Giving the Doctors Options: Our Clinical Messaging Solution

By Tony Farley and Steve Slutzky, St. Elizabeth Medical Center, Covington, Kentucky

Can hospitals move forward in providing their physicians with Web-based services, in a win-win proposition for all the stakeholders involved? At St. Elizabeth Medical Center in Covington, Kentucky, we absolutely believe that's possible and have put it to work. Our greatest achievement has been to provide our doctors with clinical messaging services that benefit all involved parties.

We believe that by offering our physicians certain kinds of IT-enabled capabilities, we can set ourselves apart from local competitors and enhance physician loyalty, always a desired outcome in a competitive healthcare marketplace. In fact, ours is a rather unique local market, one in which setting ourselves apart means really going an extra mile or two. Our medical center is a member of a secure, private-information network that offers member hospitals a number of services. Unlike CHINs (Community Health Information Networks) that were established in the early and mid 1990s, this network, called HealthBridge, did not fall apart. HealthBridge has been very successful in offering and implementing a number of collaborative data and technology benefits to its member hospitals in the metro Cincinnati and Northern Kentucky region for over a decade—using standard Web tools.

In our case, we decided three years ago to utilize some of these capabilities to benefit all the hospitals in our CHIN as well as our staff physicians. What we proposed to do was give our doctors Web-based applications so they could access critical patient information from their homes and offices. Our three-facility hospital system—in Covington, Edgewood, and Williamstown, Kentucky, serves a population of nearly 400,000, and our physicians, like others around the country, are finding more and more reasons to want access to laboratory, radiology and other results from a variety of locations in the area.

What we had had in place previously was a system that allowed physicians and hospital staff to "pull" from their own facility's system—it had no "push" capabilities. In addition, our laboratory and radiology systems weren't integrated. As a result, a physician could get a chest x-ray result from 10 years ago, but not a lab test result from two weeks ago.

Moving to eliminate such inconsistencies in our systems, and to enhance physicians' ability to deliver timely, effective patient care, by early 2000 we installed our current clinical messaging system (from Tampa-based Axolotl Corporation), which is offered to our affiliated physicians through HealthBridge. Following are highlights of its component capabilities:

• Clinical messaging. Our physicians can automatically receive their laboratory (including all subspecialty labs), radiology and transcribed reports electronically through the clinical messaging system. It's easy to use, and sends real-time clinical information to physicians and their staffs.
  
  
• The electronic in-box allows physicians and their staffs to receive and manage results on-line from their office, home or physician lounge using any secure Web browser.
  
  
• HealthBridge will store the results for three years, providing an electronic record of results. Physicians can easily import the results into their existing EMR or build one with Axolotl's other solutions.
  
  
• Chart completion. We are able to provide an alternate means for completing chart deficiencies to our affiliated physicians. This function allows physicians to complete their chart deficiencies from their office or home.
  
  
• Eliminated printing and distribution of paper based reports saving us staff time and printing /mailing costs
  
  
• The high-speed HealthBridge network is completely secure and HIPAA-compliant.

In creating these capabilities for our physicians, we knew that a key element of success would be physician buy-in. As a result, we began by picking a handful of physicians who were technology-positive and engaging them in building our beta program. After completing the testing and validation, in March 2000 we held a dinner for our physicians and provided them with a demonstration. We were already live at that point, and all that was required for physicians was to sign up for the full program; at that point, their "clinical in-boxes" became active and they began receiving their laboratory and radiology results and medical transcription electronically. Over 50 physician groups, representing over 250 active staff physicians, are now using the system.

The physicians using the system have expressed very strong satisfaction with it, and are delighted by the speed, efficiency and ease of use. The only real challenge has been convincing physicians and physician groups to sign up for high-speed Internet connections in their practices in order to make the best use of the system, and to upgrade to good PCs. Many of our physicians, like doctors nationwide, didn't even have a currently capable PC in their offices (meaning Pentium 1 or better). In the current environment of reduced reimbursements and higher malpractice insurance costs, such situations will remain the rule nationwide, physicians loath to spend their own funds to buy good, basic personal computing equipment.

In any case, we know we're making headway in important ways. Building this system has taken us out of the paper-pushing business, as well as out of the morass of phone calling that most physician offices and hospitals have to deal with to chase down lab results. Physician, physician staff, hospital staff, and patient satisfaction are all improved; results are available immediately from any secure browser - no more lost results.

So, what have we learned through all this? One key lesson is that it's important not to make an initiative like this solely an IS department project; instead, it's crucial to get your organization's clinical leaders together and develop a team approach, with stated organizational goals and objectives. As we mentioned, one of our goals was to differentiate our medical center from others in our market; and by creating this system, we have achieved that goal. Also, it's important to choose a partner (vendor) whose product is flexible and is willing to work with your organization to create a solution that works for you. We were fortunate in that, as well. Finally, you need to take something of a marketing approach to this kind of initiative, looking at your physicians as customers, and evaluating how you can improve customer satisfaction in that regard. And finally you need to develop a good training program and ongoing support for your system.

We are extremely pleased with our venture into electronic communication and delivery of results, and we believe that our success is widely replicable, given the right strategies, planning and execution. In the end, the satisfaction of all the stakeholders with the implementation will provide a litmus test for success. We're fortunate to say our litmus test has gone well.

Tony Farley is the Director of Information Systems and Steve Slutzky is the Physician Services Representative for St. Elizabeth's Medical Center.