Situation Analysis:
- The St. Louis health care market is highly competitive, with four hospital systems vying for market share and quality dominance. The metropolitan area has a large population of uninsured, Medicaid and underinsured (i.e., safety net) patients and a well-developed federally qualified health care clinic (FQHC) primary-care system.
- The safety net patients are widely dispersed throughout the metropolitan area and tend to use multiple sources of care, in particular the hospital emergency medical system, resulting in increased costs, longer stays in the emergency departments (ED) and less continuity of care for this population of patients.
- The seven hospitals and 15 clinics that serve the targeted safety net population have newly implemented and legacy health care information technology on various platforms and in different locations. The diversity of legacy systems include, but are not limited to, three instances of Cerner"s inpatient clinical systems (HIS), three instances of EPIC"s inpatient clinical system (HIS), seven instances of NexGen"s ambulatory EMR and four instances of Sage Energy ambulatory EMR.
Approach:
The St. Louis health care organizations formed an integrated health network (IHN) to collaborate on a solution that would provide a more coordinated and collaborative approach to serving the safety net population. The IHN began by developing goals and objectives to accomplish this task, then launched a demonstration project, placing health care coordinators within the EDs to identify safety net patients and educate them about health care utilization and the importance of primary and follow-up care. Next, community-based "health care coaches" were added to counsel patients and match them to primary-care locations based on where they lived or worked and their medical needs. With these resources in place, the IHN realized the need for an automated approach to consolidate medical information from their disparate systems to deliver a comprehensive longitudinal medical history for the safety-net patients. This would allow providers to better assess, plan and treat these patients regardless of where they presented. And finally, the IHN recognized that implementing secure clinical messaging would facilitate physician-to-physician interaction, as well as automate the interactions of health care coordinators, health care coaches and FQHC administrative staffs.
Solution ICA Developed for the Client:
ICA developed a phased implementation approach, first integrating existing health care technology into vaulted data with patient matching capabilities to allow the segregation of source data by participant as well as the delivery of a longitudinal health care record. This was accomplished by selecting critical feeding systems, piloting the approach and then expanding the aggregation phase throughout the community. In addition to implementing the aggregation and point of care display of a comprehensive longitudinal record, ICA is rolling out secure clinical messaging across the various EDs, FQHCs and the social infrastructure (coordinators and coaches). Customized limited views of non-clinical information were developed to accommodate the social-infrastructure messaging capabilities to ensure the appropriate assignment of primary-care sites while protecting the personal health information of the population served.
Impact of the ICA Solution:
| Previous Environment | ICA Environment |
| Incomplete health care information about safety-net patients was prolonging ED length of stay. | Comprehensive medical information at ED presentation will allow for expedited assessment and treatment of ED patients, reducing length of stay and, potentially, hospital admissions. |
| Lack of clinical history and record of ED visits was decreasing the continuity of care. | All members of the health care team and social support network will have the information they need to properly refer, treat and follow up with safety-net patients |
| Incomplete data at the point of care was causing replication of diagnostic and medication ordering. | View of all diagnostic results, medication history and treatment will reduce replications of labs, radiology exams, and medications. |
| Lack of clinical communication between the ED, primary care network and social support services was reducing quality outcomes | Secure clinical messaging on a 24/7 basis will enable providers to communicate within a unified system with the clinical information to improve continuity of care, timely follow-up and ongoing evaluation of patient conditions. |
Accomplishments to date and solution going forward:
- Technical assessments and leadership meetings have occurred on both the executive and technical levels at all institutions. Sample data, integration planning, policy and procedure development has begun.
- Technical infrastructure design was completed in January 2009.
- Obtained board approval in March 2009 for project goals and objectives, planning, and timeline.
- Technical feasibility environment "live" May 2009.
- Phase 1 roll-out of the production environment, July 2009.
