Physician buy-in, designing EMR are focus of Texas system's next phase

Allowing providers 'a choice of tools' crucial to success

As Southern Texas Hospital System (STHS) moves forward with the implementation of its regional health information organization (RHIO), the focus must remain on its ultimate purpose — patient-centric collective data — and on creating value for each stakeholder, says Shannon Calhoun, executive director for the Goliad-based organization.

"There is no absolute, specific definition of the parameters of what a RHIO can do," Calhoun points out. "So RHIOs can be information exchanges, can be information sharing, can be collective information — and can happen through a host of different technologies, all of which have to address interoperability."

The first steps in the STHS project were to establish a secure data center and to begin addressing the technology and relationships supporting the technology, she adds; creating a smart card was the beginning piece of those technologies.

With assistance from a federal grant, STHS connected five of its eight hospitals through software to a central data repository that allows patients to carry a card with a microprocessor chip containing their personal health summary.

The next piece had to do with clinical information supported by an electronic medical record (EMR), Calhoun says. "We are pursuing funding and relationships and technology to allow us to do that with economies of scale.

"The question there would be how to raise the level of use of EMRs in the community in an affordable manner and still provide for the technical support and choices of the provider," she adds. "EMRs are tools for providers, and one does not want to take away the choice of tools that a particular provider would use.

"While attention has been given to getting smart cards in the hands of consumers, and hospital staff have rallied around the efficiencies the cards can facilitate, it is crucial to have the support and participation of physicians," Calhoun says. "How long will you carry a card every day if it's only usable at hospitals?

"The purpose of the EMR is that we really need to have data, not only from the hospital but from the physician," she says. "If [information] comes directly from the physician and is burned on the card, it is more accurate and precise than if the patient is giving the answer as to what medications he or she is on.

"Right now, that information comes from the patient, not the physician," Calhoun adds. "We need to have EMRs working with the smart card in order to raise the level of trusted, accurate information. As it becomes more automated, it becomes less complicated."

There is also the question of how information systems talk to one another, she says. "Say I went to a general practitioner and then to a cardiologist; how do you get the data in one place to the other and have the patient's information at one point? That is being patient-centric.

"We don't want to have [the patient] record exist only at the data center and everybody has to log in," Calhoun notes. "There are unified and federated RHIOs. We're sort of a hybrid."

The next phase of STHS's RHIO project will involve meeting with physicians in the medical communities that support each of its member hospitals and demonstrating the advantages of their participation, Calhoun says.

For example, while an EMR is typically thought of as a way to efficiently store patient data, she notes, it also can be a resource for supporting all of the things that a physician might know and use. "Think of the Physicians' Desk Reference [being included], the ability to have prompting to prescriptions that you use regularly, and having those red-flagged to a person's age and weight."

The question to be posed to physicians and other providers, she says, is, "What do you need in your toolbox?"

"An EMR has become a huge resource tool to allow automation of a host of things a physician does with paper today," she says. "One we've looked at shows a picture of the body that allows the user to look at the circulatory system. That can be an educational tool for the physician to use with a patient."

A cardiologist or a surgeon, for example, might want more specific information related to those specialties, Calhoun says, but would not need the variety of CPT codes that would be used by a general practitioner.

"As an organization, we would not want to presume what any one of those physicians can use, but should set parameters and make an offering of what we could provide and support."

Another value-added piece for physicians in phase two of the project is the automation of physician orders, she says. Practitioners will be able to enter their orders into some sort of software, Calhoun adds, whether through the EMR or through a practice management system that interfaces with the smart card software or directly into the smart card software.

"When the patient goes to the hospital and swipes in the card, the orders are there," she says, adding that STHS is also beginning work on communicating patient signatures and precertification in the same way.

"Interoperability and interfaces [are key]," Calhoun says. "Once [the system] interfaces with payers and government and employers — they are also stakeholders — that rounds out the ability to create a patient-centric system."

(Editor's note: Shannon Calhoun can be reached at