A vision of the future in Baltimore

Information exchange between U.S. hospitals and community physicians is still fairly primitive. Except in a few forward-looking health systems, only employed physicians have access to "enterprise" information systems that encompass inpatient and outpatient care. Most other physicians who have any online access to hospital data have to log into web portals—sometimes shared by multiple institutions—to view the information in their offices, and hospital-based doctors have little online access to outpatient records.

So it's surprising that a continuing care retirement community—comprising independent living, assisted living, long-term care and rehab facilities—has taken the lead in establishing interoperability with a non-related-hospital. Erickson Retirement Communities, which runs 18 CCRCs across the country, has interfaced the GE Centricity EHR at its Charlestown facility in suburban Baltimore with the Meditech EHR at nearby St. Agnes Hospital.

The HL7 interface allows hospital and ER physicians to view problem, med, and allergy lists, advance directives, and some lab results extracted from Erickson's EHR in real time. They can access this outpatient summary by clicking on a tab in Meditech. Charlestown's five full-time physicians receive discharge summaries, as well as hospital medication and allergy lists that go right into their charts for use when the patient comes in for a followup visit. They also have remote access to their ambulatory EHR in the hospital.

"Physicians can only make decisions as good as the information they have," Matthew Narrett, executive vice president and chief medical officer of Erickson, says. "So it's essential to give them more information, which results in better decisions. Better decisions should lead to better outcomes, as well as cost savings with the reduction of redundant testing."

There are also benefits to checking on a patient's medications when they're admitted and after they're discharged, he notes. According to CMS, he says, "25 percent of seniors have adverse drug events following hospitalization. Some of that's due to new medications and reactions to them. But some of it's due to drug-drug interactions."

Erickson, which has facilities in Colorado, Illinois, Maryland, Masachusetts, Michigan, New Jersey, Pennsylvania, Texas, and Virginia, is pursuing similar arrangements with other hospitals that care for some of its 20,000 residents. For example, Narrett says, Erickson is developing a link between its retirement community in Overland Park, KS, and Saint Luke's Health System in Kansas City.

All of Erickson's facilities use the Centricity EHR. So the limiting factors are whether hospitals have EHRs and whether they're willing to help pay for an interface with Centricity. The new HL7 Continuity of Care Document (CCD), which both inpatient and outpatient software vendors may start to adopt next year, would give a big boost to Erickson's interoperability plans, Narrett says.