The Information Services (IS) department supports many of the strategic priorities and centralizes the management of the technical infrastructure for of the EMHS. The IS strategic plan is a piece of the overall EMHS strategic plan. Prior to 2005 the organizations that comprised the health system maintained their own technical infrastructure and applications. Since 2005, the IS department has begun to consolidate the infrastructure bringing together all of the EMHS hospitals onto the same EHR, PACS, billing, human resources, payroll, coding and abstracting applications. The top priorities for the IS department at the time of the interview were: implementing the MU Program requirements, transitioning to ICD-10, addressing the infrastructure needs to support the ACO, and merge a new hospital and home care into the EMHS.
EMHS eligible providers have attested for MU Stage 1 and are aggressively working on Stage 2. Based on interview discussions, IS leaders are finding MU Stage 2 requirements much more complete than Stage 1 and fit into the organization's interoperability platform.
For budgetary reasons, EMHS was not able to move to a single EHR application for all of the HHAs in the division until the Beacon grant. The grant provided the extra funding to bring together all of the home care and hospice agencies onto a single set of applications (McKesson).
Eastern Maine HomeCare Technology Infrastructure
TABLE J-5. EMHC Software Applications
EMHC has multiple software applications supporting their operations. Table J-5 provides a summary of the applications that support the home care and hospice operations. The EMHC division does not use the same EHR application as the EMHS hospitals and physician practices. The hospitals use the Cerner EHR application and the physician practices use GE Centricity. Cerner also has an application known as PowerChart (referenced earlier in the report). PowerChart supports organizations that have multiple entities by providing quick access and viewing of the most frequently used and/or clinically relevant information. The hospital provides access to its LTPAC partners to PowerChart to facilitate HIE at transition and during shared care.
Electronic Health Record Systems
Moving toward one EHR vendor has been a significant project for EMHC. As hospitals and home care agencies merged, each agency had their own EHR application. The Beacon Community Grant provided the financial resources to invest in a single EHR infrastructure across all home care and hospice sites. This allowed the organization to build interfaces to the hospital HIT systems, HIN and other service providers such as pharmacies and labs. The interfaces could be leveraged to connect other LTPAC organizations to EMHS and/or HIN.
As noted above, EMHC has McKesson Horizon Homecare EHR application and utilizes various clinical modules including:
- Inquiry/referral tracking;
- Face Sheet and Census;
- Comprehensive Assessment and OASIS;
- Physician Orders including Medications;
- Interdisciplinary Notes;
- User Defined Assessments;
- Clinical Decision Support; and
- Physician Orders, Medication and Treatment Records.
Eastern Maine HomeCare's Work List for Electronic Health Record, Telehealth and Health Information Exchange
The EMHS's IS department in collaboration with EMHC have identified three priority projects currently under development. The following projects, once complete, will improve EMHC's interoperability and HIE capabilities:
Interface between Phillips Telehealth and McKesson Horizon EHR: EMHC is working on an interface between Phillips telehealth and the McKesson EHR so staff can access the patient's clinical information from a single source rather than two separate systems. Currently having issues with the different segments of HL7 being transmitted between systems. Once the interface is complete, staff will have access to the telehealth data transmitted from the patient home in the EMHC EHR.
Physician Portal to McKesson Horizon HomeCare: EMHC is completing a project to set up a physician portal so physicians, medical assistants, or care managers can log into the Home Care EHR. In May 2013, this project was in the demonstration phase. Primary care clinicians will have access to telehealth data (including results and trending), other clinical data in the home care record, and perform functions like write and sign the home care POC as well as other orders.
Home Health Lab Data to HIE: The IT department is working on an interface to send home health care lab results to HIN.