Hospital IT departments prescribe portals for physicians

Virginia Commonwealth University Health System already has sophisticated electronic medical record (EMR) systems. The regional teaching hospital has been recognized in the past as one of the "most wired" healthcare institutions in the United States by Hospitals & Health Networks magazine.

Yet, like other health systems under pressure to leverage technology to improve patient care, reduce errors and lower costs, Virginia Commonwealth University (VCU) Health System has turned to a Web portal geared specifically for physicians to have the most relevant data at the patient's bedside.

"Physicians complained that the systemwide EMR wasn't as flexible as it could be at the point of care," explains Dr. Alistair Erskine, chief medical information officer of VCU Health System. "The hope is that by using portable devices with access to clinical data, physicians will see improved workflow and better access to relevant data." Physicians have generally had a rocky relationship with hospital IT departments over the years. Many claim that the applications aren't designed to match the way they work. Most hospitals have separate systems for demographic, lab and radiology data, and doctors must log in to each system separately to get at it, explains Peter Kuhn, president of portal vendor Medseek.

"It's very time-consuming. They have four or five different passwords to remember, and they have to change passwords every six weeks or so," Kuhn says. "By consolidating access to all those under one user interface, the portal solves some of that. The physician can get quick access to all that information in one screen and shave many minutes off the time it takes to get data on a patient."

That also leads to savings at the help desk, Kuhn notes, where a large percentage of the work can just be helping people with passwords. "Enlightened health systems see a portal as a way to change their relationship with the physician," says Pam Arlotto, president of Maestro Strategies, a healthcare IT consultancy in Atlanta. "They have to recognize this is a way to connect with and energize their medical staff." She says that along with that potential, however, they must realize it involves a lot of work. "It's more than just rolling out a software application," she says. "They have to do a lot of homework on the appropriate content and how it will impact work processes."

The VCU Health System implementation of a portal from PatientKeeper deals with knowledge management issues on several fronts: In finance, it promises to automate and improve the efficiency of billing for professional fees. On the clinical side, PatientKeeper's applications allow physicians to access their patients' electronic records, write prescriptions, document patient encounters and send messages to other caregivers. VCU Health System's electronic medical record from Cerner is designed to focus on the workflow that everybody in the medical center is doing, Erskine explains, and therefore caters to all kinds of workflow. "PatientKeeper is smaller in scope and can focus on the way physicians like to see information," he says. For instance, physicians can display common lab panels in the form of "fishbone" diagrams.

There's a common view that physicians are not tech friendly, but Stephen Hau, VP of marketing and business development at PatientKeeper, says that's not accurate. "They were among the first to use pagers, cell phones and PDAs," he says, "but they're selective about using the appropriate technology."

Hospitals are drawn to portals because they can have an impact on patient safety and patient satisfaction. "The doctors are happy because it saves them time," Hau adds. VCU Health System expects significant efficiency gains from the PatientKeeper charge capture system for billing. Previously, physicians would write out notes that the billing office would have to translate into codes to submit to payers. With physicians doing electronic data entry, the billing office will be able to see the information on an almost immediate basis without having to translate from physicians' notes.

"Paper had reached the end of its usefulness as a billing mechanism," Erskine says. "There should be a huge gain in the quality of billing. The accountability and reconciliation process is being improved."

The automated billing software is also being synchronized with the Cerner EMR so that if a patient is admitted with an acute symptom such as asthma, as well as several chronic illnesses such as diabetes and high blood pressure, all of the issues that the patient was treated for are updated automatically between the two programs so that the physician will be reminded to bill for treating the chronic as well as the acute conditions. "It ensures you're billing for everything you're actually doing," Erskine says.

Involving doctors in product development

Implementing a physician portal can be tricky, especially when it involves trying to convert skeptical doctors who have been reluctant to use computers in their practice.

Nancy Jones, CIO at Akron General Medical Center, believes the success of the implementation of a physician portal depends on getting doctors involved in its development early.

Physicians at the 537-bed tertiary care facility in Ohio complained about the health information system that provided access to clinical data, labs and radiology, she recalls, "so we asked them if they'd be willing to work with us on creating this portal."

To her surprise, 25 doctors volunteered to attend monthly meetings to assess progress and make changes. "We had a small group willing to play guinea pigs to help us design and tailor it to their needs," Jones says, "and get at what was most critical to them, which was patient data."

Built in 2003 using Oracle's Enterprise Edition development tools, the portal lets physicians add notes to patient charts and features such tools as McKesson's Horizon Admin-Rx, an electronic medication barcoding system that seeks to ensure that patients receive the right medication and dosage. Physicians can also access and print all forms they need through the portal. They can customize and sort the information the way they want it. A doctor can sit in a car in the parking lot and sort the data in the order of which patients he or she is going to see. "The breakthrough was in the IT people getting a good understanding of how the physicians