Tucked between large metropolitan centers on the East Coast, Berkshire Medical Center serves a population of about 130,000 people across 1,000 square miles of western Massachusetts. Clinicians there have launched a health information exchange (HIE) using dbMotionTM Solution, proving that small communities can harness big data.

At Population Health University, our recent annual user conference, we gained insights from Berkshire’s Chief Medical Information Officer Mark Snowise, MD. “In a small community like ours, if we want to progress, we had to find some way to get everyone connected and talking to each other,” he said.

Launching the Berkshire HIE

Three years ago, the hospital approached the broader healthcare community with a plan to improve data sharing. Initially the hospital hoped to align the various providers by using the same electronic health record (EHR).

The hospital-based practices and several community practices chose Allscripts TouchWorks® EHR; however, it was just one of nine EHRs deployed in the community. Building a regional HIE, powered by an EHR-agnostic solution, was the logical solution. Clinicians agreed an HIE would help improve care, and they identified specific priorities for acute and ambulatory providers.

Physician practices were looking for quick, easy access to meaningful data held in clinical notes. They recognized that understanding the thought processes of other providers across the continuum would enable better care coordination. Clinicians also want tools to enable better population health management, and to help them meet Patient-Centered Medical Home or Accountable Care Organization measures.

On the hospital side, clinicians likewise needed quick, easy access to comprehensive patient health information. But Dr. Snowise observed that it was imperative to simplify existing processes. Physicians needed a consolidated way to access the data, and they wanted to provide a consolidated way for patients to access the data. The hospitals also wanted to connect to regional and state HIEs.

Building out the dbMotion-powered HIE

Dr. Snowise was part of the team that selected the dbMotion connectivity platform after seeing a demonstration. “We loved the idea that we could get clinical notes,” he said. “We loved that we could access patient information in dbMotion from our individual EHR in patient context.”

The project officially kicked off in February 2013 and the first feeds went “live” this spring. Along the way, Berkshire had to wrestle with questions common in HIE builds:

What data should we send? At first, it seems the obvious answer is to send everything. But the Berkshire community carefully weighed its options and decided to pare it down. For example, the team chose to exclude medication lists from the hospital for various reasons, including that it is difficult for hospitals to indicate when a patient stops taking medications.

How do we meet patient consent requirements? This question is difficult in an environment where local and state HIEs have different opt-in/opt-out participation requirements.

What is the most user-friendly way to present the data? Berkshire spent time structuring the views so that the order and content was familiar to physicians.

How do we protect confidential encounters? Certain types of treatment (e.g., for substance abuse or mental health issues) require sensitivity and confidentiality. EHR vendors have different ways of blocking confidential encounters, and HIEs must be able to reconcile these approaches.

“We’re just starting our journey with an HIE,” said Dr. Snowise. “But our small community is well on the road to big data.”

5 lessons learned from Berkshire’s HIE implementation

Dr. Snowise concluded with invaluable advice for organizations about to embark on an HIE implementation:

    1. Don’t undertake major IT upgrades to existing system during implementation.
    2. Nothing is out of the box. Plan to do a lot of mapping.
    3. Usability testing is key. Get physician involvement early on.
    4. Understand limitations of system. Take into account in the build and training of providers.
    5. Maintenance is just as important as the build. It’s important to discuss ownership of ongoing HIE responsibilities.

In the end, the effort will be worth it. “What we can do now with Allscripts and dbMotion, we could never do five years ago,” said Dr. Snowise. “I believe that it will lead to improved patient care.”

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About the author

Joel Diamond, MD, serves as Chief Medical Officer for Allscripts dbMotion Solution. Previously, he held positions as Chief Medical Information Officer and Chairman of the Physician Advisory Board at UPMC/St. Margaret Memorial Hospital, where he helped achieve 100% adoption of CPOE. Dr. Diamond graduated from medical school at the State University of New York, Health Science Center at Syracuse in 1988, and completed his residency in Family Medicine at UPMC/St. Margaret Memorial Hospital in 1991. In addition to his position with Allscripts, Dr. Diamond is an active partner at Handelsman Family Practice in Pittsburgh, PA.

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