Since implementing the CONNECT software in October 2009, Thayer County Health Services’ (TCHS) IT system can be queried for patient data such as transcription documentation and lab results. Likewise, the Hebron, Neb.-based comprehensive primary care system can query other systems that are using CONNECT, which enables hook up to the Nationwide Health Information Network (NHIN) infrastructure.
“We are forerunners in this,” said CIO Dan Engle. Thus far, only a few healthcare organizations and regional HIEs have deployed CONNECT, including Redwood MedNet in Mendocino, Calif. This will change as more healthcare organizations come on board, he said.
TCHS is currently writing a grant to become a Beacon Community. If awarded, TCHS will make its electronic patient data available to local veterans (Offutt Air Force Base is located in southeastern Neb.). The grant would fund the development of a portal connecting its long-term care facility to its electronic health record (EHR) system, allowing physicians to access patient information and be able to message and e-prescribe. The exchange of information will provide complete medication reconciliation with long-term care patients, Beck said. TCHS expects its long-term care facility to become entirely paperless in 2010. “We want to be leaders in helping long-term care,” she said.
The grant will enable four other hospitals, namely St. Elizabeth’s Regional Medical Center, BryanLGH, and two hospitals in Auburn and Crete, to become electronic and connect to the NHIN to help veterans, said Beck.
TCHS’ journey as a health information exchange (HIE) forerunner commenced when it received a $1.6 million Critical Access Hospital Health Information Technology Grant. TCHS had established a goal to be “entirely paperless” and was off to a good start already, said CEO Joyce Beck. The grant enabled information exchange among its 19-bed critical access hospital, satellite clinics, long-term care facilities, pharmacy and emergency responders.
The next step was determining what to do with the information, which resided at the hospital, Beck said. TCHS made the information portable through bracelets and cards that could be downloaded via USB ports. “We really wanted patients and doctors to have access to updated information,” she said. In June 2009, TCHS explored interoperable solutions, including the Nebrska Health Information Initiative (NeHII) and NHIN.TCHS dispatch
ed a team to Washington, D.C., to learn more about their options through David Blumenthal, MD, and his Office of the National Coordinator for Health IT (ONC). “The overwhelming message for interoperability is to transcend boundaries and cross borders, with no silos,” said Engle. With a nod to its “snow birds” residents who spend the winters in other parts of the country, TCHS chose the NHIN route because it wanted its patient data to “go anywhere in the U.S.,” Beck said.
TCHS chose CONNECT’s open-source technology because it would encourage multiple vendors to easily adopt it, Engle said. A demonstration of the software highlighted its portability, functionality and ability to interface, he said. Low cost was also a factor in the decision. The Veterans Affairs and Defense departments are working on a Virtual Lifetime Electronic Record (VLER). “The NHIN is where you become a part of that,” Beck said. The VLER project aligns with TCHS’ goal of making its patient data available to its veterans.
Before TCHS got the $1.6 million grant, it had amassed donations from foundations, the hospital guild and private donors. “Enough people believed in what we were doing,” Beck said. It helped tremendously that TCHS engaged in a broad and deep education campaign out in the community. “If they don’t support EHRs, it’s because they don’t understand EHRs,” Beck said.
TCHS also fostered the right culture within its hospital to adopt the technology, Engle said. “We hardwired excellence,” Beck said. Through leadership books and training, TCHS created a culture in which everyone has a voice and is comfortable to use that voice, especially in the midst of major changes, she said.
The most significant benefit of the combination of the culture change and interoperable EHRs has been patient safety improvement, Beck said. There were 48 reported medication errors involving medications swallowed in the first quarter of 2004. Today, the medication errors, which include near misses that didn’t result in the wrong medications being swallowed, are down to six. Medication reconciliation went up from 16 percent to 100 percent. Deploying interoperable EHRs, says Beck, is a “slam dunk."
