HIE Profile: Big Bend RHIOPanhandlin Patients Information for Change
Health information exchange (HIE) isn't about technology or money, according to Allen Byington, executive director of the Tallahassee, Fla.-based Big Bend Regional Healthcare Information Organization. It's a change management game where providers need to adopt and embrace the technology that could revolutionize communication among all providers.
"Fear of workflow disruption has been a barrier to the adoption of HIE services because of workflow memory from communication systems developed decades ago. Besides the fax machine, not much has changed except an increased volume in the amount of information being communicated," says Byington.
Providers need to embrace change by adopting HIE services for more effective communication. "We're creating the medical internet along with the privacy and security needed to protect patient records. The real focus is to create communication between the hospital and the physician in a bi-directional manner," Byington noted in a webinar hosted by the National eHealth Collaborative on Oct. 20 as part of their NeHC University series.
Serving 12 counties in Florida, Big Bend was created in 2005 and awarded $814,000 in seed funding from Florida's Health Information Networks grant program over two-and-a-half state budget cycles. As a provider-driven HIE, Big Bend's vision was to put the physician on top of the healthcare totem pole through an advanced portal platform using one access point and single login for patient information outside the EMR.
Going into production in late 2007, Byington says the organization will probably interact within the portal environment for the next three to five years as they wait for advanced communication capabilities of their EMRs.
HIEs are uniquely poised both technologically and politically to integrate local and state data and deliver it to the healthcare providers of the community, he notes. From a clinical perspective, the HIE helps put the control of how data are displayed and organized into the hands of the physicians who are providing the care services.
At Big Bend, a federated architecture was intentionally designed so that data are not comingled and each connected data source has its own participation agreement and database on Big Bend's servers. This was done as a data management initiative, according to Byington, where Big Bend maintains databases on their platform from the data feed and provides the auditing required for issues of security and access to the data received from providers.
"There is little infrastructure in the industry that is capable of providing federated feeds at a physician or hospital level," he says.
Big Bend's services include clinical interfacing, web portal access and patient lookup, clinical messaging, referral management, electronic public health reporting, clinical notifications and meaningful use consulting.
Providers, like Vascular Surgery Associates (VSA), also located in Tallahassee, have harnessed services from Big Bend for practice management gains. According to April Livingston, the patient accounts coordinator and IT project manager at VSA, the practice depends on Big Bend's services for new patient referral management and uploading patient notes so clinicians and referring physicians can connect to VSA for patient clinical information access.
Because VSA schedules five or six new patients a day and may have 15 to 20 new patient referrals present daily from referring physicians to schedule appointments, Big Bend's patient referral service speeds up the appointment process since certain clinical information is required to be populated into VSA's system before an appointment is made. "Once a referral is logged into the system, their information is in our system forever," says Livingston.
Additionally, the use of importing and exporting patient notes to and from Big Bend into a patient's chart has saved time which was previously devoted to hunting down a patient's paper chart, Livingston notes. "You don't have to stop the care process to wait for documents."
A barrier of adoption is that stakeholders are hesitant to participate without solid standards surrounding HIE, Byington says. A top-down structure impacts the funding needed to build a locally based HIE infrastructure, which is required to access a state or nationwide system. He estimates that delays in achieving local HIE by focusing on bigger systems first is going to cause significant loss of savings from local HIE by three to six years.
Rather than lose savings, the group is taking a cost-effective approach with the technology already in place. As they look to the future, "we're moving forward without standards," says Byington, but keeping an eye out "to make sure we can migrate once they surface."
"Fear of workflow disruption has been a barrier to the adoption of HIE services because of workflow memory from communication systems developed decades ago. Besides the fax machine, not much has changed except an increased volume in the amount of information being communicated," says Byington.
Providers need to embrace change by adopting HIE services for more effective communication. "We're creating the medical internet along with the privacy and security needed to protect patient records. The real focus is to create communication between the hospital and the physician in a bi-directional manner," Byington noted in a webinar hosted by the National eHealth Collaborative on Oct. 20 as part of their NeHC University series.
Serving 12 counties in Florida, Big Bend was created in 2005 and awarded $814,000 in seed funding from Florida's Health Information Networks grant program over two-and-a-half state budget cycles. As a provider-driven HIE, Big Bend's vision was to put the physician on top of the healthcare totem pole through an advanced portal platform using one access point and single login for patient information outside the EMR.
Going into production in late 2007, Byington says the organization will probably interact within the portal environment for the next three to five years as they wait for advanced communication capabilities of their EMRs.
HIEs are uniquely poised both technologically and politically to integrate local and state data and deliver it to the healthcare providers of the community, he notes. From a clinical perspective, the HIE helps put the control of how data are displayed and organized into the hands of the physicians who are providing the care services.
At Big Bend, a federated architecture was intentionally designed so that data are not comingled and each connected data source has its own participation agreement and database on Big Bend's servers. This was done as a data management initiative, according to Byington, where Big Bend maintains databases on their platform from the data feed and provides the auditing required for issues of security and access to the data received from providers.
"There is little infrastructure in the industry that is capable of providing federated feeds at a physician or hospital level," he says.
Big Bend's services include clinical interfacing, web portal access and patient lookup, clinical messaging, referral management, electronic public health reporting, clinical notifications and meaningful use consulting.
Providers, like Vascular Surgery Associates (VSA), also located in Tallahassee, have harnessed services from Big Bend for practice management gains. According to April Livingston, the patient accounts coordinator and IT project manager at VSA, the practice depends on Big Bend's services for new patient referral management and uploading patient notes so clinicians and referring physicians can connect to VSA for patient clinical information access.
Because VSA schedules five or six new patients a day and may have 15 to 20 new patient referrals present daily from referring physicians to schedule appointments, Big Bend's patient referral service speeds up the appointment process since certain clinical information is required to be populated into VSA's system before an appointment is made. "Once a referral is logged into the system, their information is in our system forever," says Livingston.
Additionally, the use of importing and exporting patient notes to and from Big Bend into a patient's chart has saved time which was previously devoted to hunting down a patient's paper chart, Livingston notes. "You don't have to stop the care process to wait for documents."
A barrier of adoption is that stakeholders are hesitant to participate without solid standards surrounding HIE, Byington says. A top-down structure impacts the funding needed to build a locally based HIE infrastructure, which is required to access a state or nationwide system. He estimates that delays in achieving local HIE by focusing on bigger systems first is going to cause significant loss of savings from local HIE by three to six years.
Rather than lose savings, the group is taking a cost-effective approach with the technology already in place. As they look to the future, "we're moving forward without standards," says Byington, but keeping an eye out "to make sure we can migrate once they surface."
| Order Set Integration: A Critical Step to Advancing Care |
| Sponsored by an educational grant from Wolters Kluwer by Hasan Zia, MD Standardization of care and adoption of evidence-based medicine into clinical practice are two central tenets of meaningful use of EHRs. At Sibley Memorial Hospital, we have found the integration of evidence-based order sets with the EHR for point-of-care access as one way to accomplish these goals. The impact order sets, which I call clinical pathways, can have on improved clinical decision-making is best illustrated in critical care environments where the risks and benefits related to all interventions are magnified. Sibley recently completed a six-month pilot program wherein we converted our paper-based ICU order sets to ProVation Order Sets, powered by UpToDate Decision Support, refining them as appropriate based on supporting medical evidence linked within the software. Once deployed and in use by our critical care clinicians, we found that these order sets serve as a powerful checklist to ensure that nothing is overlooked—a reality for even the most detail-oriented physician. By streamlining our order sets, ProVation Order Sets has changed our practice in the ICU. Interventions and therapies proven to benefit all patients are now included as part of all admission orders. This allows patients receive best-practice care, while still giving our physicians the flexibility to decide what is best for each individual. Reflexive or “routine” orders that are not always necessary have also been eliminated, reducing costs without impacting quality of care. Finally, electronic order sets have improved clinical workflow and patient safety by replacing illegible/incomplete handwritten orders that required clarification before implementation. Dr. Zia is CMIO and director of critical care and emergency surgery for Sibley Memorial Hospital, a 328-bed acute care hospital in Washington, D.C. |