Improving operational efficiency at East Alabama Medical CenterHIMSS Media Case Study
How an Alabama healthcare system’s interface team used an integration engine to improve workflows for everyone – including them
Every healthcare organization strives for operational efficiency to keep down costs while improving patient care. The information technology (IT) team at East Alabama Medical Center took that goal to heart. By adopting a robust integration engine, integration developers can now manage three times as many projects – with fewer people. Staff and clinician workflows also have improved so that potentially life-saving data is now more freely available in three times as many places using a new web interface.
“It is the culture of our organization to constantly seek to improve in all areas of our business,” said Sarah Gray, vice president for information technology at East Alabama, based in Opelika. “When it comes to computing systems… it helps to have an interface or integration team that cares about continuous improvement and sees a way to make it better.”
Hospital integration architects are constantly challenged to create a means for users to access records, lab results and other patient data regardless of the software used. That level of interoperability is usually time-consuming and rife with challenges, not the least of which is reconciling so many different systems so clinical staff and physicians can easily add, access and extract accurate patient data within electronic medical records (Electronic Medical Record (EMR), as defined in Defining Key Health Information Technology Terms (The National Alliance for Health Information Technology, April 28, 2008): An electronic record of health-related information on an individual that can be...).
“Being on the interface team, we’re tied into 80 to 90 percent of workflows in our organization, more so than a lot of other groups,” said Jeremy Goslin, a senior system architect who has been at East Alabama for more than a decade. “You’re also in a position to see where workflows could be improved. In the case of our Clinic EMR options and Optum Computer-Assisted Coding (CAC), it was easy to see we could do these things better as other goals aligned to push those forward.”
Finding a better way for clinics to access EMRs
East Alabama’s IT department is broken into three groups: PC technicians handle hardware; the systems team focuses on servers and network infrastructure; and the application support group is responsible for software running on a server, such as EMRs. Within the application support group is a small team of integration developers who had been using integration tools that worked well but required a steep learning curve.
“It is the culture of our organization to constantly seek to improve in all areas of our business.”Sarah Gray
Gray realized there had to be a solution better suited that could be used by both novice and seasoned developers. Through a staff recommendation, the team decided on Corepoint Health.
After a few years of using Corepoint Integration Engine, East Alabama Medical Center integrated its interface team with their web development team. That new combination sparked a solution to a problem with frequently changing clinic EMR demands. The combined team designed a web-based system, which made it easier for providers and their support people to make changes in the interfaces between the hospital EMR and their clinic EMRs without having to modify their interfaces. Corepoint’s Web services are a standardized way of integrating applications. Using open standards, businesses can communicate without in-depth knowledge of one another’s systems, beyond the communication protocol. Because all communication is XML-based, web se... technology made this possible.
“We have physicians that move around, so maybe they are on Greenway this quarter but could be on athenahealth or Allscripts the next,” Goslin explained. “They are going to look for the best thing for their office workflow.”
After three days, a new web-based query system was in place. Now, when a doctor changes EMRs, rather than continually rebuilding an entirely new interface, sifting through and/or altering code, developers can make changes on the fly by updating a web page as needed. In turn, users need only change their EMR software choice in a drop-down menu to continue receiving the exact same
results, but at a new location.
Such a transfer request used to take the team some time and logic work to create. “Now it’s just going in and adjusting settings in the website – and in near real-time,” Gray said.
East Alabama uses Cerner Millennium, and the interface team soon realized another benefit of using Corepoint Integration Engine Web Services was the ease of adding new results using this EMR platform. For instance, in early 2017 the hospital will be adding an anatomic pathology module from Cerner Millennium to its general laboratory and microbiology offerings.
This required the interface team to determine which clinics would want certain lab results. The best way to do that was to follow a similar process to querying EMRs and adding an option to the Clinic EMR Options website to receive anatomic pathology results. It only required a little logic work, but now clinicians can more easily access lab results from one place regardless of the EMR or clinic involved.
“Where it’s really useful for us is when we bring in a new doctor’s office,” Goslin said. “We can share a form and say, ‘Here’s the buffet. What do you want to help provide care for our patients?’ This is important because you’re always walking that knife’s edge of giving them the data they need versus burying them in all the data we generate.”
East Alabama’s clinical community has responded well to the new web interface. Physicians are particularly pleased that EMR changes or new interface requirements can be accomplished quickly – without waiting months for interfaces to be rewritten. And support personnel can make the changes, simply by accessing options in a website. “When physicians don’t have to wait for results, patients get more timely care. It’s really a win win,” he said. It’s also freed up hours weekly for Goslin and his developers. “Any solution that works is great. Any solution that works and you really don’t have to maintain it is even better,” he pointed out.
“When physicians don’t have to wait for results, patients get more timely care. It’s really a win-win.”Jeremy Goslin
In addition to creating more efficient ways to put critical data into physician’s hands, and more quickly share that data with patients at their discretion, the East Alabama interface team needed to prepare for a major cultural change: jumping from ICD-9 is a classification used in the medical field that stands for International Classification of Diseases, 9th revision. This classification is predominately the standard classification of diseases, injuries, and cause of death for the purpose of ... to ICD-10, which represented a fivefold increase in diagnosis and in-patient procedure codes.
“This was a very big issue at the time in healthcare in America because everyone in the country had to change from one coding system to another, and the ICD-10 system had exponentially more codes in it,” Gray said. “So we implemented Optum CAC in an effort to make that system better for our coders.”
East Alabama’s previous coding workflow system meant opening up a program, reading the documentation available in Cerner Millennium and, based on that documentation, entering codes that would then be sent to the billing system interface.
“We had a lot of heartburn when it came to the transition from ICD-9 to ICD-10,” Goslin said. The new codes were quite specific – Goslin’s favorite being W58.02, “struck by alligator” – and that additional specificity needed documentation to back up the code. Corepoint Integration Engine’s ability to work optimally in a Cerner Millennium environment again proved useful, especially when it came to sifting through a huge volume of data that doesn’t always display consistently.
“We’re a paperless hospital, so documents are very easy to generate and easy to store on a computer and access later. That means we have a plethora of documents to find and sift through inside Cerner Millennium,” Goslin explained. “Once you decide you want to put all that documentation somewhere else, you run into the problem of digging through a haystack of paperwork, looking for those golden needles of quality documentation for Optum CAC to read and pull out codes.”
Goslin pointed out that East Alabama was duplicating documents and codes. “We had problems where the patient’s last name was Hand, and we didn’t have it appropriately headed and formatted,” he said. “As such, Optum thought the patient had a problem with their hand and suggested ICD-10 codes related to hand surgery.
That is where Corepoint stepped in. ”First, the interface team built a database of all quality documents they wanted (the “needles” of valuable data for coders in the haystacks). The team worked with medical staff to curate these documents. Then Corepoint Integration Engine took those curated documents, primarily plain text or rich text formatted, stored in Cerner Millennium and pared down to the highest quality documents only.
That paring was a very long process, Goslin admitted, because there was so much documentation in Cerner Millennium. “It took the better part of a year to go through and revise,” he said. But, he added, as a result of developing those coding workflows and documentation standards, coders were better prepared for the ICD-10 transition.
“That was a workflow-ease-of-life change for the coders,” Goslin said. “Rather than struggle to retrain an entire team of people to take some time to scroll for data at the bottom, we put it at the top for them, so their workflow didn’t have to change or slow down.” Before deploying the Corepoint solution, Gray’s interface team of four managed about 70 interfaces total. Today, three full-time developers manage 170 interfaces total.
“Sit with your end-users. Discover how they actually use the system on a day-to-day basis. That’s where we find the most potential to help improve the experience.”Jeremy Goslin
Getting the job done
“We’re busy,” Goslin said. “It’s not easy, but I think it would be flat-out impossible without an interface engine as robust and capable as Corepoint.”
The early successes seen with the Clinic EMR and Optum CAC initiatives gives him and Gray hope that the East Alabama Medical Center IT teams will continue to provide a higher level of transparency, control and coding accuracy despite a project’s complexity.
“I don’t think you can ever study your workflows, best practices and user experiences enough,” Goslin said. “Sit with your end-users. Discover how they actually use the system on a day-to-day basis. That’s where we find the most potential to help improve the experience.”
Beyond Meaningful Use