutions are more positive about the technology's potential. Furthermore, even those whose physicians are still using paper records tend to see the advantages of EHRs. This has become so prevalent that approximately 75 percent of patients whose doctors depend on paper say their care would likely be improved if their physician turned to an EHR.

Christine Bechtel, vice president at the National Partnership, explained that the growing consumer support of EHRs is critical, as patients will likely drive the technology forward and ensure continued political efforts to drive innovation. "For health IT to deliver on its promise, consumers must support it. If they don't, we will see political pressure for repeal and the promise will be squandered. What we found is encouraging, but there are still potential landmines ahead," said Bechtel.

Farzad Mostashari, national coordinator for health IT at the U.S. Department of Health and Human Services, echoed this sentiment, pointing out that patients are often put on the back burner when technology becomes the focus, even though the innovation is designed to improve the patient experience.  For medical providers working to optimize EHRs for patient needs, healthcare system integration is emerging as a key technology. Integration allows organizations to connect their EHR platforms and automate data updates and other similar processes. This keeps all physicians within the care spectrum up to date and ready to meet the needs of patients.

Considering the rapid rise of EHR systems, the push to achieve meaningful use and the growing importance of HIEs within this sphere, healthcare system integration is emerging as a key need in the health sector. With the HIMSS12 Conference next week, the use of innovative healthcare solutions is undoubtedly on the mind of many healthcare practitioners.

As more medical facilities make the move to EHRs, many experts agree 2012 will see most organizations striving for meaningful use and working to deploy HIE systems in an effort to improve collaboration throughout the sector. Success in these areas will require creative deployment strategies, IT leadership and a focus on integrating information between different aspects of the EHR solution.

Enabling providers to effectively share medical information between emergency care EHRs and insurance and payment records systems is just one of the critical functions of information integration.

Topics of this nature will be a major priority at HIMSS12, with the event focusing on the motto "Linking people, potential and progress." Within the conference itself, this means that visitors will be able to interact with leaders in the healthcare IT industry and see first hand how different medical providers have implemented advanced technologies and integrated them to support information-sharing initiatives that are becoming so critical in the sector.

The catchphrase also describes the overarching trends in the healthcare industry, establishing the event as a microcosm of the sector as a whole. Progress is becoming the keyword of the healthcare sector. Years of inefficient operational models bred stagnation and created an industry that was built around insurance and billing, not patient care. Government initiatives are working to curb this trend, pushing for progress that will create potential in the industry.

The rapid pace of healthcare IT's evolution has established the sector's potential. Now that the foundation is in place, it is time for the sector to move on to integrating EHR infrastructure and developing policies that support meaningful use and HIE expansion. These measures could take healthcare from the goal of progress to the point where it reaches its full potential and brings the focus back to the people. Integration is an essential link between patients and the care that medical providers can offer them.

With its focus on progress, potential and people, HIMSS12 is poised to give medical providers the tools and knowledge they need to enable healthcare information integration and collaboration in such a way that they can better meet meaningful use standards and improve HIE infrastructure.

With a new year comes a fresh start and as 2012 creeps closer, it’s time to think about new IT approaches. Whether government mandated reform or non-required initiatives, certain IT practices will significantly help to streamline workflows, save money and improve overall patient care in the new year.

There is no question that meaningful use (MU) compliance should be one, if not the, top health IT priority in the new year. Along the same line, health information exchange (HIE) offers tremendous potential for the future, and is increasingly viewed as an essential step in improving the quality, safety and efficiency problems that plague U.S. healthcare delivery.

HIE interoperability is also key as it relates to meaningful use objectives like electronic exchange of clinical information and summaries of care, along with submitting lab results to public health agencies, etc. And while the full details of Stage 2 Meaningful Use are still emerging, it’s expected that data exchange requirements will be among the amped up mandates. Healthcare providers need to be prepared, especially providers within the MEDITECH community who find HIE connectivity particularly challenging.  

For MEDITECH organizations working to embrace meaningful use, HIE initiatives such as the process of updating and feeding data to its healthcare information system and exchanging data bi-directionally with physician offices can be especially difficult. These organizations need automated, scalable integration technology to bridge their healthcare systems and an expert interoperability partner to manage the process.  Building an integration landscape to store and manage more data and to have the ability to extract the data more rapidly will allow hospitals to participate more easily and quickly when MU standards are finalized.

For instance, Beaufort Memorial Hospital, a 197-bed acute care hospital in Beaufort, SC, is using Summit Express Connect to help report immunizations to public health agencies and exchange data directionally with physician offices. The engine enabled Beaufort to reduce its number of interfaces needed to develop or deploy to have data exchanged between its various applications, the EHRs and other electronic ordering systems used by doctors in the Beaufort community. Furthermore, building an interoperability environment to manage more data to meet the Stage 1 Meaningful Use criteria, Beaufort will have the basic infrastructure in place for health information exchange, which by design will enable the hospital to qualify for the more complex HIE requirements that are expected for Stage 2.

Beaufort Memorial is a great example of how health IT initiatives like MU and HIE go hand in hand and how strategically meeting meaningful use guidelines can be achieved by implementing an HIE.

What IT practices will your healthcare organization take on in the New Year?

Achieving meaningful use in MEDITECH HIT environments brings some special challenges – technical, financial and cultural.  While overcoming these challenges requires a lot of hard work, focus and specific expertise, organizations that take a smart approach to meaningful use (and other major initiatives like 6.0 migration, HIERHIO connectivity, and provider office integration) can not only achieve success for the immediate goal, but can also set the stage for long term benefits including significant cost savings and streamlined integration projects going forward.

Technically, the MEDITECH platform presents a number of challenges for organizations seeking to implement an EHR and demonstrate meaningful use.  Most of these boil down to the difficulty and expense associated with establishing one- or two-way data sharing among MEDITECH, the EHR and the other clinical and financial systems in the organization that need to be integrated to achieve meaningful use. 

The financial challenge – above and beyond the time and expense associated with implementing integrations among systems – is that organizations must purchase each MEDITECH interface with another system and pay annual maintenance fees.  Those incentive payments are nice, but between the EHR itself and all of the interface costs alone, no one is making a profit on meaningful use.

The good news is that interface engine solutions that replace many point-to-point integrations with a single one-to-many connection can eliminate those interface fees, save a lot of time and effort in integration work and ongoing management, and make every future integration initiative a much more time- and cost-effective proposition.

We have worked with many organizations – see our case study from Olympic Medical Center – to save big bucks on interface costs while streamlining integration efforts with Summit Express Connect.  Do you have an interface engine success story?  We would love hear it. 

Crawl before you can walk, walk before you can run...we all are very familiar with the concept.  But how many individuals that you know leap into huge automation and integration projects without knowing the why behind the how?  If you don’t clearly understand the ‘why’ of a project, knowing the ‘what’, ‘when’ and ‘how’ is harder than you think! 

Enter in Scripting… scripting is the jack of all trades.  Motto in the Summit halls “if you can type it, you can script it!”  Scripting is typically categorized in three flavors:  Batch, Real-Time, and Interactive.  Batch scripts are the big time savers allowing you to connect to a datasource (i.e. spreadsheet) and enter in buckets of data in minutes with no human transcription errors!  Talk about efficiency.

Back to the original question though – how many times has your organization been faced with the situation where you need to connect to a disparate 3^rd party system and interfacing is just simply not possible or cost prohibited? Or perhaps your desired interface is needed immediately but the timelines delivered by your HCIS or 3^rd party vendor just don’t jive?

Again enter in scripting!  A scripted interface (Real-Time) is quick to deploy and can achieve a near real-time data exchange as well as provide a means to map or cross-walk data between systems. Some examples include Blood Bank interfaces, glucose interfaces, point of care devices, streamlined registration or remote office connectivity.  The possibilities are endless!  We have clients currently integrating clinical patient centric data between their 3^rd party ED systems and MEDITECH with scripting playing a key role. Talk about cost savings, ease of use and contributing to the goal of a comprehensive patient EMR.

Last use case worth mentioning because I don’t know about you but time is precious these days… Ever consider interactive scripting?  Let the script act as a FTE.  Examples include patient registration kiosks and real-time eligibility/ insurance verifications.

Finally, a few words of wisdom to impart; Set the standard high on what automation technology you are going to invest in.  You want a reliable and scalable solution to handle any of the flavors above including a technology platform that is interchangeable no matter what HCIS or HCIS version you are running. 

Ready to accomplish more with less? 

MEDITECH has put their stake in the ground with over eight years of research and development behind their 6.0 platform.  For those newer to the 6.0 platform it promises streamlined clinical and business workflows via role-based desktop configuration which allows organizations the ability to deliver better patient care by increasing access to critical information across many venues.  The newer technology allows for higher availability, better access over the internet and ensures your multi-disciplinary teams are working in closer tandem then ever before.  

Gone are the days of department centric workflow, paper reliance and information system short comings. The MEDITECH 6.0 technology will bring your organization through the Clinical Transformation process.  Have I got your attention?  The buzz is certainly out there in the MEDITECH community and organizations are asking the question, “How can I ensure my organization is ready?”

Fast forward through the contract negotiation process and picture that your organization is now in the implementation queue ready to migrate to MEDITECH 6.0; you’ve mapped out your hardware and infrastructure needs, set up your core team and potentially hired additional consulting resources to get the job done.  You have begun your application planning and proposed changes to ensure your organization provides the highest standard of patient care and you are confident that you will reap the benefits of moving to the new MEDITECH 6.0 platform.  After all this planning centered on applications, hardware and infrastructure, you are probably thinking - “What’s left to consider?”  

One of the biggest considerations that must take place early in the planning process is the evaluation of your current integration state.  Even the most MEDITECH centric organizations are currently interfacing with multiple 3rd party ancillary systems or point of care technology.  This is the most opportune time to evaluate your current landscape for both your standard HL7 interfaces as well as any custom interfaces that may be in place.  This could include interfaces designed by MEDITECH or 3rd party vendors.  While you are at it, now is a good time to take inventory of your scripted workflows and interfaces as well.  One must consider the importance of this integration and data sharing as it impacts productivity of your end users and ultimately your patients’ safety as that too depends on these connections.  Without a doubt as you implement MEDITECH 6.0 there will be an expectation from your end users in other departments such as OR and ED to integrate their respective devices to the core HIS.  As you continue to implement these advanced clinical systems you will be asked for sophisticated integration connections to complex devices such as bio medical and smart pumps.  Are you beginning to realize the changes to your interface topography?

If you review the posted MEDITECH 6.0 workplan and converted 6.0 clients, a forward facing topic is integration analysis and strategy.  As you embark on this amazing transformation you must ask the following questions:

1. What’s the state of our interfaces?  Should we conduct an audit and map them out? Are there any cost savings to be found?
2. Do we have the staff bandwidth and competency levels to manage interface migration?
3. What will my migration plan be for our interfaces?   Will all current interfaces be necessary in 6.0?  Do I need to purchase or develop new interfaces for our Migration to 6.0? How will I map out the timing, sequence and hardware needs?
4. If Advanced Clinicals will be an added addition to our implementation, what integration strategies must take place to ensure our staff has access to the most accurate real-time information?
5. What if direct interface connectivity isn’t an option (HL7/XML feeds)?  How can I leverage technology to integrate all systems?

 
These are just a few questions that come to mind but hang in there because there are proven solutions and evidence based roadmaps out there to help you along the way.

Let’s take a look first at current state.   If you mapped out on paper a diagram of your current interfaces would it look like a spaghetti diagram?  Do you have more point to point interfaces than you expected?  How many times can you send ADT information outbound from MEDITECH?  Do you count ten, fifteen or fifty ADT feeds currently being managed?  Now is the best time to consider how to maximize your current investment and determine how standard interfaces can be leveraged which will provide immediate cost savings.  Should you consider moving from a point to point strategy to an interface engine?  Don’t forget when implementing Advanced Clinicals your need for an integration strategy grows exponentially.

The question now becomes centered on interface & integration migration.   As part of the resource planning your organization must review current allocated FTE’s and access the internal bandwidth to handle the interface migration, timing, testing and go live support.  Your organization should review if interface standards have changed from one platform to the next, meaning was it custom in Magic and will it correctly repoint in 6.0? What time allocation is necessary to work with the 3rd party vendors to seamlessly migrate?

One must consider options such as outsourcing, where industry experts handle the interface/integration maintenance or hiring additional staff to support this task.   It’s important to ensure the migration of your interfaces and integration is seamless not only for the happiness of your staff but patient care and data integrity depend on it.  

Lastly, let’s look at future state.  Where in your implementation plan does Advanced Clinicals fit? Oh and by the way… advanced clinicals are no longer defined by the nursing units electronically documenting and bar-coding medications, advanced clinicals are departments such as OR, ED, and Cardiology.  These departments will depend on connectivity to complex technology and the move toward a comprehensive Medical Record will require this integration.  This integration includes interfacing multiple patient monitor systems such as PACS Systems, Cardiology PACS Systems, Smart Pumps, OR Anesthesia systems and ED Monitoring systems back to the MEDITECH HIS.  

Can you imagine what your point to point interface diagram will look like with these additional departments now interfacing?   If your hospital is like all others you are working with multiple third party vendors, with different interface specifications and capabilities, imagine the management around this.  As the clinical transformation is taking place patient safety depends on real-time, accurate data to be delivered to all care givers.  Interfaces can’t go down, it just becomes unacceptable.  

When migrating to 6.0, now is the time to map and build a tactical and strategic integration strategy to ensure you have the right technology and proper levels of staff in place while adhering to your 6.0 project budget.  As your organization looks to make this commitment to achieve clinical transformation and deliver the highest patient care with 6.0, evaluating your integration strategy should be at the forefront, rather than an after thought.  By making this a priority early on, your staff will be able to focus on the application aspects of building and maintaining the MEDITECH 6.0 system.  The results will be a new system designed and implemented to improve patient safety, achieve end-user acceptance, with guaranteed cost savings along the way.

In this installment of Summit Connection I thought it would be worthwhile to discuss the importance of selecting the right interface engine for your Healthcare Information System (HCIS). The interface engine is the central location that ensures clinical and business data is passed smoothly and securely amongst multiple HIT systems. Government regulations such as the American Recovery and Reinvestment Act (ARRA) of 2009, have mandated hospitals to foster open channels of communication with local physician offices and clinics electronically. This particular act has provided incentives for hospitals to strengthen their HCIS to improve communication flow among multiple entities, with the ultimate goal of improving the safety and quality of patient care.
Why purchase an interface engine vs. using individual point-to-point interfaces?

Implementing an interface engine will provide a healthcare organization the flexibility to develop and manage an array of interfaces from one central application. Here are four examples of how a well-equipped interface engine will provide efficiency and cost-containment to your organization:

1.)    Consolidates status and alerting views: Monitors all interface activities from one central location
2.)    Enhances flexibility:  Maps and filters interfaces to your liking and easily incorporates future interfaces
3.)    Automates documentation: Enables seamless reporting and task distribution
4.)    Cuts costs: Ensures rapid ROI by reusing interfaces and reducing maintenance fees from multiple interfaces and vendors

What makes a good interface engine?

The best interface engines offer very high levels of flexibility, enabling the user to initiate and control its core functions according to their specific needs and environment. An interface that facilitates exploration and a trial and error process for its users works best; users will become better at incorporating the proper settings for their unique interests.  Most importantly, the interface should assist in preventing user errors, highlighting the most important information upfront. Consistency is also key. A humble layout is simpler to master and also provides a consistent appearance. The design should foster a good balance between maximizing functionality and maintaining simplicity.
 
If you are in the beginning stages of upgrading your interface there are several items to keep in mind:

•    Size of organization
•    Number of facilities
•    Type of messaging format (HL7 or non-HL7)
•    Current pain points that are being experienced
•    Budget constraints
•    Time needed for training / implementation

Rushing or not undertaking a thorough evaluation when choosing an interface engine could bring about dire consequences for your organization. Remember, choosing a vendor that will properly train your IT staff is of most importance to ensure staff can accurately implement the interface and respond appropriately to a problem.  It is also advantageous to maintain a strong partnership with the vendor to receive swift and thorough answers to questions.

Not seen by the end user, but recognized as the “heart” of the entire HIT infrastructure, the interface engine typically goes unnoticed until it fails. If a malfunction to the interface engine does occur, a stoppage to the entire HIT system ensues -- resulting in crucial data exchange being halted and patient care being disrupted. That’s why spending the time to choose the proper interface is important!

I look forward to your thoughts.

-Ellen

Next blog post: Best practices to ensure a successful MEDITECH 6.0 migration

To kickoff 2011, we at Summit Healthcare are thrilled to present Summit Connection, a blog intended for hospital CIOs and healthcare IT people everywhere. My name is Ellen Bellini, Summit Healthcare’s product marketing manager, and I will be posting thought-provoking pieces relating to a host of hot-button issues in the healthcare IT space. On a perpetual basis I will provide insight and best practices designed to drive improved workflow and time efficiency for your healthcare organization. Upcoming postings will inform you about the process of selecting an interface engine, undergoing a MEDITECH 6.0 migration as seamlessly as possible, achieving real Physician Office Integration and successfully executing other endeavors.

This blog will be updated regularly in a short, easy-to-read format and provide you with important takeaway objectives. With ever-evolving technologies and government regulations from Washington, D.C., we felt it was imperative that CIOs and IT personnel have a reliable resource where mandates and trends could be analyzed for their viewing on a reoccurring basis. We aspire to use this platform to successfully uncover and provide strategies for these emerging issues.
We hope that you make Summit Connection one of your regular visits for HIT news and best practices. Please engage us with questions and comments. Feedback is appreciated!

Next blog post: Selecting the right interface engine for your needs