An interview with IT executives www.usa.siemens.com/healthcare Health Information Exchange (HIE) at Inspira Health Network Answers for life.
An interview with IT executives Inspira Health Network is a community health system comprising three hospitals in southern New Jersey, with more than 5,000 employees and 800 affiliated physicians. It is an early adopter of health information exchange technology. This interview features answers to common questions about HIE technology by Tom Pacek, the health system s Vice President and Chief Information Officer, and Ed Rodriguez, Director of Ambulatory Informatics. 2
Q: What is the role of health information exchange (HIE) at Inspira Health Network? Tom Pacek: The HIE helps to provide physicians with access to the latest information on their patients, virtually regardless of location. In the office or in the hospital, they get the same information, and can coordinate care with other providers. As a result, a physician will know, for example, not to order a lab test when one was just ordered yesterday. Q: Why didn t you go with the public entities that exist today instead of a private HIE solution? Tom Pacek: Public HIEs were prevalent in the state of New Jersey when we started looking, and we pursued a public HIE first. But honestly, they could not deliver a working product for us within an acceptable time frame. So we did an analysis of vendors in that market space and determined that the Siemens HIE could be implemented shortly after contract signing. We were up and running in four months. Today, some of the public HIEs we were looking at still are not fully operational. Q: How many practices do you have connected now? Ed Rodriguez: We have two hospitals connected to the exchange as well as up to 36 EMRs and more than 600 providers using the portal. Then we have a home health facility connected to the exchange along with skilled nursing facilities and even a fitness facility. Q: How has the solution affected your relationship with the physician community? Tom Pacek: Our HIE solution has really tied the physician community to the organization. We compete for ambulatory practices, and it helps by making it easier for physicians to get data into their electronic medical records, either directly or through the patient portal. They have access to the latest information on their patients from practically anywhere. Our HIE solution has really tied the physician community to the organization. 3
Q: What can you tell us about New Jersey SHINE? Tom Pacek: New Jersey SHINE is the public HIE that we formed here in the southern part of the state. It is four health systems including Cape Regional, Shore Medical Center, Underwood Memorial Hospital, and Inspira Health Network that have come together to share patient data and to pursue federally funded grants to help us provide support for our physicians in the community as well as to offset our expenses related to health information exchange. It s a great group of individuals. We have a couple of competing hospitals, but we are very collaborative at the board level. We re working to grow the organization quickly and be one of the leaders in the state with respect to sharing health information. Q: How does New Jersey SHINE differ from a private HIE? Tom Pacek: With New Jersey SHINE, we re able to share data across a broader area than we do with our private HIE. It s a big area to be able to share information. So it really extends the continuum of care even when a patient is not planning their care. Like when they re off on vacation and something accidental happens to them. And we can provide them the best possible care at those facilities too. Q: How does your HIE solution help you meet Meaningful Use requirements? Tom Pacek: Patient engagement is an important part of Meaningful Use, and we need to be able to prove that our patients are using the system and accessing the data electronically. Patient portal capabilities are key to helping us satisfy that requirement. For example, it gives us a better mechanism for delivering discharge instructions to patients as required by Meaningful Use. We deliver discharge instructions right into the patient portal, and patients have access to them immediately. So if they forget what their discharge instructions were, they can just refer back to the portal. And the information s right there for them. It gives us a better mechanism for delivering discharge instructions to patients as required by Meaningful Use. 4
The office staff loves it. They have the latest patient insurance information and no longer have to call the hospital to get it. Ed Rodriguez: The HIE helps us address care coordination requirements. One project was a referral to the extended care facilities and the skilled nursing homes. Case management initiates the process using the exchange referral and the documentation continues back and forth between the facility and our case management until a bed is allocated for a patient and a decision is made between the patient and the patient s family as to where best to place that patient. We ve implemented a new scheduling process. In the past, OR scheduling has been done through a phone call to the OR. Now it s initiated via electronic referral form. Documentation is sent to the OR, which schedules the patient, and responds to the provider s office or surgeon using the same form. Q: How well does your HIE interoperate with non-siemens solutions? Ed Rodriguez: All of our physician offices are using non-siemens solutions. Sending and receiving data is not a problem at all. We have had no problems connecting any non-siemens systems into the exchange. Q: Have you seen any measurable cost-savings from the project? Tom Pacek: We ve gained efficiencies of paper reduction. We don t have to do reporting back and forth to physician office. We ve saved on mailings. We ve saved on postage. We ve saved on resource time. Our staff doesn t need to be answering phone calls from physician offices and getting information. Staff resources are significantly more efficient now because the volume of phone calls is reduced. We really have reduced costs in the EDs, labs, and radiology again, costs from printing documents and sending paper mail. Q: How does the HIE help promote physician affiliation? Ed Rodriguez: The physician response to the HIE was slow at first. As they realized the value, the response has become great. They re getting their lab results, reports, and consults immediately into their EMR. We have several providers or several practices that are champions. They ll tell their counterparts, You need to connect onto the exchange. You ll save yourself time and you ll save yourself a lot of headaches. Everything you need is in the exchange. We have an active practice manager s user group that s led by a physician liaison here. As these physicians realize that they re getting efficiencies using the exchange, they re selling it to other practices. Tom Pacek: It s an easy sales pitch to the doctors. It s an absolutely easy sales pitch. The physicians get information on their patients in real time, in either the ambulatory or hospital environment. Whether they re in the hospital or in the office, physicians see the complete picture of the patient. The office staff loves it. They have the latest patient insurance information and no longer have to call the hospital to get it. We have historical billing information, and they can go back, say, six months ago for a patient that had an Aetna policy but today has Cigna. They can find and compare that information without having to make a phone call. 5
When a nurse goes to a patient s home, he or she has the latest information on that patient s lab results. That s critical. So adoption s been very great here at Inspira Health Network. That s one of the things that we are very proud of. Our adoption rate of our health information exchange here far exceeds anything else in the state of New Jersey. Q: What was your biggest challenge in implementing the HIE? Ed Rodriguez: The biggest challenge was technology. We ve dealt with a lot of vendors that try to make those standards conform to the exchange. Q: So essentially you encountered different standards. Ed Rodriguez: Different variations of the same standard. Like how one vendor interprets HL7 standard for interfacing. Vendors interpret them differently because of technological limitations in their applications. We re able to incorporate those variances through the exchange and we process those transactions accordingly. Q: What have you learned in the process that you might do differently? Tom Pacek: We originally rolled the solution out by only connecting it directly to practices with EMRs. We were hesitant to roll out the web-based clinical portal to doctors without an EMR. We were afraid that the excellent HIE capabilities would delay adoption of physician EMRs in their own ambulatory practices because they d perceive they have enough clinical functionality with just our HIE. Today, I would not hesitate to do both simultaneously. Physician adoption rates are up, and there s less of a concern about physicians thinking that the HIE clinical portal is all that they need. They realize they need more than that. So I would say that you should roll out the webbased HIE clinical portal as quickly as possible. You get immediate efficiencies to the physician offices, plus reward their use of EMRs as quickly as you can. Q: We ve been talking mostly about physicians and their connectivity at this point. What s been your most creative connection to the HIE that s not necessarily physician related? Tom Pacek: We have our own home health agency connected to the exchange. It gets lab results delivered right to their EMR. So when a nurse goes to a patient s home, he or she has the latest information on that patient s lab results. That s critical. 6
Q: How about non-medical organizations? I think you mentioned physical fitness facilities or even religious institutions. Tom Pacek: With our HIE, we also provide capabilities for referrals to our fitness center. Physicians can fill out the referral form right online in the exchange. They send it electronically to the fitness center to start the process. The fitness center will even notify the physician if a patient doesn t show up as expected. So it s a great two-way communication without ever having to pick up the phone. The fitness center also delivers an electronic report to the physician practice. Q: Has the technology had an impact on patient length of stay? Tom Pacek: We believe it s had a significant impact on our average length of stay. That was a byproduct that we didn t even think about when we started to talk about health information exchange. We have case managers using the HIE to help coordinate care and identify patients who need to be placed into rehab centers or long-term care facilities. The case managers used to come in and look for patients to see who might be coming their way. Today, they don t have to come in anymore. Instead, they go into the exchange and send messages to all 12 long-term care or rehab facilities that service our area and provide relevant information about the patient. Ed Rodriguez: They can even attach patient documents with relevant information and ask, for example, if there is a skilled nursing bed available within the next 24 or 48 hours whatever the time frame is that we re looking for discharge. We give them a heads-up, and they love it because they can make a quick assessment and say yes, we have a bed here. Q: What surprised you about this project? Ed Rodriguez: Speed to up time. From the moment the contract was signed to the day that we started transmitting transactions into the exchange was three months. The data was QA d, we had lab, radiology, and transcription reports in the exchange in four months. That shocked the heck out of me. Tom Pacek: It has really sped up our processes, reduced paper, and made it much more efficient for us to get patients out the door in a timely fashion. That saves us money and makes us happy. It has really sped up our processes, reduced paper and made it much more efficient for us to get patients out the door in a timely fashion. 7
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