September/October 2015 Issue
Starting in 2015, Arkansas Medicare-eligible
health care providers must have an electronic
health-records system and exhibit meaningful use
of it to avoid penalties from Medicare, but many
challenges exist in total buy-in for a statewide system.
Photography courtesy of
University of Arkansas for Medical Sciences
Top photo: The University of Arkansas for Medical Sciences Medical Center won the 2015 Most Wired Award from the American Hospital Association Health Forum and the College of Healthcare Information Management Executives
Clipboards and paper charts are becoming relics in doctors’ offices and hospitals, replaced by screens, hand-held devices and electronic records that allow health care providers to keep track of patients’ care.
According to the Office of the National Coordinator for Health Information Technology, or ONC, 78.2 percent of the acute care hospitals in Arkansas had already adopted a basic electronic health-records system by 2013. An estimated 60 percent of physicians’ offices in the state were using electronic health-record systems by then as well.
The University of Arkansas for Medical Sciences Medical Center, winner of the 2015 Most Wired Award from the American Hospital Association Health Forum and the College of Healthcare Information Management Executives, implemented an integrated, electronic health information management system by Epic Systems Corp. last year at its main campus and Little Rock-area clinics.
Dr. Roxane Townsend, UAMS Medical Center’s chief executive officer, said she expects the hospital’s regional programs, still on an older system, will be converted to Epic in a couple of years. Epic allows for connecting with any other hospital or clinic that uses Epic software in the country.
“It’s been a huge step forward for our practitioners to be able to access information across the continuum of care so you have one single patient record within our entity, and it makes information sharing much better and much safer, really, for our patients and helps us with our quality efforts,” Townsend said.
Health Care Efficiency
Starting in 2015, Arkansas Medicare-eligible health care providers must demonstrate not only that they have electronic health records but also that they are using them in a meaningful way, such as by reporting certain data to state agencies, handling referrals, exchanging records with specialists and creating patient portals for prescription renewals, appointment requests and more. Doing so allows them to avoid financial penalties from Medicare, which rewards physicians who cut costs by using data analysis, and may also make them eligible for incentive money.
“I think a central issue to the new primary care population management is being able to have timely data on your patients to be able to manage them and to know where they are and what they’re doing because, more and more, we’re going to be accountable for not just the patient in front of us in the clinic but the entire population that we’re trying to manage,” said Dr. Lonnie Robinson of Regional Family Medicine in Mountain Home, recognized as an Arkansas Patient-Centered Medical Home, an Arkansas Medicaid model meant to make health care more efficient by coordinating the overall care of patients.
“Unless we can get information on what’s been happening with our patients, it’s really difficult for us to do anything meaningful to change outcomes,” Robinson said.
The Arkansas Office of Health Information Technology received $7.9 million in federal grant money and state matching funds to create what is now the State Health Alliance for Records Exchange, or SHARE. OHIT is working toward a funding model that will sustain SHARE.
Currently, more than 1.4 million secure patient records are exchanged through the network, with 32 Arkansas hospitals and 388 provider practices participating, said Janis Bartlett, OHIT policy director.
SHARE offers three levels of participation. The most basic involves the transfer of patient records via a secure, direct messaging system. The most sophisticated allows facilities to integrate electronic health records with SHARE.
“It’s been a huge step forward for our practitioners to be able to access information across the continuum of care so you have one single patient record within our entity, and it makes information sharing much better and much safer, really, for our patients and helps us with our quality efforts.”
— Roxane Townsend, chief executive officer at the University of Arkansas for Medical Sciences
Information uploaded to the health information exchange is available to other SHARE users in real time, as soon as a lab result is in or a medical visit is complete, for example.
“There are a lot of stories about people who arrive in the emergency room with their record taped to the gurney, and the person is unconscious so they’re not able to say they have a chronic health condition,” said Bartlett. “So that information is able to be retained in the health information exchange and prevents duplication of testing. In addition, by having their records available through SHARE, the patient can be confident that they do not have to keep up with their medical records by themselves. Finally, having one’s medical record in SHARE cuts down on the administrative cost of locating and maintaining the medical record — even the cost of faxing is cut down because the information is in the health information exchange.”
It also cuts down on time, said Debbie Stewart, an LPN at Cave City Nursing Home in Cave City. She uses SHARE to track lab results she used to spend hours each day pulling files to record.
Stewart has referred to electronic health records about her own care, as well. She had an MRI to check out a possibly torn meniscus during a recent doctor visit and was able to read her doctor’s report online later that afternoon.
Individuals can’t access their entire medical records through SHARE; they have to get those records from individual providers instead. SHARE’s policies require providers to give patients the opportunity to opt out of sharing their records.
Bartlett sees great value and potential in the exchange and encourages people whose providers don’t participate in SHARE to ask them to join.
Some doctors hope to join but haven’t yet been able to do so.
“I would like to see it working, but we haven’t connected with them for whatever reason,” said Robinson.
Regional Family Medicine uses the secure-messaging system of SHARE and can connect with other SHARE users in this tool, but they are awaiting full connectivity. Bartlett said SHARE’s records show that Regional Family Medicine connected to use SHARE’s secure messaging on March 15 and is in the queue to fully integrate with SHARE.
In the meantime, Robinson has turned his attention to Texas-based Lightbeam Health Solutions, which allows him to pull health information and payer information for patients assigned to his clinic.
“Just from a new era of value-based reimbursement, trying to analyze your population and manage not just the patient sitting in front of you but your entire population — and understanding who’s doing what — because if there’s a patient who belongs to you, and they’re going to the ER 58 times a year but they haven’t seen you, you can’t really intervene to say, ‘Hey, Mr. Smith, I’m your primary care doctor, and I’d like to see you rather than you going to the ER,’” Robinson said. “‘Why don’t you come see me once a month instead?’”
Ultimately, he sees benefits from both services.
“The whole transformation that’s taking place in primary care — we’re hiring care coordinators in our practice to target patients like that,” Robinson said. “In order to do that, you have to have information, which is why things like SHARE and Lightbeam would be important things for practices to have access to. We see patients for ER and hospital follow-ups; we don’t have information in our hands to be able to act on. We have access to the hospital EMRs [electronic medical records] at our clinic, but we don’t have access to other outlying hospitals, and one of the more frustrating issues for us has been that, especially our pediatric patients seen at [Arkansas Children’s Hospital], it’s really hard to get any information about specifics about their stay.”
Dan Bowles, executive director of Aledade Inc., a Maryland-based company that handles technology for primary care physicians in nine states, including Arkansas, said SHARE has been helpful for some of his clients and less so for others.
“The suburban practices outside of Little Rock have a little bit better luck with SHARE and with care coordination more broadly,” Bowles said. “The northern, more rural practices are a little more challenged in that regard. But from our perspective, we are big proponents of care coordination and kind of the primary aims that SHARE is pursuing.”
Aledade’s interface team establishes connections between its clients’ systems and SHARE, as well as with other electronic health record systems.
“It’s an access issue,” Bowles said. “We’re willing to work with any health information technology provider or any health care provider to be able to get the best care for our patients. Our northern practices, I guess, are less well-connected with local hospitals and skilled nursing facilities and other practices in the area. That’s part of the reason we’ve been in touch with SHARE and been working with SHARE. Some of those facilities are on SHARE and have indicated that they only want to do health-information exchange through SHARE because they don’t want to duplicate efforts.”
Managing The ‘Clunkiness’
For clients that need to connect to more than one system to track information about their patients, Bowles “manages the clunkiness.”
“If one practice has patients who are going to Baptist and going to UAMS that is on SHARE, we will manage the feed that’s coming in from Baptist and manage the feed that’s coming in from SHARE and present that information to the doctor on one screen,” Bowles said. “So they don’t have to click around multiple places for it.”
Like UAMS, Baptist Health uses Epic. Baptist also subscribes to Surescripts, an information system that makes connections between pharmacies, doctors’ offices, hospitals and benefit managers possible, even those using different software systems. And the hospital also signed up for SimpleSHARE, a new, modified functionality SHARE offers to hospitals that already have health-information system programs in place. With SimpleSHARE, Baptist can exchange patient information with other providers through Surescripts.
“We are participating in SHARE, just not at the full level, and that’s because we have a set of tools that accomplish the same things,” said David House, chief information officer at Baptist Health. “We’re always looking for the best way to do things for our patients and our providers and that we can do the most cost-effectively.”
Greg Wolverton, chief information officer at ARCare in Jonesboro, is a proponent of SHARE.
“There are a lot of benefits to it, at least for us, other than just the most pragmatic ones of being able to share information and pull information back,” Wolverton said. “I think there’s things like the virtual health record, which we use as a failover in case our systems are down.”
Within a few weeks, Wolverton said, SHARE will make it possible for institutions like ARCare to submit immunizations in real time to the Arkansas Department of Health instead of having nurses enter that data.
“Time is money,” Wolverton said. “If you’re pulling data out, that’s less time that they have to spend doing the paperwork of health care and more time that they get to actually spend with the people providing health care. That’s the power of SHARE. It’s pretty cool — the technology is evolving more and more every day.”
Still, he said, for SHARE to be a truly statewide system, it will have to gain the support — and participation — of parties all over the state.
“I think what it needs is more maturity in terms of more time spent in bigger bites than in taking smaller bites and spending a lot of time on them,” Wolverton said.
Bartlett does not necessarily disagree.
“We were created under an executive order by Gov. [Mike] Beebe in 2010, and by statute we became a state agency in 2011, so SHARE has been stood up in the past five years,” she said. “We feel like we’ve made remarkable progress over the last couple of years in building up the exchange and in terms of reaching out to the health care community to let them know that we’re here. That said, there are still a lot of challenges that we have yet to overcome.”