CEO SUMMARY: In Houston, Memorial Hermann Healthcare System has put together a health information exchange (HIE) to serve the Houston market. By design, this HIE not only gives physicians immediate access to a wide variety of patient data, but also supports the type of workflow required for Memorial Hermann’s new accountable care organization to succeed. Memorial Hermann’s laboratory outreach program is using the HIE to forge closer clinical relationships with physicians in the community.
THERE IS A NEW CATEGORY OF PLAYER in the American healthcare system. It is the health information exchange (HIE) and it has the potential to be both an enemy and a friend to local clinical laboratories and anatomic pathology groups.
Lab executives should view HIEs as both a consolidator of patient data—including laboratory test results—and an integration platform that supports new models of tightly integrated clinical care, including accountable care organizations (ACO) and medical homes.
For both reasons—as clinical data consolidator and as clinical workflow integrator—it is essential that every clinical laboratory and pathology group have an understanding of how HIEs can enhance their labs’ competitive position even as the HIE can make it easier for competing labs to also do business within the communities served by the HIE.
Aware of this dual nature of threat and opportunity, a prominent academic center in Houston, Texas, recently launched its own HIE as part of its strategy to be a clinical and workflow leader within its service region. Early evidence shows that this HIE is creating new opportunities for the medical center’s laboratory outreach program to build market share while delivering greater value to the physicians and other clients it serves.
It was in August 2011, when Memorial Hermann Healthcare System publicly announced that the Memorial Hermann Information Exchange (MHiE) was operational. A distinguishing factor about this HIE is that it is provider-owned and provider-operated.
“Here at Memorial Hermann, we developed MHiE to achieve several goals that range from clinical to operational,” stated Robert Weeks, MHA, Administrative Director for Information Technology at Memorial Hermann. He was speaking at THE DARK REPORT’S Executive War College last May in New Orleans, Louisiana.
Weeks brings an interesting perspective to his current job. He has 22 years of healthcare experience. He started as a paramedic in the emergency room and later worked as a phlebotomist before going into health information technology.
Plumbing For ACOs
“The reason I got into healthcare was to improve patient care,” observed Weeks. “Thus, when I talk about the MHiE, I explain that this technology is all about improving patient care. At the same time, these developments in information technology provide the plumbing for accountable care because they enable providers to improve the transitions of care from one setting to another.”
In fact, improved workflow is one secret contributing to the effectiveness of MHiE. Lab executives should take note of Weeks’ comments on this subject. “MHiE allows us to improve workflow in ways that were previously not possible,” he declared. “We launched this MHiE system on August 1, 2011, so it is still relatively new.
“Today, MHiE is connected to 15 Memorial Hermann hospitals and seven ambulatory facilities,” he continued. “Via informed consent, more than 317,000 patients have agreed to participate in this system. MHiE has exchanged more than 100,000 continuity of care documents (CCDs).
“MHiE sends and receives data with providers and others outside the walls of the hospital. For example, when a participating patient transitions from the ER to primary care, a consented CCD goes to the primary care physician,” emphasized Weeks.
“When community healthcare providers become exchange members with MHiE, any provider using a standards-based informatics system can both send and receive patient data,” he continued. “In the absence of a certified EMR, MHiE can be viewed via secure web screens. MHiE exchange capabilities include orders, results, documents, images, and CCDs.
“Having demonstrated that we can transmit all of these documents, it’s important to know that an HIE is not about moving documents,” stated Weeks. “MHiE improves workflow by allowing us to deliver key clinical information to caregivers where and when they need it. By delivering the data needed by providers, we promote clinical excellence, improve both clinical integration and the patient experience, while at the same time we are reducing operating costs.
Point Of Care Support
“From a strategy standpoint, we are using innovations in technology to improve the delivery of information,” he said. “In that way, our MHiE contributes to improved clinical care. This is true whether you are in the laboratory, a provider of inpatient or ambulatory services, someone doing billing, or as a patient.
“Pathologists know that lab test results are highly important,” continued Weeks. “Thus, delivering these data to physicians when they need it is critical to their ability to make timely and accurate decisions, about patient care. MHiE delivers those results in a timely way. At the same time, it keeps costs down by preventing the need for repeat, redundant testing.
“How our clinicians use MHiE may sound simple as I describe it, but that overlooks the complexity and hard work it takes to keep all the parts working smoothly,” he noted. “As of today, MHiE remains the only live HIE in Houston. Also, for the past seven years, our facilities have made national lists of the ‘most wired’ hospitals.
“Keep in mind the scale of this endeavor,” continued Weeks. “Memorial Hermann is the largest healthcare system in Texas. This includes 23,500 employees and 4,500 physicians on staff who work in 15 major facilities. Across the greater Houston metropolitan area, we serve another 9,500 referring physicians. Add to this a number of retail operations.
“Memorial Hermann also has a large laboratory outreach program, and 30 patient service centers doing lab draws,” he stated. “In our outreach lab program, we do 800,000 lab transactions each month.
“We contract with three pathology groups,” added Weeks. “There are nine hospital-based laboratories that run approximately 1.5 million to 1.8 million lab tests per month. “Our efforts to achieve a high degree of clinical integration across our systems go back 15 to 20 years,” Weeks commented. “Our hospital clinical systems can talk to registration and billing systems and vice versa.
“We’ll spend the next 15 to 20 years achieving that same degree of interoperability outside of our walls,” he said. “Developing that capability further will allow us to support the ongoing development of our accountable care organization. Its formation was announced earlier this year.
“Use of our MHiE to support the ACO is significant,” Weeks stated. “It will help us migrate from a fee-for-service payment model to a reimbursement model that is more like capitation—where we will get paid once to provide all services needed by every patient in the ACO.
Better Patient Management
“Most hospital administrators want to stay on the fee-for-service side where they can bill for volume, procedures, lab tests, and for having patients in hospital beds,” offered Weeks. “But most of healthcare is starting to move toward tight management of every patient. That means volume and procedures are no longer the key to reimbursement.”
Weeks acknowledges that the era of the ACO has not yet arrived. “Right now, our health system has one foot on the dock and one foot in the boat,” Weeks explained. “That means we are learning as we go. “For example, as an ACO, we need to identify our at-risk population and manage those patients,” he said. “That’s why we have case and care managers who monitor and engage patients.
“Here is where timely access to data is essential,” stated Weeks. “For instance, care managers working with diabetes patients need to identify which patients have had their hemoglobin A1c test done in the past six months and which have not.
“Today we use technology to derive such alerts from hospital, ambulatory, and HIE data,” Weeks added. “In the example of the diabetes patient who needs a hemoglobin A1c test, if that alert is not on an ambulatory care manager’s list, a printed alert is sent to the clinic where the patient is scheduled to visit next.
“This example shows how Memorial Hermann currently uses lab data to improve care,” emphasized Weeks. “After all, when there are gaps in the data, there are gaps in care.
“Don’t overlook the fact that, to do this well, we have to get data from outside the walls of the hospitals,” he stated. “That requires us to connect to a wide variety of electronic medical record (EMR) systems so that any affiliated physician can get clinical lab, radiology, and hospital data.
“MHiE is the informatics plumbing to support this and it is already in place,” Weeks continued. “Currently, we have integration with a number of EMR systems and other health informatics products. That number increases as we achieve integration with additional vendors’ products.
“Some specific examples show the importance of integrating with as many informatics systems as possible,” he said. “We currently host about 500 physicians on the eClinical Works EMR in our data center. Other physicians use GE’s Centricity EMR. We have a strong partnership with University of Texas Physicians, who use the AllScripts EMR. These EMRs are connected through MHiE today.”
Since 2007, Memorial Hermann has partnered with RediClinics to operate rapid-access clinics in retail locations throughout Houston. As many as 30 of these clinics connect through MHiE and access lab test data and other patient information via this channel.
“We are also taking steps to create connections with post-acute care agencies, community clinics, federally-qualified health centers, and other types of health providers who serve our patients,” Weeks said.
Access To Lab Test Data
“Whenever a participating patient moves from one setting or one physician to another, the structured clinical care document is passed along with them,” noted Weeks. “In serving physicians across different care settings, we need to feed lab test data in a useful way. It is true that different physicians will use lab test data in different ways. So, before we could pass along the lab results, we had to decide how we wanted to display the lab data.
How To Display Lab Data
“Take the example of a patient who stayed in the ICU for 30 days,” explained Weeks. “Just that ICU stay may have generated thousands of lab test results. By default, do physicians want just the latest lab tests or all 30 days of tests?
“Keep in mind that it is a little thing like this that determines whether sending the data is a nuisance or clinically relevant,” he said. “Next, our laboratory had to decide if we wanted to push lab test data out to providers or keep it here and let providers come and pull that data from us. We decided on the pull model.”
In the short time since MHiE has been operational, the laboratory outreach program at Memorial Hermann has used the MHiE’s capabilities to deliver more value to referring physicians. This is producing two benefits.
First, it increases the loyalty of physicians using the outreach laboratory. Second, it positions the Memorial Hermann outreach lab as the preferred resource for supporting its parent organization’s nascent ACO. And there is more to come.
Enhancing MHiE Features
“Looking ahead, we are actively working on a number of ways to improve the MHiE,” noted Weeks. “For example, we are adding additional sections to the CCDs for family and social histories.
“We are also doing a gap analysis on which types of physicians’ notes would best supplement the data we have in the CCD data section of MHiE,” he added. “We want to determine whether some providers may want us to add ER notes, discharge summaries, or progress and consult notes.”
In several ways, the ongoing development of Memorial Hermann’s HIE directly benefits the laboratory outreach program. “We anticipate that continued growth in the number of providers who are in the network and using MHiE will open the door for our laboratory outreach program to become their lab test provider,” said Weeks. “We can deliver added value via MiHE and that helps us differentiate our lab in a competitive marketplace.”
THE DARK REPORT observes that Memorial Hermann Healthcare System provides an early case study of one strategy to achieve clinical integration within a regional market. Memorial Hermann is using MHiE as the integrator of informatics. MHiE then becomes one cornerstone for further development of Memorial Hermann’s ACO.
At the same time, the capabilities of MHiE are being leveraged by Memorial Hermann’s lab outreach program to deliver more value and gain new clients. That appears to be one significant short-term benefit. Over the long term, as the Memorial Hermann ACO becomes fully operational, it is this same informatics integration that positions the lab outreach program to be the ACO’s primary lab test provider.
How Memorial Hermann Uses Technology To Improve Patient Care and Reduce Cost
IN A FEE-FOR-SERVICE HEALTHCARE SYSTEM, the more tests and procedures that are done each day, the more providers and health systems can bill. But fee-for-service payment will soon give way to other forms of reimbursement that do not pay for increased volume of services.
Forward-looking health systems are seeking more efficient ways to deliver care in anticipation of these new reimbursement arrangements. “Let me provide you with an example of how the Memorial Hermann Healthcare System uses its health information exchange (MHiE) technology to increase efficiency and improve care,” stated Robert Weeks, MHA, Memorial Hermann’s Administrative Director for Information Technology.
“A 10-year-old girl in Beaumont, Texas, has a complex facture of her hip and femur,” he explained. “It’s a weekend and she needs to be transported by air ambulance. On the phone to arrange the transport, the staff in our Emergency Department asks if the Beaumont facility has any images of the girl’s injuries. The answer is, ‘yes,’ and we ask the hospital to send the images over our image gateway.
“Before the helicopter with the 10-year-old patient arrives, the images are transmitted to us and displayed on the large screens in our operating room,” he noted. “The images also are stored in our Picture Archive and Communication (PAC) System.
“When the patient lands, she is wheeled directly into the OR for surgery,” he said. “There was no need for additional images, thus saving time and costs. This is a real example and the patient had the surgery, then was sent home after getting the appropriate therapy.
“We didn’t need to do additional imaging nor repeat imaging that had already been done,” he pointed out. “Thus, besides not adding to the cost of care, we didn’t needlessly expose this patient to more radiation. This is just one case, but it shows how we already use technology to control costs and improve care at the same time.”
Regional HIEs Already Helping Hospital Labs
IN RECENT YEARS, REGIONAL HEALTH INFORMATION EXCHANGES (HIE) have proved to be helpful to local hospital laboratories wanting to expand their outreach business.
THE DARK REPORT has provided coverage of these developments, including:
HIE’s Diagnostic Exchange System Serves Outreach Physicians with Lab and Radiology
ONE PRIMARY FUNCTION of Memorial Hermann Healthcare System’s Memorial Health Information Exchange (MHiE) is the ability to enable outreach physicians to send lab test orders and to receive lab test results.
“The MHiE Diagnostic Health Exchange functions as a router between a physician’s EMR system and Memorial Hermann Outreach Services,” said Robert Weeks, MHA, “MHiE makes our diagnostic and therapeutic test results immediately available to the referring physicians who are members of our HIE. Even if these physicians do not have an EMR, every exchange member has access to an online web portal that allows them to submit lab orders and view results anytime from anywhere.
“We developed this orders-and-results exchange with LifePoint Informatics of Glen Rock, New Jersey,” he explained. “It’s primarily for our lab outreach business that now serves more than 9,000 outreach physicians who use MHiE.
“Currently MHiE can fully connect to many EMR products,” continued Weeks. “That enables us to receive electronic orders in our labs and then send electronic results back to our ordering physicians. It’s a significant system that manages 800,000 lab outreach transactions each month.
“We also have a companion system called the MHiE Image Gateway,” observed Weeks. “This is an image exchange system that handles radiology orders and results. It is the only operating image exchange in Houston.
MHiE Image Gateway is connected to 15 of our own hospitals and more than 34 other facilities located within 100 miles of Houston,” he said. “It allows physicians to receive electronic radiology test results, access radiology image links via a secure portal, and view transcription documents.
“Recently, we enabled a feature allowing physicians to enter radiology test orders directly in the EMR and let patients schedule a visit to a radiologist as well,” noted Weeks. “Also, we’re developing the ability to access our secure web portal via mobile devices.
“We intend to leverage this experience and our capabilities in handling digital images,” predicted Weeks. “When pathologists begin sending and receiving digital images, MHiE and our lab will be able to accommodate those images.”