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                 Your thoughts in my hands ....

Intermountain Healthcare Coordinates EHR Systems

Since passage of the American Recovery and Reinvestment Act of 2009 (ARRA), medical practices across the country have been working to become compliant and certified in the processes and technologies established by the law. To access billions of dollars of incentives, physicians, clinics, hospitals and other medical providers have been seeking technology that will bring them current with the expectations of the law regarding Electronic Health Records (EHR’s). The purpose is to coordinate care across medical disciplines, as well as to maintain a continuum of care across the nation. Fundamentally, the law requires electronic management of medical records so as to:

- better engage patients in their personal health care decisions;

- connect health care resources with medical activities that demonstrate “meaningful use” (MU)

for the patient and the overall health care system, and

- clarify the overall health of the nation by streamlining the collection of the health data that has

the most impact on government resources.     

Since 2011, over $20B dollars of incentives have been distributed for healthcare information technology (HIT) projects to accelerate the adoption of EHRs and other technology, and to have the technology used in a meaningful way. One large medical system, Intermountain Healthcare, based in Salt Lake City Utah, reported on their process of becoming compliant in Phase 1 in a 2014 report to the NIH. Their experience reveals some of the challenges of adopting the reforms while maintaining high-quality medical care for their patients. 

Note that Intermountain is comprised of 22 hospitals, with over 900 physicians working in 170 ambulatory clinics. The scope of their enterprise is large, which created unique challenges in itself. However, their dedication to the change-over, and the methodical steps they took to achieve it demonstrated that process was doable. They believe the exercise resulted in both improved care for patients and an improved financial situation for their non-profit organization.   

When they started the process, Intermountain was using two “home grown” clinical information systems. Across their network, over 13,500 users contributed over 123,000 patient record documents or entries per month on a wider variety of issues than those required by ARRA. Implementing the standards of the EHR and MU meant that much of their existing system would require modification. Two teams, one for EHR and the other for MU, were assembled, and each analyzed the corporations’ status regarding those two aspects. On the EHR aspect, they identified 47 requirements that required some enhancement or completely new development to pass certification. On the MU side, there were 10 “meaningful use” workflows that would require changes to clinician workflow, to bring all of their hospitals and ambulatory providers above the required thresholds.

Within initial the EHR review, computerized records systems then in use had bugs across their network and in all areas of the recording process. Regarding the tracking of health information, all systems needed reprogramming to capture health indicators such as smoking history, BMI’s, active medication lists, problem lists, and vital signs. From the technology perspective, audit logs, submission to public health registries, patient-specific education resources, and electronic copies of health information, discharge summaries and instructions were made consistent across the enterprise.     

Regarding initial records of MU data and technology, only approximately half (55%) of providers used the Computer Provider Order Entry process; 5% used electronic prescribing; 20% had up to date patient problem lists; 45% had patient medication allergy lists; 20% had recorded patient smoking status; 20% demonstrated timely access to health information and half (50%) were able to demonstrate appropriate patient-specific education resources.

The teams then developed processes to modify practices to address the EHR and MU standards. They also incorporated the time and attention they paid to the process itself and reported that as the cost of the EHR certification project. Over the course of three years, 2011 through 2013, each aspect of the Intermountain system was overhauled to reflect the federal strategy. At the end of the process, all their systems achieved EHR and MU Phase 1 certification. The cost of the effort was estimated at $17.3M; the incentives received as a result totaled $46.3M.

After Phase 1 certification had been achieved, information systems, physicians, and hospitals were queried as to both positive and negative impacts of the process and the end system. All agreed that the results to date are still preliminary as the entity engages more fully in the new systems over time. From the information systems standpoint, some previously planned projects were delayed by the decision to prioritize the EHR/MU process. Other projects were accelerated because the MU activity directly impacted those processes. The clinical staff determined that the enterprise improved its reputation as word of its certification for MU spread. And they believe that the MU activity likely improved patient engagement.

As an entity, Intermountain reported that the process was very informational to them and that they saw growth in the use of the EHR over time. They determined to pursue further analysis of their implementation of Phase 1 as they prepared to tackle Phase 2 of the ARRA plan.

Phase 2 of the plan addresses advanced clinical practices by adding a few more technical and clinical data pieces and increasing the required number of MU measures that the health entity must demonstrate for certification purposes. It officially launched in 2014. Phase 3 will be looking at improved outcomes. Its proposed operating rule was published on April 15, 2015, and it will launch in 2016.

The federal governments’ embrace of technology for health care purposes demonstrates a forward view to improving both the health of the citizens and the health of the country. Intermountains’ embrace of the process is informational and inspirational because it shows that any entity, large or small, can tackle and master the process effectively and economically.

(c) PSornson 2005-2016