# Presentation: 007666

## Integration, the other I-Word

*Denni McColm, CIO*
*Citizens Memorial Hospital*

## Interoperability

- Capability to exchange data with systems from different vendors.
- . . . where patient records are available electronically virtually anywhere in the world.

## Integration

- One system deployed across the continuum of care / across providers, hospitals
- One database, one EMR
- EMR that crosses care settings & providers

## Slide 4

## Integration & Interoperability

- Integrated at local or regional level
- Integrated across the continuum and/or across providers
- Integrated system interoperable using new standards

## The CMH Story

- About Citizens Memorial Hospital
- 74 Beds
- Medical/Surgical, ICU, OB, Psychiatry
- 16 Physician Clinics
- Home Care & Hospice Services
- Citizens Memorial Health Care Foundation
- 5 Long Term Care Facilities
- Residential Care
- Bolivar Family Care Center
- Central Care Cancer Center
- TCTI, Nursing School

## Project Infocare

- One EMR, patient-centered, integrated
- All visits from across continuum of care
- No paper charts in the hospital and one LTC
- 100% of admitting physicians use CPOE in hospital & LTC facilities
- EMR available in hospital, LTC facilities, CMH-owned physician clinics, independent clinics, and by remote access
- Visits in EMR from physician clinics and emergency department, implementation of full clinical documentation in process

## Consensus Around Integration

- Project Goals
- Enhance access to care
- Improve continuity of care
- Provide physician connectivity
- Gain operational efficiency
- Support facilities & services expansion
- Push quality & performance improvement

## Project Infocare Vision

- Enable a patient to enter anywhere into the continuum of care and have a personal identity that is maintained across that continuum
- Physicians and other caregivers will have access to all of that patient’s medical information within the healthcare continuum

**Notes:**
Vision statement adopted during implementation planning

## Guidelines for Acquisition

- Common system solutions will be implemented for like functions where the system can meet 70%-80% of department or facility requirements which will provide for _operational integration across the continuum of care_.

## Slide 11

## Results

- 64,860 patient records in EMR since inception in December, 2002
- Each patient has, on average, six visits in the EMR from across the continuum.
- 92% of patients seen in the past year were “known to the system” (i.e. they already had a record in the EMR)

## Value of Integration

- $$$$$
- Information Sharing
- Byproducts

## $$$$ Benefits of Integration

- $6,000,000 investment spread over multiple settings
- Software, implementation, network, devices, staff time & benefits, travel & training
- Sharing of technical expertise
- Reduction in receivables

## Information Sharing Benefits

- Always available, always current
- Coordination of care - transitions across care settings non-issue
- Information to support physicians in providing quality care

## Slide 16

## Other Benefits

- Learning curve for providers
- Scheduling where the patient is
- Staff sharing across settings
- Patient Friendly registration processes (good-bye to the medical clipboard!!)

## Lessons Learned about Integration

- Extensive planning adds value
- Needs, acquisition, implementation
- Include administrative support
- Involve building consensus
- Develop written agreements
- Variations across the continuum
- Adapt without compromising patient-centeredness
- Respect the I-Word

##  Coming . . .

- Physician Clinics Electronic Ambulatory Record (1 down, 15 to go)
- Emergency Department full clinical documentation and ordering (2 phases down, 2 to go)
- Bedside Medication Verification
- Evidence-based clinical decision support
- Patient Portal

## Integration, The other I-Word

- Provides quality & efficiency
- Promotes patient safety through information availability
- Reduces the “hassle factor” for physicians
- Plus – when the rest of the world is ready for interoperability – we’ll have a lot of data to share