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- A new remotely hosted technology released by GE Healthcare
will get its first test at a Texas hospital, and some rural Wisconsin healthcare facilities also are looking to make the transition to digital records with a hosted model.
GE's new remote hosting product, Centricity Enterprise Remote Services (CERS), is designed to enable comprehensive medical record interoperability, and do so more affordably. The integration and deployment of CERS will be put to the test in January 2007, when its first customer, the Heart Hospital Baylor Plano, opens its doors.
GE Healthcare executives are enthusiastic about remote hosting, and although it is still too early to estimate how many mid-sized Wisconsin hospitals will purchase CERS or equivalent remote services, the Rural Wisconsin Health Cooperative
's director of IT, Louis Wenzlow, shares their excitement. "In terms of remote-hosted ASP models, I think this may be the future for many smaller hospitals," he said.The EHR transition
For many businesses, the application service provider or ASP model is a more cost effective way of delivering the benefits of licensed software, without the complexity of hosting and the steep investments associated with it. Typically, the ASP assumes responsibility for technical support and server maintenance.
GE's hosted product is marketed as a tool to help mid-sized institutions adopt integrated electronic health records (EHRs). The CERS product will provide existing GE system capabilities on a remotely hosted ASP subscription basis, allowing hospitals to avoid the costs of installing and upgrading hardware and software.
"Remote hosting puts sophisticated health information technology within reach of many more hospitals, not just academic medical centers and large integrated delivery networks," said David Henriksen, vice president and general manager of GE Healthcare. "Integrated software solutions could yield significant benefits in terms of both efficiency and quality of care, but until now mid-sized organizations simply didn't have the resources to implement or maintain such a robust system."
The GE service offers a variety of functions to client institutions, including computerized order processing, nursing and physician documentation, electronic medication administration records (MAR), and patient management. These functions could conceivably facilitate hospital operations in numerous institutions. However, providers often must grapple with more fundamental considerations before purchasing a product like CERS.
"The success of the product is not so much its features and functionality but, by and large, it really comes down to the price and, for the clinical staff, its all about deployment," said Dr. Barry Chaiken, associate chief medical officer at BearingPoint, Inc.
, a business systems integration and management consulting company headquartered in McLean, Virginia.
"If you have a great system deployed poorly, it's a disaster," Chaiken said. "I don't care how perfect [the application] is."Long way to go
CERS also is oriented around the wider goal of increasing digital collaboration of patient medical information across communities of care providers. This objective was nationalized in April 2004, when President Bush called for all Americans to be covered by interoperable electronic health records (EHRs) within 10 years.
Today, the country is still a long way from achieving that initiative. "We have a lot to do, a lot of issues to address, and a lot of negotiations to complete," Chaiken said.
Although people have "made yeoman efforts to move this along," Chaiken said, the remaining tasks are formidable. They include harmonizing product standards and data fields for applications like CERS, building functional regional health information organizations (RHIOs) capable of exchanging patient information across regions, resolving the conflict between distributed and centralized EHR models, and overcoming the political impasse posed by states with disparate privacy laws.
Another fundamental snag is the financial incentive for physicians.
Ravi Kalla, CEO of Symphony Corp
., a Madison-based customer software developer, believes the full adoption of EHRs is 15 to 20 years away, in part because nobody can answer the question: How will physicians benefit from such a change?
"And that's because most of the cost savings from patient-centric care will come from the provider side," said Kalla, a member of Gov. Doyle's e-Healthcare Quality and Patient Safety Board.
For many physicians considering implementing EMR systems, the cost savings accrue almost solely to their payers, employers, and patients, despite the fact that they, themselves, are enduring financial strains.
"Physicians are paying their nurses and administrative staffs more, plus their rents are going up, their utilities are going up, gas is going up, but reimbursement is going down," Chaiken said. "And it is important to remember that many physicians' offices are small businesses, just like any other small business."Rural assurance
Many of those small businesses are member hospitals of the Rural Wisconsin Health Cooperative, which has worked to develop a coordinated system of rural healthcare among freestanding entities. They are primarily critical access hospitals, meaning they have 25 beds or less, but the need for coordinated healthcare extends beyond large city hospitals.
Their idea of data integration will most likely be one hosted by the collaborative of participants rather than the vendor. "We are in the middle of a vendor selection process," Wenzlow said, "for an integrated hospital system that would be shared from a single data center by multiple participants."
No matter what model is used, he noted, the goal is to achieve benefits of remotely hosted applications, including robust clinical data exchange at a reduced cost.
Wenzlow noted that the RWHC is not breaking new ground. Other independent hospital collaboratives use this model, including Inland Northwest Health Services
in Spokane, Wash., SISU Medical Systems
in Duluth, Minn., and Kalispell Regional Medical Center
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