January / February 2010

Online Connectivity

Linking Providers and Patients to Create a Community of Care

The government campaign to stimulate physician adoption of health information technology is focused on electronic health records (EHR). But other types of information technology that are considerably more affordable and less difficult to implement can also help improve safety and care quality. For example, electronic prescribing improves medication safety by providing drug interaction alerts and reducing drug dispensing errors at pharmacies (Institute of Medicine, 2006). Online transmission of hospital lab results supports clinical decision making by giving office-based physicians key information when they need it (Piva et al., 20009; Rosenbloom et al., 2004). And a secure electronic messaging system enhances communications among physicians and between doctors and patients, leading to better coordination of care (Hereford& Bell, 2003).

The best way to use these online tools is in conjunction with an EHR that automates clinical work and includes advanced decision support features. But the vast majority of physicians do not have EHRs (Hsiao et al., 2008). The good news is that online connectivity technologies that include ePrescribing can help those doctors provide higher quality care right now.  At the same time, the tools can prepare them to move to EHRs and qualify for government financial incentives.

Likewise, hospitals that use these tools will be in a good position to meet the “meaningful use” requirements being developed pursuant to the HITECH Act, which offers federal subsidies to meaningful users of qualified EHRs.  The HIT Policy Committee’s Information Exchange Workgroup has estimated that 45% of meaningful use criteria are supported by health information exchange (McGraw et al., 2009).

We represent three healthcare systems that came to these realizations in different ways. What we have all found is that physicians will use a secure, web-based Software-as-a-Service (SaaS) platform to communicate with their patients, their hospitals, and each other, to varying extents. But they have to be convinced that the technology will improve care and make their lives easier. Similarly, many patients are willing to communicate online with their providers, asking questions about their care, getting lab results, and requesting appointments, prescription refills, and referrals. But, like physicians, some patients need a nudge to try something new; therefore, together with our affiliated physicians, we have developed various techniques to market the service to patients. One of our common marketing strategies to increase enrollment is to brand the service with the names of our organizations and integrate it into our web portals.

Another shared realization is that we’re using the online communications technology to build health information exchanges (HIEs) in our communities. This has been the holy grail of health IT since President George W. Bush announced his goal of providing every American with an interconnected electronic health record in 2004. Today the government is promoting a National Health Information Network that, so far, mainly affects federal agencies (Ferris, 2008). But large-scale interconnectivity is not going to happen that way. Data sharing will occur first at the local level, and HIEs will connect with other local hubs to create larger networks. The impetus for data sharing is for local physicians, hospitals, and other service providers to create a seamless view of the patient experience.

The online service that we’re using offers a broad range of functionalities, and each of our organizations has chosen to introduce parts of the service in a different order and at a different pace. What we have implemented so far reflects our hospital systems’ individual philosophies and priorities. But in the end, we all want to connect our healthcare providers with each other and with our patients to provide the very best quality of care. What follows are descriptions of how each system has gone about deploying and using this technology to benefit our distinct needs.