A Dose of Technology

"I am envious of their position because they were building from scratch," says David Holland, vice president and CIO of Genesys Health System, Grand Blanc, Mich. "Unfortunately, I am left with a legacy situation where I'm dealing with a lot of existing systems and crossover of data between the many systems that we have."

Likewise, Indiana Heart Center's solution provider--GE Medical Systems Information Technologies--is the envy of most health-care integrators. Under terms of the multimillion-dollar assignment, GE integrated its digital patient-information system, dubbed Centricity, with various applications and points of data input from notebook PCs and workstations to medical-monitoring devices.

In practice--no pun intended--nurses and physicians at Indiana Heart Center enter patient information directly into PCs, and medical records are shared electronically among clinicians. Everything from patient charts, billing information, X-rays and even data fed in from EKG machines are wired into the hospital's patient-care systems. Doctors can view a patient's stats in real-time over the Web, be alerted of changes or retrieve records and share them with patients or consulting physicians.

GE also provides ongoing support and maintenance. And the long-term goal, adds Juli Strattman, interim CIO at Indiana Heart Center, is for GE to partner with four other hospitals in the eCommunity Health Network. "The team GE provided us is excellent," she says.

Unfortunately, existing health-care providers like Genesys have a legacy of business processes and computer systems to contend with before going totally paperless. In fact, only about 8 percent have any significant efforts afoot to automate portions of their paper-based processes, says Mark Anderson, CEO of AC Group, a health-care IT-advisory firm. By the end of this year, less than 2 percent of all providers will sign contracts to implement new, computer-based patient-record systems, according to Gartner. And by 2005, Gartner is predicting only 15 percent of all providers will have implemented them.

But that's not to say business isn't out there. Experts still say a large number of health-care providers, ranging from large hospitals to specialized clinics, are going digital. And many will be watching those providers that are on a fast track to go paperless.

Worth Watching
Perhaps the most notable example is Oakland, Calif.-based Kaiser Permanente, the nation's largest managed health-care provider. While Kaiser has successfully implemented electronic patient-care systems at all of its hospitals and ambulatory facilities, the systems are disparate and fall short of automating processes. As a result, Kaiser recently tapped health-care solution provider Epic Systems, Madison, Wis., to provide its entire nationwide system with an integrated, computerized provider order-entry (CPOE) system.

"There's no question that the industry will definitely be watching Kaiser's implementation very closely," says Barry Hieb, an analyst at Gartner.

The effort will be implemented in phases during the next three years and will cost nearly $2 billion. The goal is to provide a common digital repository where medical records are maintained across the entire health-care system, which consists of 29 medical centers and 423 medical offices across nine different states.

The system will let Kaiser store patient records that physicians, practitioners, billers and even patients will be able to securely access online. The plan is to automate functions ranging from scheduling appointments and renewing prescriptions online to providing physicians with real-time access to patient data, such as lab results, as they become available.

Andrew M. Wiesenthal, a physician who has championed Kaiser's digitization efforts, says providing a common networkwide system is a natural evolution of what the organization has been doing for more than a decade.

"There has been a lot of digitized medical data in Kaiser Permanente for a long time; we're just making the system more uniform across the country," says Wiesenthal, associate executive director of the Kaiser Permanente Federation.

Before arriving at Kaiser's headquarters, Wiesenthal oversaw its digitization effort in Boulder, Colo., where Kaiser has 450,000 members and 600 physicians. Patient documentation, including notes, orders, lab results and "you name it" have been electronic for five years, Wiesenthal says. The same is true of the Pacific Northwest and mid-Atlantic regions.

The problem, however, is that there is no way to share patient information across the system. This is critical for a number of reasons: First, if a patient moves or travels to a location that has a different system, the information is not available. It's also less conducive for sharing information on such things as internal research and best-management practices. And Kaiser Permanente is taking on the added cost of managing separate systems. "Finding a system that could scale to our needs was a huge challenge," Wiesenthal says.

Judith Faulkner, Epic Systems' founder and CEO, says her company will integrate its solution from region to region. "They are doing everything in a central model, working together with one national build," Faulkner says.

One Step At a Time
According to AC Group's Anderson, health-care organizations that are adding electronic patient-care systems are doing so on an evolutionary basis. Genesys is one such example. A year ago, the hospital embarked on a 30-month effort toward providing electronic heath-care records with the assistance of BlueWare. The Cadillac, Mich.-based solution provider had developed a Web-based, document-management solution called the Wellness Connection, based on IBM's DB2 Content Manager.

The AS/400-based system, which BlueWare integrated with Genesys' existing systems, allows practitioners to scan existing patient charts and data written by medics in an emergency room or ambulance, as well as other paper sources.

The effort started by capturing data generated by Genesys' patient-information and billing system, based on the mainframe-based Envision platform from Siemens Medical Systems. At the same time, Genesys began scanning existing paper-based documents into the BlueWare Wellness Connection.

Physicians can now access patient records, and even lab results, in real-time, Holland says. "Many times, the electronic documents get into the system quicker than the physical documents get put onto the chart," he says.

The limitation is that these documents are read-only and the various systems are not linked. During the next 18 months, Genesys and BlueWare will develop those links and provide read-write access to those systems. That will include providing access to X-rays and other medical information, says BlueWare president and CEO Rose Odette. "While it's not bleeding-edge, that's still unique," Odette says.

Genesys' Holland insists these systems are paying for themselves by reducing redundant data entry while providing physicians access to information faster, though he declined to provide specific numbers. In fact, an overall lack of specific ROI statistics industrywide is why many health-care providers are stepping into this slowly. While solution providers and vendors will argue these efforts will pay for themselves in reduced costs and improved care, there's little unbiased proof of that, AC Group's Anderson notes.

"We need to see some third-party validation, not just vendors quoting things," he says. "We've got to have more studies that show the true financial benefit."