At Your Service: Web Hosting Comes of Age

	Clinicians at Orlando Health Network in Florida access radiology images through SeeMyRadiology.com (Accelarad).

Hosted services have been an IT staple in other industries for a decade or more. Now, like never before, hospital IT departments are turning to web hosting and portal-based approaches to access, store, maintain and exchange a widening range of electronic data. With 35 trillion gigabytes (GB) of digital information expected to be created and replicated by 2020, according to a recent report by IDC, moving to a hosted system might become a necessity for healthcare organizations that don’t want to be in the data storage business.

Choices are expanding as well: Cloud computing and Software-as-a-Service (SaaS) models can provide as much capacity as customers need today and can scale up as data storage and access needs grow.

‘Windows’ for seeing information

As options for storing and exchanging information grow, so do the types of data that web hosting and portal services handle. “Physicians are accustomed to having multiple windows to access information based on what they want to see and the intensity in viewing it,” says Christopher T. Halvorsen, acting information services director at Memorial Healthcare System in Fremont, Ohio.

Memorial, a 132-bed facility, sought to address the needs of family practitioners, mental health clinical workers and others. It partnered with CooperativeCare and Fremont Physicians Association in 2007 to develop a hosted initiative built on McKesson’s Practice Partner and Horizon Physician Portal so that clinical data could be accessed multiple ways by clinicians. Memorial also is developing a third access point for physicians, a neutral EMR exchange repository from which physicians can import data into their practice management system even if they are not implemented with the McKesson program.

“The holy grail is to be able to have data from private practices and hospitals seamlessly available and logically interact with the rules of alarms or alerts,” says Halvorsen. At Memorial, Practice Partner is used in the CooperativeCare EMR Hosting Service (CEHS), the collaborative effort between CooperativeCare, Fremont Physicians Association and Memorial to implement a shared practice management and EMR system. Horizon Physician Portal enables remote viewing, and the neutral EMR exchange repository interfaces programs other than Practice Partner into Memorial’s system.

Rather than using a central database, Memorial houses Practice Partner and EMR exchange repository under an ASP (application service provider) model. Information is populated to these physician EMR tools via interfaces with the hospital’s core systems in such a way as to autopopulate Practice Partner templates as if the physician has entered the information themselves. “We store it and the physicians sign onto the system via the web. Centrally, we ensure data integrity and preserve the alarm and alert logic of the data within the practice’s EMR,” says Halvorsen.

While the hosted service model hasn’t reduced costs at Memorial, according to Halvorsen, information access is being better facilitated, in a more timely and synchronized way. This results in more physicians interacting with clinical data whether they are located in the hospital or at their practice. “What we are seeing is increased utilization and confidence that what physicians see in their practice and hospital EMR is the latest and most correct information. That makes for a better clinical decision and, ultimately, improves our quality of care. To us, that’s what meaningful use is all about,” he says.

“Is the efficacy of our communication getting better and are the orders more complete? The answer is decidedly yes,” Halvorsen says.

Clinicians pay a licensing fee to use the Practice Partner system and Memorial uses its buying power with McKesson to purchase licenses that are assigned to member physicians at a discount. Memorial’s physician partners are mostly solo enterprises or small groups with two or three doctors, says Halvorsen. “Even with the discounts and the hospital leveraging its IT infrastructure and support capabilities, the integrated EMR does not come without its extra effort and financial costs,” he says. “If the clinician is not a believer or willing to work collaboratively, you’re going to encounter real problems.”

Images in exchange

Hosted systems are a good fit for radiology images, which are heavy consumers of network bandwidth. “The HIEs and RHIOs building up across the country are not likely to be in the business of storing images,” says Rick Schooler, vice president and CIO of Orlando Health Network in Florida. The 1,798-bed system uses Accelarad’s SeeMyRadiology.com cloud platform to transfer radiology images from referring facilities from within central Florida and beyond, enabling physicians to transfer and share reports and images in real time.

Accelarad’s SaaS technology allows clinicians to access images at the point of care, according to Schooler. The hosting technology ensures that patients are receiving the appropriate care at the right time: “It’s easy for smaller hospitals to send patients to the big hospital down the road. This technology helps to assure if that’s the right decision or not,” says Schooler.

Within the first five months of 2010, Orlando Health used the cloud to transfer 360 studies from 18 referring sites, all of which were exchanged for tertiary transfers and consultations. Of those referring sites, studies transferred included 178 CTs, 134 x-rays, 14 ultrasounds and 21 MRIs.
The cloud vendor charges a monthly flat fee for its service, but if Orlando Health annualized the first five months of transfers of 1,000 studies, sent via the cloud, the potential savings per electronic study (due to non-duplication of that study) would total $1.58 million.

SeeMyRadiology.com hosts DICOM-quality studies of all types in the cloud. After 30 days, facilities have the option to either purge or archive studies. Physicians and other clinicians can access images within minutes anytime, anywhere using the system. Orlando Health plans to move its long-term versions of medical images into the cloud this year, Schooler says. Doing so could provide a savings of at least 20 percent over buying or leasing the same storage space for Orlando’s data centers, he says.

Host accommodations

Some healthcare organizations have taken on hosting duties. Case in point: the Santa Cruz HIE framework, which uses Axolotl’s Elysium Exchange technology and is built on a federated model. The data that clinicians access through the HIE’s web-based hosed service are housed with the doctors, not in a
central repository. “A federated model is better and puts doctors at ease because a lot of breaches hit [databases],” says Bill Beighe, CIO, Physicians Medical Group of Santz Cruz (PMG), Santa Cruz HIE.

Two full-service hospitals, the Santa Cruz County Public Health Services Agency, four outpatient labs, five independent radiology imaging centers and safety net clinics exchange data via the Santa Cruz HIE. The HIE connects 80 percent of the region’s physicians and staff, Beighe says, and is in the process of implementing a communitywide virtual health record (VHR) so that authorized physicians can see a patient summary with a single click.

Using Axolotl’s Elysium NHIN Gateway, documents based on the HL7 Continuity of Care Document (CCD) standard are exchanged through the HIE to referring physicians, including data elements which can be extracted and incorporated directly into the receiving systems, including EMRs with e-prescribing and ordering, Beighe says.

The ability to share clinical data across the HIE has allowed clinicians to cut the number of redundant laboratory and imaging tests—for a potential savings of $2,985 per patient, according to a December 2009 study in American Journal of Surgery, which reported 53 percent of referrals received repeat imaging exams. 

As both technology and information become more mobile, more organizations will seek out nimble healthcare IT infrastructure options. Ultimately, a variety of factors determine whether web hosting or accessing clinical data through portals is more cost-effective than in-house data storage, archiving and exchange. But as more technology gets into the hands of clinicians—and patient care improves as a result of the additional information provided—hosted services and portal-based systems are emerging.