Ten years ago, Citizens Memorial Healthcare began looking into EMR implementation, and eventually deployed a Meditech system and was paperless by 2003. By 2009, the rural Southwest Missouri network, which includes a 76-bed hospital, five long-term care facilities, 25 physician practices, a home care agency and community physicians, had achieved Stage 6 of the HIMSS Analytics EMR Adoption Model. Then, the network took aim at Stage 7, which requires bi-directional exchange of health information.

Denni McColm, CIO of Citizens Memorial Healthcare, in Bolivar, Mo., recently spoke with CMIO about interoperability, Stage 7 and beyond.

CMIO: What did you need to do to attain HIMSS Stage 7?
[HIMSS Analytics] validated us at Stage 6, and told us that there were four requirements to achieve Stage 7: to be paperless, to provide an EMR that crosses the continuum of care from the emergency room to inpatient—and we were way beyond that, to use data to improve care and outcomes ... and interoperability. We were not achieving interoperability because there was no one to interoperate with in southwest Missouri.

We talked with Iatric Systems, and they were looking at a Google Health integration project—PHRConnect—to meet the interoperability requirement. Just like in meaningful use, interoperability doesn’t have to be with a RHIO or an HIE; it can be with a patient’s personal health record [PHR], as long as it is a standards-based exchange. We began working with Iatric and Google Health [to eventually get] a bi-directional exchange: We can pull data from a Google Health record into our EMR as well.

We were Stage 7-certified two weeks after implementing the interoperability project.

CMIO: How does it work?
Google Health is a PHR that [allows patients to] input data and gather data from multiple sources, and then put it to work. The patient can sign up, can track med history, import from various sources: health insurance companies, pharmacies, you can pull data that’s sitting out there into your health record on an automatic bases.

We have a portal where we transact business with patients. That is different from Google Health, which is a place where patients can pull their data together in one place. It’s their health net worth all in one place.

Our integration partner, Iatric, connects between our Meditech EHR system and GoogleHeahth. CCR is the format Google Health requires. Therefore, Iatric takes data out of our system, format [them] in CCR and send [them] to Google Health. They also provide us with a mechanism for signing the patient up and validating patient identity. On the bi-directional side, Iatric makes requests to Google Health and pull the data back from Google Health in CCR, and import into readable format so we can input it into our system.

CMIO: One of the arguments against PHR/EMR integration is that patients won’t use it. What has patient reception been like?
We have been in Wired six or eight times. We got the HIMSS Davies Award, we’ve got Stage 6 and 7 [EMR adoption]. We thought all of those things were very cool and when we publicized those, maybe we would get the second page of the newspaper. However, when we announced we did this Google Health integration, both of the TV stations in Springfield, Mo., the biggest market near us, came running down to do the story. The reception was unbelievable; 300 people signed up immediately.

CMIO: Has PHR/EMR integration yielded results?
One of the interesting things we thought was true [was] that we were treating the same patients. [Before the EMR,] patients had records in all 32 locations. There was no way to pull that data together. Now, we are finding that every day, 95 percent of the patients who show up at the hospital, we have some record of them. We know some aspects of their history.

CMIO: What are your plans for this integration in the future?
We are planning to use Google Health to meet some of the [meaningful use] requirements, including interoperability [and] keeping track of the date range for getting patients a copy of their medical record in a timely manner.

We also have started doing patient tracking across the continuum of care and looking at patient outcomes; taking patients’ functional assessments and abilities before they come into the hospital, and tracking that through, even through their outpatient stay. It’s helped us find gaps where patients might not get all the services they need.