Hospital-Physician Portals: A First Step in Sharing Patient Data Across Care Settings
advertisement
Hospital-Physician Portals: A First Step in Sharing Patient Data Across Care Settings Clinical Data Exchange Recent focus on IT to share clinical data across patient care settings Public and private efforts have created momentum Joy M. Grossman, Thomas Bodenheimer, Kelly McKenzie for regional health information organizations (RHIOs) but large obstacles remain Little known about extent of clinical data exchange • within organizations • among affiliated providers • among unaffiliated providers AcademyHealth Annual Research Meeting, June 27, 2006 Research Objectives Study Design Assess baseline on extent of IT to share clinical Project part of Community Tracking Study (CTS) Round 5 site visits (1/05-6/05) funded by RWJF data across patient care settings Qualitative analysis of interviews in 12 CTS Examine how adoption varies across local communities randomly selected to be nationally representative communities Identify barriers and facilitators to adoption unique to this type of IT Took advantage of multi-stakeholder design • Open-ended questions asked of 250+ respondents in largest hospitals, physician groups, safety net providers and health plans; local health IT groups Clinical Data Sharing Among Affiliated Providers Most Prevalent CTS Site Visit Communities Seattle, Seattle,WA WA Little clinical data exchange between unaffiliated Syracuse, NY Syracuse, NY Boston, Boston,MA MA organizations Lansing, Lansing,MI MI Indianapolis, IN Indianapolis, IN Cleveland, Cleveland,OH OH Northern NJ Northern NJ Orange OrangeCounty, County,CA CA Phoenix, Phoenix,AZ AZ Most hospitals developing proprietary physician web portals that provide admitting physicians with remote access to patient records Little LittleRock, Rock,AR AR Greenville, Greenville,SC SC Miami, Miami,FL FL Ambulatory data sharing lags behind Hospital-based Physician Portals Most Common Tool Portals provide unified view of a patient’s record, integrating data from hospital’s disparate IT systems Variation in data available, reflecting sophistication of underlying IT systems • Most typically labs, radiology, PACs reports and images, admission/discharge summaries • May also access hospital’s archival or real-time EMR • Many have transaction capabilities, e.g. electronic signatures, CPOE • More developed portals have linkages to other IT systems, e.g. ED records, inpatient fetal monitors Hospital Competition Driving Widespread Portal Adoption Efforts to Interface with Physician EMRs Slow Hospitals working to interface with EMRs of closely affiliated practices Significant technological hurdles mean few practices can import data directly from portals Handful of examples where hospital-based physicians, e.g. ED physicians, can access ambulatory data from physician practice EMRs Competition Barrier to CommunityWide Exchange Viewed as strategy to align physicians more closely • Often responding to pressure from heavy admitters • Portals are relatively low-cost and easy to implement so a quick “win” with potential to improve efficiency and quality Little data sharing between unaffiliated One or two hospital leaders in every market • More market variation in active “followers” versus slower “laggards” • Variation within and across hospital types • Laggards typically weaker financially Provider and health plan competition and organizations • Indianapolis and MA/Boston most active • Some other local and state efforts just beginning adversarial relationships between providers and plans are viewed as significant barriers to collaborative activities • In Boston and Indianapolis, collaboration among competitors a necessary condition for success Competition as Barrier (cont’d) Patients and their data viewed as key competitive asset by hospitals, physicians and health plans • Failed past efforts have created additional mistrust in some markets • More recent efforts have addressed governance and control issues Policy Implications Competitive dynamics may influence pace of RHIO development and choice of business model • Smaller and rural hospitals may see greater gains than larger and urban hospitals • RHIOs providing core IT infrastructure or collecting fees for clinical messaging may be less attractive to urban hospitals that have made IT investments • Proprietary portals do not preclude RHIO development Health plans are not viewed as likely conveners in many markets Portal development likely to continue but whether interim step towards development of nationwide network of RHIOs remains to be seen
