When it comes to implementing information technology in health care settings, the lessons learned from addressing technological and cultural challenges can be just as valuable as the easier barriers that need to be overcome. That's what project leaders who are creating a centralized electronic medical records (EMR) system for hospitals in rural Michigan have found.
Ten critical access hospitals (CAHs) in Michigan's Upper Peninsula are working together to create a regional health information network that will allow for the communication of patient data with physicians at Marquette General Hospital -- the region's only level II trauma center. The hospitals are part of the Upper Peninsula Health Information Partnership, based in Marquette. In 2005, the Agency for Healthcare Research and Quality awarded the group a three-year, $1.5 million grant to improve patient safety and quality of care through the regional planning, development and implementation of health information technology (health IT).
The network is designed to solve a major barrier to improving the quality care for residents of Michigan's Upper Peninsula, where a small population spread over a large geographical area makes access to advanced health care services difficult. Project officials hope that a Web-based central repository of patient data will go a long way toward improving patient safety and efficiency by:
- Reducing duplicate tests or other exams when patients are transferred from one provider to another;
- Improving inpatient transfers between the critical access hospitals and Marquette General;
- Allowing clinicians to identify which medications a patient is taking when he or she is transferred between emergency departments; and
- Eliminating the need to send a courier service between hospitals to transport laboratory test results, medical records, x-rays, and other important patient data.
For example, a patient's information could be electronically recorded in the rural hospital's computer system and then updated in real time to the central database. If additional consultation is needed, a specialist at Marquette could retrieve the data and view a patient's lab results, x-rays or other diagnostic information.
Marquette General Hospital has a health IT system that it created several years ago to connect its own 175 physicians. That structure serves as the hub to link the CAHs and Marquette General. In addition, rural CAHs already have various forms of EMR systems in place and connect to Marquette General's system for services such as video teleconferencing and educational programs.
To avoid the potential technical glitches of linking all of the hospitals at once, the project is being tested in several stages. In the first phase, Helen Newberry Joy Hospital and Schoolcraft Memorial Hospital were linked to the clinical data repository. In addition to the two pilot facilities, participating hospitals include Baraga County Memorial Hospital, Bell Memorial Hospital, Grand View Health System, Iron County Community Hospital, Keweenaw Memorial Medical Center, Mackinac Straits Hospital, Munising Memorial Hospital, and Ontonagon Memorial Hospital.
Hospitals Overcome Technical, Cultural Challenges of Data Exchange
The project's first phase was not without glitches. Each pilot site tested different clinical software, which made compatibility difficult. To achieve connection, Helen Newberry Joy and Schoolcraft Memorial hospitals' clinical software systems required a series of upgrades to transmit data back and forth to the clinical repository at Marquette General.
"The toughest part is creating the interfaces during the pilots," says Donald Wheeler, FACHE, and the project's principal investigator.
In addition, data were not reported consistently between hospitals. And project leaders had the additional challenge of ensuring that patient confidentiality standards as required by the Health Insurance Portability and Accountability Act were met when transmitting patient data.
Communication among the hospitals about the necessary technological fixes also became a challenge, explains Guy Hembroff, assistant professor and chair of the Computer Network Administration program at Michigan Tech University. Too many middlemen were involved in the process, causing a communications breakdown.
To overcome these barriers, project leaders established a standards committee, with broad representation from the participating organizations. The group set standards for data consistency, using standards such as HL7, LOINC and SNOMED for transmitting information.
"The largest obstacle was compatibility," Hembroff says. "It's a lot of trial and error that had to happen."
In addition to technical barriers, project leaders had to contend with physicians' reluctance to change the way they report data to the central repository. One project site also experienced delays after its health IT director left. To address the issue, project leaders began providing technical training and continuing education for physicians. In addition, Hembroff created a survey for doctors who he thought might be the most reluctant to embrace the project. The survey gauged their potential concerns and fears about the project. Hembroff and others then worked with those doctors to address their concerns and help them get comfortable with the software. Later, they went on to champion the project to other physicians, he says.
Pilots Serve As Learning Lab for Future Data Exchange Projects
Today, Helen Newberry Joy and Schoolcraft Memorial hospitals are exchanging clinical and lab data with Marquette General. The lessons learned through this pilot have provided valuable insights for introducing the system to additional hospitals.
Project officials hope that the existing infrastructure ultimately will support an automated pharmacy system, give hospitals greater access to radiologists who can help interpret images, and help facilities retrieve andstore images in a Picture Archiving and Communications System.
Wheeler believes that the lessons learned from creating an EMR system that can be shared with multiple hospitals will help others embarking on data-sharing projects. Small, rural hospitals, which in many cases have shared resources out of necessity over the years, are the perfect learning lab, he says.
"Many people are excited by the idea of sharing data. The key is vision, determination and a willingness to roll up your sleeves," Wheeler says.