CEO SUMMARY: Partners HealthCare of Boston, Massachusetts, is creating a single informatics platform for CP and AP across all six of the hospitals that it operates. It will replace 19 different pathology systems currently used at six sites with just seven integrated pathology systems. As this happens, the anatomic pathology and clinical pathology systems will be consolidated and integrated, even as the three pathology groups serving these hospitals remain as independent group practices.
CONSOLIDATION OF INDEPENDENT PATHOLOGY GROUPS in a region can take many forms, not all of which require mergers or acquisitions to create a single, much bigger pathology group.
In Boston, Massachusetts, constituent pathology groups within Partners HealthCare are taking steps to adopt a common information system. As that happens, they will consolidate both anatomic pathology and clinical pathology services even as the groups themselves remain independent.
Consolidation Using IT
In May, Partners HealthCare announced it would implement solutions by Sunquest Information Systems throughout the laboratories of most of its healthcare facilities. Founded by Brigham and Women’s Hospital and Massachusetts General Hospital, Partners HealthCare is a teaching affiliate hospital of Harvard Medical School.
This method of pathology integration via information systems is distinct from having the individual pathology groups create a single operating organization. Instead, it is a form of consolidation via information systems infrastructure.
What adds interest to the approach of integrating pathology services via a common pathology information system is that the mix of contributing pathology groups at Partners Healthcare has its own complexity. Although Partners shows 14 hospital “members” on its web site, there are just six departments of pathology.
Departments of pathology exist at Massachusetts General Hospital (MGH), North Shore Medical Center, Newton-Wellesley Hospital, Brigham and Women’s Hospital (BWH), the Brigham and Women’s Faulker Hospital, and Cooley Dickinson Hospital. Because Cooley Dickinson has been in the Partner’s system for only one year, it will not be included in the first phases of the anatomic pathology information technology integration.
Currently, the six departments of pathology listed above are serviced by three independent pathology groups. These groups are located at MGH; BWH and BWH Faulker; and North Shore and Newton Wellesley.
The integration of pathology information systems is part of a broad IT integration project within Partners. John R. Gilbertson, M.D., is the Director of Pathology Informatics for Partners HealthCare. He is involved in this IT integration project.
“Within Partners, we will simultaneously implement both the new CP LIS and the new AP LIS,” stated Gilbertson. “Also, a common blood bank system for the community hospitals will be implemented during this phase.
Enterprise-wide EMR Is EPIC
“As this is being done, Partners will also implement an enterprise EMR,” he continued. “So actually there are four distinct projects in this one integration effort.”
According to Gilbertson, the four information technology integration projects include the following:
- An enterprise CP LIS implementation: this involves implementation of an enterprise CP LIS (Sunquest) across the Partners’ enterprise.
- An enterprise AP LIS Implementation:a single enterprise AP LIS (Sunquest Copath) across the enterprise— except that BWH and BWH- Faulkner will stay on Sunquest Powerpath for now.
- A Blood Bank implementation: Implementing the Sunquest Blood Banking Module (part of the Sunquest CP system) at the community hospitals (Newton Wellesley, North Shore Medical Center, and the BWH-Faulkner Hospital). The academic medical centers will remain on their independent implementations of Mediware for blood banking.
- The Enterprise EMR Implementation: (EPIC) will achieve integration of the new LIS systems with the new EMR system.
“The academic medical centers (AMCs) will remain on their independent HLA Systems for now,” observed Gilbertson. “This project was agreed on in 2012. It began in 2013 and will be completed in early 2017.
“For anatomic pathology, the project takes Partners from 19 systems in pathology to six (Sunquest Lab, Copath, Powerpath, Mediware at the AMCs and HLA at the AMCs),” he said. “This is actually seven implementations because the two Mediware systems and two HLA systems are independent implementations.
“When we are done, we expect to have a single informatics platform for CP and AP together,” added Gilbertson, an Associate Professor at the Harvard Medical School.
It is important to understand that these projects are motivated by the need of the parent health system to develop a fully-integrated information technology platform that can support truly integrated patient care. Yet, as this is done, it is creating the capability for independent pathology groups within the health sys- tem to more fully integrate their anatomic pathology services to the benefit of physicians and patients.
Gilbertson explained that “this is an IT-driven integration and its primary goal is to both simplify our IT infrastructure and align it with our new enterprise EMR. The pathology practices will continue to operate independently, but governance of the IT systems be a combined effort of Partners IT and committees made up of pathologists from all of the practices.
“That said, the project will give the pathology practices a set of important capabilities that we did not have before,” noted Gilbertson. “These capabilities include:
- “The ability to improve data quality, especially to provide consistent laboratory data across the Partners system.
- “The ability to improve our implementation of best practices and, over time, to better collaborate on clinical, educational, and research initiatives across the enterprise.
- “The ability to improve how we measure our efficiency and effectiveness, thus demonstrating pathology’s value to the enterprise.
- “The ability for pathologists to work together on future informatics technologies and initiatives when appropriate.
“The extent of this collaboration will be determined over time,” added Gilbertson. ‘The federated model has been very good to Partners for many years. Thus, the extent of collaboration will have to judged against our successful history of independent pathology practices.”
There will be many practical benefits for the clinical laboratories and the pathology groups within Partners. “One goal for this entire project is to provide integration between all departments and with all ordering physicians throughout the enterprise,” he said. “We have the additional goal of improving data quality. To accomplish this requires a core enterprise system throughout the departments within Partners.”
Rotation at Hospitals
Another benefit of the consolidated pathology informatics platform happens whenever pathologists rotate through the outside hospitals. “The system will provide a single consistent view of lab data and results from AP and CP testing across all sites,” he noted. “It allows us to improve data quality and consistency across the enterprise.
“For example, you can view the AP results in the Newton-Wellesley Hospital lab and those results will look very much like the results you will see at the North Shore Medical Center and in the academic medical centers,” he added. “By having the same systems across all the working pathology groups at Partners, we will have consistent lab orders and consistent lab test names while also ensuring data quality across the enterprise.
“Another benefit is that this integration allows us provide best practices across all Partners’ sites,” commented Gilbertson. “This is an IT integration driven by the departments of pathology in support of the need for a central IT system within Partners.”
Given the expected changes in reimbursement, the pathologists involved in this pathology informatics integration see it as an opportunity to measure the efficiency and effectiveness of the pathologists. “Having better data can potentially help us demonstrate pathology’s value to the enterprise,” stated Gilbertson.
“In particular, the ability to measure and report the value of anatomic and clinical pathology to the enterprise will be critically important as value-based payment arrangements become more common,” he emphasized.
“The integrated pathology and clinical laboratory system will also be ideal for training residents,” stated Gilbertson. “Partners has the two large academic medical centers in Boston and the pathologists rotate through the different hospitals in our system. Thus, having a common CP LIS and AP LIS will make it easier for residents to work at different locations and get support from our faculty.”
Standardization of the AP LIS will have another important benefit for all the pathologists working within the Partners system. “Today, our multiple IT systems make it difficult for pathology residents to move from one site to another across our system,” concluded Gilbertson. “Once implemented, our consolidated pathology and clinical laboratory IT system means that—no matter where a pathologist goes in the system—he or she will experience standard controls and a similar look and feel at each location.”