The numbers of health care providers that have not deployed electronic medical record (EMR) systems yet vary widely and change by the day. Don't count Atrius Health Inc. among them.
The 800-physician alliance of five Boston-area health care groups led by Harvard Vanguard Medical Associates has been running an Epic Systems Corp. EMR system for about 10 years. So, while many health care providers are scrambling to meet meaningful use requirements, Atrius is busy developing an EMR integration plan that enables links into other medical groups for sharing records.
One of the reasons Atrius has been able to achieve this so soon in the era of the HITECH Act is that it has had its IT infrastructure house in order long before the call for electronic health records came about. In addition to fine-tuning the Epic system for meaningful use, the IT challenges Atrius faces are in some ways not much different from those for any enterprise: managing growth in storage, and integrating new users and applications into the system.
Creating core competencies through EMR integration
"Our core architecture is in really good shape," Atrius CIO Dan Moriarty said in an interview at the company's Newton, Mass., headquarters. "But yes, you see this kind of explosion just in the number and amounts of data. For us, the growth has been as other groups have joined Atrius, [when] we roll out this [Epic] enterprise suite of apps to those groups. And so for us, the growth is more horizontal growth -- additional doctors, additional patients, more locations.
"From a core IT perspective," Moriarty said, "I don't see things in health care that look unusually daunting in terms of networking infrastructure or data centers, or storage that other industries haven't been dealing with for a long time."
What Atrius has been able to accomplish from this stage is to build on that infrastructure, create core competencies in EMR integration, develop workflows and documentation best practices and extend those competences outward. In this model, the IT department facilitates interactions with clinicians so that system designs are driven by how "clinical leadership wants to standardize care and optimize efficiency," Moriarty said.
"Atrius is kind of a definition of what the business case for a community standards and community data exchange is all about," said Moriarty, who joined the alliance earlier this year after stints as CIO of Harvard University and Harvard Medical School.
As an example of that, Atrius and the Beth Israel Deaconess Medical Center have achieved a level of integration in which Atrius personnel have a "one button" access into a patient's BIDMC medical record, Moriarty said.
"We're not exchanging data. We're not mapping this so much as linking that person right into the record," Moriarty said. "The beauty is, it takes three seconds."
Atrius is in discussions with eight other local hospitals to do similar EMR-to-EMR integration, Moriarty said. The alliance also is finishing the designs of an integration that would enable BIDMC physicians to have live access from their EMR system into Atrius', creating a bidirectional interface.
Atrius has partnered with Epic, using the Verona, Wis.-based vendor's Web services tools. As Moriarty explains, "You think about system to system, it's actually not really system to system. It's system to system, to Web layer, to Web layer … back to system."
A model for health information exchange initiatives
What Atrius and Beth Israel Deaconess have achieved is a sort of private health information exchange (HIE), a precursor to community HIEs (still to be established in many U.S. locales). Eventually, HIEs will serve as a hub through which medical groups can access data from common patients.
As Dr. Michael Lee, Atrius' director of clinical informatics explains it, HIEs would be a separate entity, possibly quasi-governmental. There already is some infrastructure in place in Massachusetts, for example, the New England Health Exchange Network, which is being used to exchange claims information.
"That architecture already exists" to advance HIE initiatives, Lee said. "It would be nice to leverage some of it, but I can't say that that would definitely go that way.
Atrius is kind of a definition of what the business case for a community standards and community data exchange is all about.
Dan Moriarty, CIO, Atrius Health
"What's going to happen is, everyone's going to need some form of connector into the exchange. So, the exchange is going to be the arbiter [of] where the information goes," Lee said. "In order to participate in the exchange, small groups are going to need at least to join the exchange from a core point, whether that's in a primary hospital or the Massachusetts Medical Society, so that that entity can then build the connector, because the exchange isn't going to build one connector for every doctor practice."
What is necessary to get to that step is development standards, which Moriarty explained are the only way EMR system integration "will economically work … getting broad participation and buy-in on standards and integration so that organizations aren't trying to do this integration with each other but rather doing it through a kind of integration hub strategy."
Moriarty and Lee both stress that the best way to affect the cost of health care is to avoid redundancy of care, trying wherever possible not to repeat billable services. And that path is through open information-sharing, which saves money by avoiding duplication. Ultimately, "you're potentially dramatically increasing quality by providing all of the knowledge that got created by your case across your whole continuum," Moriarty said.
EMR integration work still to be done
Given that the EMR integration development work is still in its infancy, Moriarty sees no end to the possibilities it can bring to health care. "I bet we'll never be done in my lifetime. You can think about it very simplistically in terms of rolling out the full practice management suite, scheduling, billing, registration, full medical record, all your ancillaries.
"Years ago you probably would have said, 'If I get all that done, I'm kind of in good shape,' but you get that done and then you want [a Personal Access Communications System], and you want intelligence in your pharmacy system or drug interactions and drug allergy interactions, and you want online dosage monitoring systems, and you want clinical data exchange with hospitals and community specialists. So, the state of the art keeps advancing at a fast-enough pace that I suspect all of us in the industry are going to have more than enough to do for our lifetimes. The organization is never going to be 'done,'" he said.
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