Q&A: At John Muir Health, the EHR is the HIE

Federal and state initiatives have come and gone, but for John Muir Health, the goal has remained the same: “a patient-centric kind of information exchange,” says Kathryn Bennett, MD, MBA, CMIO of the integrated delivery network based in Walnut Creek, Calif., located in the San Francisco Bay Area.

John Muir Health is a California not-for-profit organization that includes John Muir Medical Center-Walnut Creek Campus, a 327-bed facility that serves as Contra Costa County's only designated trauma center; and John Muir Medical Center-Concord Campus, a 254-bed medical center in Concord; as well as the John Muir Behavioral Health Center; the John Muir Physician Network; and outpatient centers in Brentwood and Rossmoor.

Bennett recently spoke with CMIO about John Muir’s clinical information exchange and the efforts get systemwide communication in preparation for connection with HIEs—or any other information exchange entities that might emerge.

CMIO: How long has the John Muir Health been working on information exchange?
About 13 years ago, when the two hospitals merged, we first got involved in this field. At that point, we were talking about CHINs [community healthcare information networks], [and] realized we needed some way to connect everybody. Then, the CHIN movement died and the RHIOs [Regional Health Information Organizations] died, but in the meantime, as we brought the two hospitals together, we realized we needed to bring physicians closer to the patients.

The hospital should not be at the center, but instead, the patient should be at the center, so we needed to figure out a way that we may get a patient-centric information exchange.

Knowing the whole HIE movement is starting back up again, we needed to be able to connect to other people who work outside our own network, like Kaiser Permanente, the county and other services around the state. We’ve been involved with development of a regional HIE.

CMIO: What technology are you using to make this happen?
RelayHealth [provides] the personal health record (PHR) as well as the connectivity. We use it as the connectivity tool within our system to deliver lab results to a competing IPA [independent practice association], and we brought up our own medical groups to get medical results in real time. We’ve started with labs and we’re getting medical imaging and cardiac—all totaling nearly a million transactions monthly. We have 297 providers enrolled in RelayHealth and 127,000 enrolled patients.

All clinical interactions and pharmacy are documented in the PHR, which is a component of the EMR. We know that 25,000 patients are self-registered and we are encouraging patients’ use of the PHR.

RelayHealth [can offer] secure messaging between providers, our plans are to use it as a referral network within our own system. The primary care group is on one information system, Cerner; and the IPA uses NextGen, so [RelayHealth provides] an easy vehicle to share data. Therefore, we can feed each other’s systems easily, rather than building point-to-point connections.

CMIO: Does the John Muir Health system connect with HIEs?
We can connect with other RelayHealth customers. We’re using RelayHealth as our internal HIE, but because we can connect to other [healthcare organizations that use] RelayHealth, it’s demonstrating the value of information exchange.

We’re going to have to figure out how we’re going to hook up to the regional information exchanges. We’re still working on that, but I think we’ll get there. It’s a step-by-step process. It’s an exercise in change management and it’s a challenge.

I’m not sure yet how it will all pan out, but we’ve been at the forefront this area of trying to encourage communication between physicians and patients, as well as within the physician and medical care community.