Wes RishelAfter publishing “It Takes a Region:” Progress Without EHRs I received an email from Alan Glaseroff updating me on the current state of the chronic disease efforts and the proliferation of EHRs, which is now up to 41% by physician count. With his permission I am including portions of his email here:
We did use C-DEMS (open source) as our registry but have used PECSYS from Aristos the last 5 years or so. It is proprietary, but allows us to customize (we have great programmers). We are also implementing an e-referral system called IRIS across the whole county and will use it to create a master patient index (the Holy Grail of regional health care data).
Over the past year EHRs have struck in Humboldt with a vengeance, mainly in the FQHCs and other safety net clinics. Open Door Community Health Centers (6 sites) are on EPIC via the Portland-based Oregon Community Health Improvement Network (OCHIN). The tribal clinics are on NexGen. Mobile Medical has ECW. One large private practice is on Allscripts (Eureka Internal Medicine) and another (Eureka Family Practice) has Practice Partner. There a few others in the specialists offices… so now we are at 41% penetration by physician count (not by practice, as the small offices haven’t yet succumbed). EHRs have only helped the registry because we have figured out how to extract data by creating reports that access the “back end” and pull out what we need (mostly weekly, some more often). We may be the first to solve this without very costly real-time interfaces. So the registry is alive and well (and results continue to improve dramatically – our IPA ranked in the top group for statewide P4P (one of 2 IPAs to achieve this in a world of well-resourced staff model multispecialty groups such as Kaiser, Sharp Rees-Stealy, Health Care Partners, and the Palo Alto Medical Foundation).
We believe we can reach most of the physicians not on EHRs. Our plan is to get them to turn ARRA incentive $ over to us. We will do (or subcontract for) the installing, training, system maintenance. [The project approach will get them] to meaningful use. … I’m hopeful the model will become more patient-centered and system-focused, rather than viewing practices as stand-alone entities.
The model for small practice EHR installation comes from the Tulare initiative undertaken by the California Health Care Foundation (CHCF). We will borrow their approach.
What lessons should I take from this new information? First off, I am prouder than ever to be in this County and to have this opportunity to sneak in some boosterism.
I would argue that it was the early community health and P4P successes that engenders cooperation that will create the specific kinds of interoperability that impact patient care. This shows that interoperability begets interoperability. Such begetting is not a technical phenomenon; it is a social one. Achieving some success makes it easier to talk about more efforts. If Alan is successful in getting physicians to assign incentive payments to cover his program it will be in part because of pre-EHR, IT-enabled successes.
I will be delighted if the Simple Interop approach enables other communities to build P4P and other capabilities without tying their success to universal roll-out of EHRs and the creation of a full formal HIE.
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Category: Healthcare Providers Interoperability Vertical Industries Tags: ARRA, disease registry, EHR, EMR, Health Information Exchange, Health Internet, Health IT, Healthcare Interoperability, Healthcare Providers, HIE, Humboldt Country, Meaningful Use, open source, p4p, patient ID, Stimulus
