Improving Rural Health Care: Implementing Innovative Integration Solutions

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Project Details -
Completed

As the three members of a small, rural health care consortium, we used existing health care information technology software and systems to integrate the current incumbent, stand-alone databases and information systems in order to share patient information more effectively. The consortium then used this as a basis for creating a seamless, comprehensive Electronic Health Record, utilizing applications compliant with those standards, to make integration possible throughout our consortium. From this project, we implemented a solution for health care providers and staff in this consortium to use a seamless, longitudinal record system to improve overall patient care and efficiency, to scale the system up when this planning project is completed to then be used by everyone working in the consortium. This new health care information technology system allows real-time access to medical records and information, portability to numerous common devices and interfaces, reduction in overall costs, enhancement of collaboration with health care organizations, government agencies, payers and other third parties, medication tracking and on-line ordering, electronic, real-time orders by physicians and other health care providers, and appropriate security. It also reduces information-related errors in treatment and overall care. The solution required no further software development or code writing. It was implemented using information messaging standards with engineering support from the vendor.

Thomas R. Sims
Picture a patient in the throes of a heart attack arriving at a small, rural hospital in Vermont. Say the patient had suffered chest pain a week earlier and had an electrocardiogram done, but the hospital physicianhas no way of checking the results of that heart test.

Now, with a new integrated reporting system, doctors at Mt. Ascutney Hospital can log onto a Web site and pull up such a patient's medical information in seconds. In some cases, the up-to-date information could literally mean the difference between life and death, says Thomas R. Sims, director of information technology at Mt. Ascutney Hospital and Health Center in Windsor, Vermont.

Sims is also the principal investigator and team leader for a three-year effort by Mt. Ascutney and its partners to upgrade the way they handle medical information. The Mt. Ascutney Healthcare Consortium includes Mt. Ascutney Hospital, Valley Radiologists and Dartmouth-Hitchcock Medical Center, a Level I Trauma Center. The system allows doctors at Dartmouth or at Mt. Ascutney to pull up a patient's electronic health record, including digitalized images of a recent CAT scan. The consortium received a $685,000 grant from the federal Agency for Healthcare Research and Quality (AHRQ) for the initiative.

Previously, a doctor might have to search through a paper chart and multiple databases to gather lab results and other relevant information on a patient. With AHRQ's support, the consortium decided to implement an electronic system that collects patient information and then stores it in a single, easily accessible place.

The existing information technology system was kept in place, and Orion Health's Concerto Physician Portal was used to collect information on a patient from multiple places and store it in one database. An integration engine was added to help transfer information from one place to another.

Doctors can now simply log onto a Web site with a single password to instantly view the patient's health information including drug allergies, treatment history, and recent test or procedure results, even some from work done outside the hospital, without ever searching through a paper chart The integrated reporting system should improve the quality of care provided to patients, particularly those with chronic diseases.

The new system has been used to provide information on diabetes to the Vermont Department of Health's chronic care registry. More than 50 percent of people with chronic diseases such as diabetes and asthma fail to get adequate treatment, according to the Vermont Department of Health.

The Orion technology allows doctors to view at a glance the medical history of a patient with diabetes--and make sure there are no gaps in treatment. For example, the system might prompt the doctor to order a vaccine that protects against pneumonia. The doctor can also easily check the electronic record to make sure the patient gets the vaccine, Sims says.

Soon the consortium will start adding information on asthma treatment. The registry gives hospitals and the state an idea of how well patients with asthma are being managed and whether there is room for improvement, Sims says.

The team has yet to track cost savings, but in theory the system should increase the efficiency of care delivered, Sims says. Under the old system, patients being treated in the Mt. Ascutney outpatient center had to give clinic staff a medical history and an insurance card. But the clinic computer couldn't transfer that information to the laboratory. So if the same patient went to the lab for tests he or she had to answer the same questions all over again.

Today the information gets entered into the computer once and doesn't have to be entered again, Sims says. That alone should save staff time, he notes.

The ability to pull up information on patients quickly and then pass it along to another health provider is a key part of life-saving care, Sims says, adding: "For physicians, knowledge is power."