Madison Hospitals Closer to Sharing

Later this month, Madison hospitals plan to "go live" with Epic Systems’ Care Everywhere interoperability system as part of a 120-day pilot program to electronically exchange patient data in emergency and urgent care settings. It is a key step in an effort to improve regional health care service wherever a patient goes in Greater Madison, even if it’s a different health system than the one that normally serves them.

The participating organizations — a community coalition of Dean Health System, St. MaryÕs Hospital, University of Wisconsin Hospitals and Clinics, UW-Medical Foundation, Meriter Health Services, and Group Health Cooperative of South Central Wisconsin — are now in a testing phase. When the pilot is launched, they will be able to replace the exchange of paper records via phone or fax with computer-based summaries of outside patient information.

Kerra Guffey, chief information officer for Meriter, said the organizations are taking a very conservative approach in that patients will have the opportunity, at each point of care, to consent to have their information electronically exchanged. "If they say no, that’s fine," Guffey stated. "Then, nothing will be exchanged."

Pilot Training

The parties have agreed to a 120-day pilot program with Epic Systems. At the end of the pilot evaluation period, each organization will decide whether it wants to walk away, or stay and become part of the national network of Epic client hospitals. Dave Lundal, vice president and regional chief information officer for SSM Health Care, the St. Louis-based parent of St. Mary’s Hospital, said Epic Systems is allowing various stakeholders to work out any bugs.

"They will want to open it up to all their clients on Care Everywhere, whether it’s their clients in Colorado, or Minnesota, or California, or Texas, or any place that has Care Everywhere," he said. "What we need to do is work out operational kinks among ourselves and make sure that we have things right so that down the road customers of Monroe Clinic or ThedaCare in Appleton or Aspirus System [Wausau] are comfortable with the process as well."

The case for electronic data exchange is that it is superior to paper records in terms of accuracy (fewer medical errors) and security. In Madison, participating organizations will use a common patient consent form. Patients will be informed that each exchange would be a complete release of information, and they will have the option to say no.

As part of the pilot, Meriter is defining some metrics to determine how many people have consented, and what have been the concerns if they have chosen not to. They also want to make sure patients feel comfortable with the way their options are explained. "We’ll be assessing it all through the pilot period," Guffey said. "At the end of the pilot, we have to be ready to make our decision one way or the other."

The consent form also will address the handling of mental health records, which was a bone of contention that had to be resolved through legislation. The consent form must be compliant with state and federal law, including statutes that protect metal health patients. In this context, state law has always allowed medication information to be shared, but the fact that someone was treated at a mental health facility is supposed to be kept confidential.

Patients will therefore have the option to "opt in" when asked to share data about any status as a mental health patient. "By signing the consent form, they are opting in to the health information exchange," Guffey noted. "Otherwise, nothing exchanges."

Annette Fox, a registered nurse and director of clinical systems for the Wisconsin Integrated Information Technology and Telemedicine System (WIITTS), a regional IT network, said Madison health organizations also have been addressing issues like workflow and safety. There is consensus that electronic patient data exchange is the right thing to do from clinical and patient-care standpoints, she said, but operational planning and legal issues cannot be ignored.

All of the stakeholders would be well-served by a common legal framework. "We’ve been working hand-in-hand on all of those things because the law will apply to all of us," Fox stated.

Epic Exchange

In transitioning to electronic data exchange, one advantage local hospitals share is their status as Epic Systems customers. In the case of the electronic exchange of outside patient records, the Care Everywhere system enables different computer systems and programs to interact with one another.

Epic offers Care Everywhere for free, so the costs associated with electronic patient data exchange have been minimal. Most of the expense involves installation and maintenance services and staff time. Emergency and urgent care staffs will have to be trained on the Care Everywhere system and on the consent form prior to the pilot go-live in late March.

Denise Gomez, director of applications for Meriter, said Care Everywhere is not difficult to use. For emergency and urgent care personnel, it mostly involves an awareness of where to find information. There also is very specific training for registration on how to establish connections between the organizations.

Gomez said the Epic product would enable an exchange of reports, not specific data sets contained in medical records. The report of patient information includes lab records, medication, allergies, and provider notes, and there is both an overall summary and an encounter-level summary of each relevant medical encounter.

"It’s very similar to what hospitals do today when they exchange outside information," Gomez explained. "If a patient were to go to a hospital with outside records, it’s really a report view of their information."

In the event an emergency patient is unable to communicate and therefore provide consent, the same state laws that apply in the "paper world" would apply in the electronic context. "Today, you are able to provide for ongoing care and treatment of a patient in a critical situation," Guffey said. "You are able to contact the medical records department of the organization in which you’re trying to receive information. It will work the same way in a Care Everywhere world."

In addition to emergency and urgent care settings, Lundal said area hospitals considered using electronic data exchange in maternity wards during the pilot. Eventually, geographic expansion may not be the only example of growth in the use of electronic patient data exchange, but multiple care settings as well. "I think it’s possible in a lot of care settings but the other one we considered for the pilot was for [delivering] babies," he noted. "So a physician showing up to deliver babies would have access to that patient’s medical record and Care Everywhere would be a nice tool for that."

Private Sector to Rescue

Lundal noted that the history of this data exchange effort began with an organization called the Madison Patient Safety Collaborative, which had received a grant to examine how local providers could exchange health information via electronic medical records. The collaborative had met several times when it was approached by Epic Systems about working together on the project.

He believes such partnerships, where vendors comply with communication protocols as part of an exchange, are much more likely to expand electronic patient data exchange than some kind of national or regional repository, in part because there is considerable expense involved in setting up the repositories.

Greater Madison isn’t the only area trying to accommodate electronic patient data exchange. The same type of program is being attempted in metropolitan Milwaukee with the Wisconsin Health Information Exchange. An organization called CalRHIO was attempting to form a statewide program in California, but the state’s health services agency formed a new governance entity.

These efforts are structured differently, but they all place value on the transition away from paper records. Said WIITT’s Annette Fox: "All of the organizations [in Madison] feel very strongly that the information needs to be shared electronically so that physicians can make good clinical decisions."

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