Category: Physician Practice
June 1 2016
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Interview with Brian Sandager, chief information officer at Lowell General Hospital

In an evolving market, Lowell General Hospital, a member of Circle Health, uses information technology (IT) as a strategic asset in its partnerships with affiliated physician practices in its community of Lowell, Mass. In an affiliated practice model, integration of patient records and the corresponding improvement of patient care creates long-term alignment in a physician community. We spoke with Brian Sandager, chief information officer at Lowell General Hospital, on using an affiliated model strategy for its community and the role of interoperability in its success.

What is Circle Health’s affiliated model strategy?

The majority of our marketplace is independent practices. Of nearly 600 physicians in our community, only 54 are employed by the hospital, with around 430 that Circle Health shares risk with through joint agreements. Circle Health’s core culture as a community health system is part of what makes an affiliated model work. We are entrusted by our affiliated practices to take care of their patients in the acute space. There is a lot of choice in our market for where these practices can send their patients, so we rely on referrals and partnerships to be successful.

Increasing complexity of health care is creating challenges for small practice physicians. Circle Health can provide a unique service by managing things like billing, IT, human resources and property management. This allows practices to remain independent by leveraging the strengths of our health system. We also have a lot of affiliated practices who have joined our network and rent space in our integrated Cerner Millennium electronic health record (EHR) domain. Through our risk-based contracts, we provide EHR consulting services to help with selection, implementation and optimization so small practices can meet Meaningful Use and other quality measures associated with risk-based contracts. We want to make sure we are a good partner to these practices to make their lives a little easier so they can focus on patient care.

Can you talk more about your shared EHR domain model?

We decided to try a new strategy, adding independent physicians to our EHR domain as if they were just another doctor in the hospital. I give credit to Cerner for taking our idea and coming up with a great strategy to make it work. Like everything, there were challenges, but the journey itself has taught us a lot about the needs of our affiliated physicians. We decided to look at pediatrics and OBGYN as practices that could benefit the most from a shared EHR domain. Circle Health is one of the biggest labor and delivery hospitals in the area, and these practices have a specific need to access patient records in both the inpatient and outpatient environments. As a newborn is moved to pediatrics, we have its fetal record integrated into the system and accessible. All of the newborn’s records are available with Cerner in one integrated domain.

What is the role of interoperability in the success of Circle Health’s Affiliated Model?

Affiliated and integrated domain strategies do not replace the need for interoperability and population health strategies. When we look to where we’ve moved the meter, Circle Health has 113 physicians on the integrated domain and 45 on the Cerner Application Service Provider domain, so there are still a lot of physicians on other EHRs who we need to talk to, share data with and overall be able to manage our populations. We need to share data across the community and make sure we are putting patients at the appropriate venue of care.

How is Circle Health using CommonWell?

With CommonWell, we’re seeing the ability to move away from push technology, to pull technology. We are starting to have beneficial use cases on how we use CommonWell more effectively, with situations where fewer physicians are having to sort through data. We are using CommonWell as our core pull technology, using it as an example to get other EHR vendors to the table to work towards eliminating push technology. I really like the ability to give back time in a physician’s day. Our physician community is becoming more interested in CommonWell because we are showing them how it can make their lives easier.

What are you doing to help doctors cope with data overload with the current push technology?

In the short term, we are consolidating a lot of repetitive data that comes with push technology, combining information from multiple document sources into a concise transfer of care (TOC) document. We send a comprehensive TOC document, opposed to sending multiple documents that affiliated practices need to sort through. The long term solution is CommonWell, and we need to educate our physicians to ensure it is effective. That will take some time, but we expect to be in a good position in late 2017 to turn off our push technology.