The mounting economic challenges and the uncertain regulatory environment ensure that the pace of mergers in the healthcare industry will continue to accelerate, at the same time as the industry is moving into the digital age. Converting a single health care system from paper to meaningful-use certified electronic medical records (EMR) software is incredibly challenging and time consuming. However, conducting such transition while two health care entities are merging is more than twice as difficult because the potential for patient-endangering errors is very high, especially while merging non-complementary EMR systems.
Via Wall Street Journal:
Hospitals around the country are finding themselves forced to juggle the demands of moving to electronic health records, just as a wave of mergers disrupts the healthcare industry.
In the latest deal, two of New York’s biggest hospital chains, NYU Langone Medical Center and Continuum Health Partners, agreed to pursue discussions of a merger last week. The potential merger is the latest hospital marriage as healthcare systems around the country seek greater efficiency. Last year, Provena Health agreed to merge with Resurrection Health Care. Ascension Health, the nation’s largest Catholic health system, also agreed in 2011 to join with Alexian Brothers Health System. A March report from Moody’s said that the pace of hospital mergers will only quicken, as reimbursements from both Medicare and private insurers shrink.
CIOs must handle IT integration of the merged hospitals, just as they are leading a transition to electronic medical records. Around 30% of hospitals have already made the move to electronic medical records, up from just 11% in 2009, according to Dave Garets, executive director of The Advisory Board Company,a medical research firm.
The digital transition enables them to share in federal incentives. As part of President Barack Obama’s 2009 stimulus bill, the federal government offered $19 billion to hospitals and doctors who can demonstrate they are using electronic medical records to write patient histories, order medications and report quality improvements.
The Obama administration hopes that by pushing America’s health system towards electronic records it can slow rising healthcare costs by reducing duplicate tests and human error.
If the merger went through, Mark Moroses, CIO of Continuum, would work with partners at NYU Langone to meld dozens of billing, procurement and patient care systems over the next few years. At the same time he is in the process of moving the chain of hospitals, which includes Beth Israel, St. Luke’s, and Roosevelt, to digital healthcare records. That will allow the chain to claim $20 million to $30 million in government stimulus incentives over the next four years, he told CIO Journal.
Mergers can complicate the transition to electronic records. Hospitals have different technical terms, and methods of documenting care, complicating the migration of data between the two institutions. And because patient health is on the line, there is no room for error, says Moroses.
That level of accuracy requires many test runs before the real migration occurs, with doctors and nurses scrutinizing samples of the transfer to spot out potential mistakes, says Moroses.
In order to claim the government money, Continuum will need to prove that doctors are entering data from patient charts into its GE Centricity record keeping software. Nurses already enter basic information like blood pressure and medication information into wireless computers-on-wheels (or COWs as they’re called), which are brought into patient rooms.
Moroses says even his hospital’s current level of electronic medical record adoption is paying off. Electronic records are eliminating situations in which tests might have been reordered simply because paperwork didn’t transfer to another department. Patient allergy information is instantly available to doctors, because it is digital. And medications are less likely to be delivered to the wrong room or the wrong patient—-a mistake that can prove deadly. “Bad handwriting on prescriptions — I know it’s clichéd but you have a real improvement here,” Moroses said.
Over the next few months, doctors will begin entering longer patient histories, including detailed diagnoses, into the system as well. Moroses is also piloting the use of iPads with a handful of doctors. He’d like 95% of physicians across the hospital system to be using the devices over the next two years.
“The iPad is the first device with a long enough battery life,” Moroses said. “The challenge, so far, is navigating through the patient information on [the iPad’s] smaller screen.”
Moroses said Continuum is also part of a Department of Defense research project, which aims to allow the hospital to use data culled from the records to do predictive analytics. The project, which also includes John Hopkins Medical Center, will allow electronic records to produce alerts when data indicates a patient is at risk, and help researchers watch for trends on how treatments and dosage amounts affect patients.
As Continuum increases its use of electronic records, it will also have to prepare to merge its records with NYU Langone, without reversing the progress it made to secure millions in government grant money.
Moroses does not yet know what steps will go into the integration – the merger has not even been approved yet by government regulators. When it does his orders will come from the business units (“If they tell us to take a hill we’ll take a hill,” he said.)
But the experience of another major hospital chain North Shore-Long Island Jewish Health System, which took over Lenox Hill Hospital in 2010, offers clues.
To receive $8 million in government funding, North Shore chief medical information officer Michael Oppenheim is helping Lenox Hill ramp up its electronic record keeping to the level already in place at some of North Shore’s 12 other hospitals. To reach that goal Oppenheim is migrating Lenox Hill’s data to a newer version of the Allscripts medical record keeping system. (Lenox Hill currently uses an older version made by the same company, which is not on the list of systems the federal government will reimburse.)
While most data will transfer smoothly from one system to another, in some cases terminologies used by two hospitals don’t match. For example, one hospital may call an injury a “chief malady” and the other system may call it a “primary complaint,” complicating the migration.
Oppenheim plans to increase the number of Panasonic Toughbook tablets into Lenox Hill to allow doctors to enter data from patient charts directly into the system. But getting people onboard using the new tools and following a new set of protocols is the toughest part, Oppenheim said.
“You have to explain to the leadership that there is an upside,” Oppenheim said. “You want them to buy in rather than feel this is something coming from corporate. But in the end the fall back is that they don’t have an option of not going this way.”
CORRECTION: NYU Langone Medical Center and Continuum Health Partners agreed to pursue discussions of a merger last week. An earlier version of this article stated that the two hospitals had agreed to merge. Also, Mark Moroses, CIO of Continuum, will work with partners at NYU Langone should the hospitals merge. The earlier version of this article stated that Mark Moroses is already working with those partners.
“For Hospital CIOs, Mergers Complicate Move to Electronic Records,” Wall Street Journal (June 13, 2012)