Exchange of Ideas Holyoke Medical Center Innovates with Shared Patient Information

It’s an increasingly connected world out there, Carl Cameron says, and healthcare providers can no longer deny it.

As director of Information Technology at Holyoke Medical Center, he understands better than most the trends and government mandates that have begun to collide like tectonic plates in his industry — forever altering the medical landscape.

Fortunately, he said, HMC has been well ahead of the game.

Take, for example, the Healthcare Information and Management Systems Society (HIMSS) and its data-analysis arm, HIMSS Analytics, which tracks the progress of healthcare organizations toward meeting federal mandates for electronic health records (EMR).

“They are the organizational IT group for healthcare,” Cameron explained, “and six or seven years ago, they determined how hospitals are rated with implementation of EMR and how that ties into patient safety and improved outcomes. They start with stage 0 — basically very little automation at all — and go up to stage 7, a complete electronic record throughout the hospital.

“We were recently validated as a stage-6 hospital,” he continued, adding that there are only 15 such institutions in Massachusetts, and only 11{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of all U.S. hospitals rate at stage 6 or higher, “so just being in that category kind of puts us ahead of where most hospital systems are.”

That effort has encompassed several fronts, from HMC’s adoption of computerized physician order entry in 2009 — three years before the state required it — to a switch from paper chart entry to doctors using computer tablets when interacting with patients.

Perhaps most ambitious, though, has been the hospital’s partnership with EMR vendor eClinicalWorks and its progress in connecting patient records with community physicians outside the hospital.

“One of the projects that we’re in the process of implementing — one that puts us a little bit ahead of others — is our health-information exchange,” Cameron said, explaining that 40 community doctors were initially recruited into the system.

“We’re also working with Holyoke Health Center [HHC] to bring an additional 30 providers on board connecting to the health-information exchange,” he added, noting that additional plans are in the works to connect 30 providers from River Valley Counseling, where behavioral-health patients are referred from HHC.

“This kind of closes the gap in terms of episodic care,” Cameron said, noting that, traditionally, “if a patient visits a physician or the ED, they document it, and the information stops there; it’s not shared across the continuum to other caregivers involved in that patient’s care.”

By creating a health-information exchange, he explained, the hospital reduces the chance of diagnosis or treatment error by making information about a patient’s last primary-care visit, current medications, recent procedures and test results, and the like immediately available to whomever happens to be treating them.

“So, if I walk into the emergency room today and I was at my primary-care office three weeks ago,” he said, “the ED physicians can see what I was there for, what medications my primary-care doctor prescribed, any new medications, if I have any allergies, those types of things.”

Cameron was quick to note that patients are not required to participate in the exchange, but the vast majority do. “We have a whole patient-consent process where patients must opt in, but the opt-in rate is around 93{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5}.”

And the exchange could grow to include more than just written records, he added.

“One thing that’s going to set us apart over the next six to 12 months is the ability to add imaging results through the exchange — not just being able to see the patient information, but diagnostic images that have been taken.”

The exchange will also eventually help the hospital with public-health tracking and reporting, Cameron said. “Because the health exchange is going to become the repository of information, it will enable us to do population health reporting. For example, how many diabetics are there in the community, and are they following up with their patient care? It really allows us to manage chronic diseases better.”

A robust health-information exchange makes sense especially against the backdrop of the nascent accountable-care model of healthcare delivery, by which several providers in the community take joint responsibility for a patient’s long-term care.

“We see the health exchange as a foundation — that’s what we’re doing, setting the foundation for these other initiatives,” he told HCN. “Very quickly we anticipate being up over 100 physicians in the health exchange, and we only went up with this in November, so we’ve made some good traction.”

The end goal, Cameron said, is to share information among various healthcare institutions. “I see that happening in multiple ways. I see us forming partnerships with other hospitals to create connectivity or expand the highway, so to speak, and I see the state as an important partner as well, to create that connectivity beyond the local borders in Western Mass.,” he explained, citing the example of a patient in Springfield with a cancer diagnosis who seeks a second opinion or some specialized treatment in Boston.

“I think we’re a ways off from that, but we’ve taken the first steps with the state,” he said, noting that he is also working with a colleague in Illinois on testing the functionality of health-information exchanges across state lines, and researching how state and federal laws would govern such an effort.

Patients will soon benefit from EMR in other ways, too. For example, Holyoke Medical Center will roll out its ‘patient portal’ by the end of August, allowing patients to access their hospital records online.

“That’s new, and that’s coming,” Cameron said. “We’ve actually rolled that out internally to employees as a way to get feedback. We’re helping our vendor to develop it and make changes to the product.”

He recognizes that this brave new world of shared and accessible information is a shock to the system for many — not just patients, but providers, too.

“Physicians are all overwhelmed with this push to electronic health records, so we’re working very hard to create partnerships with physicians, to create ease of use and efficiency. We’re trying to help them transition from the old way of practicing to what the new way is going to be.”

He conceded that many physicians are anxious and feel like EMR is being forced on them. “But it is going to help improve healthcare. It is going to make the system more efficient — but it’s going to take some time.

“The way I try to articulate it is, banking and manufacturing have all had IT systems for 30, 40 years,” Cameron told HCN. “On the clinical side, we’re in healthcare IT 1.0. We’re very early in the process. There are going to be bumps in the road, but we have to work together to fix them as we move forward.”

At the end of the day, he said, “I don’t lose sight of the fact that, yes, we’re doing a lot with technology, but it’s all about patient care, patient safety, and improving outcomes.”