Competitive Collaboration

Madison health care organizations are certainly getting more technologically savvy. Dean Clinic claims to be the first health care organization in the country to offer its patients mobile access to Epic-based medical records (MyChart) with an iPhone application. Whether or not this "app" becomes a killer, expect others to quickly follow suit, but it's another local technology advance that could have a profound impact on the way emergency and acute care is delivered here and elsewhere. Thanks to Epic Systems software, patient data exchange is not only achievable locally, but statewide and nationally, too.

Following a 120-day pilot program, Madison hospitals have decided to become part of a national network of Epic client hospitals that exchange patient data electronically in emergency and acute-care settings. They are working from the inside out, first connecting themselves and then linking to other Epic Care Everywhere users in the region, state, and nation. Care Everywhere is an interoperability system that allows different computer systems and programs to interact with one another — in this case to enable emergency department personnel to gain access to important medical information on a patient's electronic health record, even if they are brought to a health system than doesn't normally serve them.

Between all the health care organizations in Madison, there were approximately 10,000 successful links made during the 120-day pilot timeframe. Dave Lundal, vice president and regional CIO for SSM Health Care, called the pilot a success from two standpoints: first, on the basis of the results and second, from the level of collaboration among the health care providers in town. Madison is known to have a collegial health care industry, but competitors can't always be counted on to work together.

This case was different, in part because electronic medical records are superior to paper records in terms of accuracy (no handwriting to decipher by fax) and security, and in part because every local hospital uses the applicable Epic product. "I believe one of the quotes from one of the organizations is that it would be unethical to turn off the data exchange at this point," Lundal said.

Annette Fox, director of clinical systems for the Wisconsin Integrated Information Technology and Telemedicine System, a regional IT network, said post-pilot surveys uncovered multiple stories of how the system improved care. With the patient's consent, emergency and acute-care personnel have access to lab records, medications, allergies, provider notes, and relevant encounter-level summaries — right at the point of care. "Nobody was dragging their feet on this program," Fox noted. "Everyone was in favor of moving forward with it."

In the case of people who arrive unconscious and are unable to provide consent, that's covered, too. Since those are precisely the patients who most benefit from access to Care Everywhere, local hospitals worked to come up with workflows that abide by state law. Ditto for laws pertaining to the privacy of mental health patients.

That's not to say the system is perfect. From a technical standpoint, not all health information can be delivered through Care Everywhere. For example, records of PACS (Picture Archiving and Communications System) images, or X-rays, are stored outside of Epic, with links to the images. They are accessible within organizations; between organizations, there are not enough good ways to share the images. In all, local health care organizations have made a list of 10 capabilities they'd still like to have.

The technology might need tweaking, but the process is buttoned down. "Everything is within Epic, where providers are doing the rest of their work," Fox explained. "This isn't the whole electronic health record, where you have to look at every work flow and a total process redesign. We didn't have to do a total process redesign."

As a result, care providers can simply go with the flow.

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