Before adopting the Novo Agent Grid, Utah’s Intermountain Healthcare (IHC), Salt Lake City, thought it was pretty technologically advanced. The statewide community-owned health care system, which features 20 operational hospitals, 120 clinics, and more than 700 directly employed physicians, was already using a standard laboratory information system (LIS), implemented across the board, and had a system in place to interface lab results in a clinical data repository, providing clinicians with access to the system the ability to view select lab orders and results.
But for a number of clinics in the system, things were moving too slowly. Paper and faxes still reigned supreme when it came to delivering lab results and physicians’ reports to the practices. For these multispecialty, multiphysician clinics, the effort was costing time and money that could be better spent elsewhere.
A few independent nonemployed, affiliated physician groups who were following the trend of automating much of their workflow to eliminate this growing clerical nightmare approached IHC with the request to find an alternative. They proposed implementing a system that would work with both IHC’s LIS and their individual EMRs to provide them with searchable, two-way information in real time, and deposit lab results and reports into patient files in the EMR instantly.
Originally, IHC planned to adopt a home-built solution that would interface out to some of the larger clinics that were most eager to establish more direct connectivity. “It was a 4- to 6-month project that used up a lot of our IT resources to develop and implement,” explains Ryan Smith, assistant vice president of e-business online services at IHC. “We quickly realized we didn’t have the ability or the resources for something like that,” he says.
One System Fits All
At a health system as complex as IHC, clinics may use as many as 15 to 20 different EMR vendors. In many cases, clinics can further tailor their EMRs by medical specialty or individual needs. The result is that two systems are rarely alike. The challenge for IHC was not only implementing a system that would link the hospital’s data flow with the clinics’ EMRs, but finding one that would do this seamlessly without forcing clinics to change from EMRs they were comfortable with.
That’s when Novo Innovations, Alpharetta, Ga, came in and presented its Novo Agent Grid solution. The Novo Agent is a community-exchange grid based on the use of software agents (essentially, software “robots”). According to the company, once installed, a software agent resides inside the hospital network, collecting, filtering, and distributing result data throughout the community, while other agents are installed at the clinics, receiving and translating information pertaining to that practice’s patients. Results can then be sent from a hospital directly to Novo and automatically deposited into the right patient’s files in the clinic’s EMR. The whole process, from when the hospital hits “send” to when the data is stored into the patient files, takes about 2 minutes. If the clinic’s EMR happens to be down at the time, Novo will store the information until the system is back up.
The system’s versatility, however, is what struck a chord with IHC. “Novo has the ability to go well beyond lab results,” Smith says. “At the time, Novo was one of the few companies who said that lab results is just one data type. The same pipeline can be used to send other types of information, like radiology text reports, discharge summaries, or any kind of hospital report,” he explains.
And for a health care network that uses more than 1,000 different kinds of reports throughout almost 20 different departments, the benefits far outweighed the apprehensions of adjusting to a new system. IHC was impressed with the flexibility and hands-off nature of the system, and decided to give it a try, sending out its first reports in October 2007.
While setting up the system in the clinics can be lengthy—installation time can take anywhere from 1 month for really motivated clinics, to more to than 8 months for clinics dragging their feet—actually setting up the transfer of data from IHC to the clinic is quick and seamless. IHC’s trained implementation team works with the clinic and relays some basic information to Novo, such as what types of tests they request and who their EMR provider is. The team then runs a lightweight IT installation in the clinic and works with Novo and IHC to go live. “It just takes a few hours from our side,” Smith says. “Then we can start sending data to them.”
The time-consuming part is adjusting to the new system, according to Smith. “Usually, what takes the clinics a long time is learning the system and having the office manager validate the data and make sure that it all matches up,” he says. An average implementation usually ends up taking about 8 weeks.
Labs experienced the easiest transition to the system. “It’s pretty transparent to the lab,” notes IHC Lab Marketing Director Scott Romney. “They’re hands off to the data as soon as the results are done and transmitted from the LIS outbound to any of our reporting systems. There is no change from the lab-management standpoint,” he notes.
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And once operational, clinics will begin noticing the increased efficiency immediately. For paper-based clinics, that can mean a substantial amount of time saved when it comes to collecting and scanning faxes and manually attaching them to patient files. For clinics using Web-based results programs, it means a lot less time copying and pasting results from online forms into files one at a time.
As might be expected, IHC is hard at work connecting additional clinics to the system. “Eighty percent of our volume comes from close to 20% of our client list,” Romney says. IHC’s goal over the next 2 years is to get operational with those 20%, namely multispecialty, multiphysician clinics.
“The more practices we can have on this, the better business it is,” Smith explains. “It’s good for the patient as well. Their data is coming quicker and more robust, and in a more interactive and actionable form.”
Stephen Noonoo is associate editor of CLP.