With dwindling dollars and cuts to reimbursement, more and more cardiovascular practices have integrated with hospitals to keep their doors open. Data management challenges exacerbate the arduous integration process. While some have worked to create almost seamless systems, there are often several hurdles to overcome during the process.
As initiatives under the Health IT for Economic and Clinical Health (HITECH) Act push forward, hospitals will be required to meet meaningful use requirements. And, deciding how to marry disparate health IT systems between newly integrated practices will be key.
Contract and budgetary issues rise to the top as the most challenging aspects of a merger, but piecing together how to share patient data from a practice setting with a hospital or integrated delivery network may be an even more daunting task. There is no one-size-fits-all approach. Instead, the integration team will need to devise a plan to provide accuracy and connectivity during the data transfer process.
Not just patient data
Health IT systems have become the link between patient care and quality data tracking and reporting, and the EMR allows for the transfer of patient data to clinical registries, other facilities and affiliated practices. But, with facilities able to choose from more than hundreds of health IT vendors, when hospital integration takes place, it may involve incompatible systems.
The challenge is connecting these disparate health IT systems, merging master patient indexes (MPIs) and joining clinical and financial data into one sophisticated, yet simple system, says Harry B. Rhodes, MBA, director of practice leadership at the American Health Information Management Association. And, this is no inexpensive task.
For Appleton Cardiology, a 17-physician practice that integrated with ThedaCare, which has five-hospitals and 22-physicians serving northeastern Wisconsin, merging clinical data was a seamless process, but grasping how to transfer financial data was another story, says Larry Sobal, MBA, MHA, system vice president of cardiovascular services at ThedaCare.
Appleton physicians already had worked alongside hospital staff prior to the merger, and luckily, the practice and hospital were using the same EMR system. "This made it easy to push patient data over to the hospital setting," Sobal notes. However, since Appleton had been using a stand-alone billing and documentation application, the financial data could not be transferred to the hospital.
"Currently, we are living in two separate applications and we have found it to be very difficult to recreate patient information," says Thomas Strauch, manager of cardiovascular operations and finance at ThedaCare. Consequently, employees are forced to create financial statements each month using a manual, paper-based system.
"The system is currently incapable of doing this automatically and for now, this is the only way we are able to get a complete picture of our finances," Strauch says.
After the merger, Appleton's staff had to be trained on the hospital's inpatient billing system, but now, 11 months in, there is still no single, user-friendly accounting system to aggregate data, Sobal notes.
Piece by piece, putting it together
Last year, when Michigan's Saint Joseph Mercy Health System acquired Michigan Heart, a 34-cardiologist, eight-office practice, based in Ypsilanti, Mich., the brainteaser of the deal was figuring out how to push data from the practice side to the hospital setting.
"Our major challenge was ensuring that the existing practice system was speaking the same language as the hospital's system as we attempted to share patient data," says Aaron Wootton, MBA, manager of clinical informatics at Michigan Heart. "While you don't necessarily need to buy new infrastructure for a merger, you do need to build a bridge between the two existing infrastructures."
Most importantly, all parties need access to the appropriate data, says Wootton. Therefore, Michigan Heart worked with the St. Joseph's emergency room (ER) and other hospitals within the system to ensure that the ERs had access to medical records, so staff could look up patient data as quickly and efficiently as possible.
Marty Rosenberg, MS, managing director at Navigant Health in Atlanta, says while interfacing systems may help bridge the gap between practice data and hospital data, hospital systems could pay up to $30,000 for this capability, depending on the complexity of the system needed.