Encouraged by newly authorized federal funds and a broadening scope of systems and options, East Tennessee's healthcare providers are ramping up their efforts for a regional, integrated electronic medical records system.

 

Most major providers already have some elements in place, anything and everything from electronic pharmacy operations to computerized registration. As the goal of a fully automated platform becomes more reachable, physician practices and other satellite providers throughout the region are being actively pushed to link into the evolving systems.

 

To that end, the Health Information Technology for Economic and Clinical Health, or HITECH Act, which mandates that all patient health records be maintained in a standard electronic format, provides $30 billion in federal funds through the American Recovery and Reinvestment Act of 2009. Physicians and providers who install and are using new systems by 2010 will be able to earn up to $44,000 from Medicare, and up to $75,000 from Medicaid, on a monthly basis for up to $119,000 over a 5-year period. On the flip side, late adopters get less money, and those who do not have any kind of system in place by 2010 will begin to be penalized.

 

This carrot-and-stick approach is definitely eliminating the EMR fence sitters, said Scott Burke, divisional chief information officer and vice president of information systems for Mercy Health Partners.

 

"This provides an economic alternative for some of the smaller practices that really don't have a budget carved out for IT," Burke said. "This gives them a very low cost of entry and gets them into the EMR game. They can tap into our system, so it helps us test those aspects of hosting and takes us to the next step in terms of being able to share data regionally."

 

System providers are wasting no time marketing their products to hospitals, clinics and offices alike, and are finding very receptive ears all around, said Adnane Khalil, vice president of technology and chief information officer at Shared Health Inc., a public/private Health Information Exchange (HIE) based in Chattanooga.

 

"Right now the EMR world is in somewhat of a frenzy, with people going after different systems and different solutions," Khalil said. "As an HIE and processor, we are teaming up with a lot of the vendors to provide connectivity, but also providing some tools that allow us to stay in line with all the different EMR implementations."

 

Shared Health now offers its various programs to hospital systems in an effort to help them connect with physician networks and other providers in their communities to provide prescription records, clinical data and more. The end goal is not only to have all the players utilizing EMR functions, but also to have them seamlessly connected, Khalil said.

 

"Many conversations we have begun with a desire to look into [EMR] solutions for prescribing, and quickly move into what else is available," he said. "Physicians want to provide better care, and when they look at clinical decision support, chronic condition management and other programs, they want to get those tools and have that information available."

 

East Tennessee's major providers are working the problem from two ends: tapping into individual physicians' offices and clinical sites, as well as CareSpark, the Regional Health Information Organization (RHIO) that includes 17 counties in Tennessee and Virginia and covers 750,000 residents, 21 hospitals and 1,200 physicians.

 

"Our participation with a RHIO means that we are now asking if a patient wants to opt in or out at admission," said Mike Bundy, vice president of support services and operations for Wellmont Health System. "If they opt in, we will share that information with the RHIO, which is pretty aggressive at this point."

 

"All of us are really proceeding along the same journey," added Stephen Combs, MD, senior vice president of medical affairs for Wellmont and a board-certified pediatrician. "Some are further than others, but soon we should all be able to meaningfully share data. It's not good enough just to have it electronically available; you have to be able to share it with someone else who is going to be a patient's care provider."

 

To that end, a region where all the players cooperate even as they compete is a strong plus, said Bundy.

 

"The two major health systems here own large physician groups, and all of the entities are pursuing this together," he said, "It is relatively easy for us to plug in. We already have some groups here who ware sharing radiographic images, and we're not seeing being able to share discharge summaries and anything in a patient's electronic chart as some insurmountable task. We'll be able to do it in a year or so."

 

At Mercy, the IT challenge is to connect with the outside world while also creating a single, codified system within. With the 2007 merger of Baptist Health System with St. Mary's Health System, much has had to be done to create a cohesive platform across a large new entity, while also looking to be networked to the outside world as well.

 

"We've been consolidating the systems that each side brought to the game," Burke said. "By September 2009 we'll be at the level of readiness to move forward with other EMR requirements. Our parent company, Catholic Healthcare Partners, has signed an enterprise agreement with Epic software for their clinical application suite, so we'll be moving in that direction with our EMR management."

 

By 2012 the full Epic system will be in place, and during the two years leading up to that, Mercy will be working with HealthBridge, a Cincinnati-based HIE that can host physicians and others who need to tie into Mercy's systems now.

 

"This is our transitional strategy between now and when Epic is in," Burke said. "This is how we make sure that we have a solution in place that lines up with the timing requirements associated with HITECH, but also gives us two full years of putting a system in place and gives us a tremendous opportunity to wring more value out of the investments we've already made and continue to standardize our processes and procedures across the entire region."
The two-pronged approach has also been a necessity for Mountain States Health Alliance, which had fully integrated its ten Tennessee hospitals at around the same time it purchased five new facilities in Virginia.

 

"We had a highly integrated platform, deployed in layers," said Richard Eshbach, vice president and chief information officer for MSHA, of Project: SAFETYfirst, the health provider's EMR system. "It is not something that was cobbled together. But the five Virginia hospitals all had different vendors and levels of implementation, so now we're trying to pull all those together."

 

Having an integrated EMR strategy in place has been key to bringing in the new facilities, he says, and will allow for the entire system to be under one tech umbrella by 2012.

 

"We have a successful strategy to have a fully integrated delivery network, and it will allow us to standardize things now and also in the future," Eshbach said.

 

All the parties involved in EMR efforts agree that the momentum they're seeing now is unprecedented, and that big things were afoot even before the federal money was announced. That cash incentive has provided a tipping point, and has ramped up implementation schedules to a degree that was unimaginable even a year ago.