Health information exchange: Securing a new frontier

When an EF-5 tornado blasted through Moore, Oklahoma, in May of 2013, the local 45-bed hospital was completely destroyed. But health records for more than 2 million patients in the entire Oklahoma City area were backed up by a regional health information exchange and stored safely in a data warehouse, so they remained intact.

Dee Cantrell

"Ubiquitous access to patient data, no matter where the patient presents for care, is a critical path to make sure that safe care happens," says Emory Healthcare CIO Dee Cantrell.

For the past three years, Cantrell and her team of information architects have been implementing a health information exchange, or HIE, at Emory to provide the infrastructure and mechanism by which Emory's own electronic medical record (EeMR, pronounced "eemer") can share information with other EMRs. Over the past year, they have begun the process of "on-boarding" other EMRs in the Emory Healthcare Network (which includes private practices throughout Georgia) to this HIE. And in February, HIE readiness allowed Emory to become the first provider to join the Georgia Health Information Network, or GaHIN.

Jodi Tarpinian

Now most major provider systems in Georgia have become GaHIN members or are in queue to connect, says Cantrell, who chairs the GaHIN technology committee and who, along with her staff, has helped GaHIN enhance the on-boarding process for all providers.

GaHIN serves as a hub for Georgia providers to share patient data securely with one another and provides access to state immunization records and Medicaid claims data. "It connects health-related state agencies, service area HIEs, hospitals, clinics, physician practices, long-term care facilities, payers, labs, pharmacies, and academic health centers, and just recently, HealtheWay [a nonprofit, public-private collaborative that operationally supports the national eHealth Exchange]," says Cantrell.

Julie Marquardt

Although it has "Georgia" in its name, GaHIN is not a state agency, but rather a 501c3 nonprofit organization, and it only exchanges data, as opposed to storing it. It was created with funds channeled through Georgia's Department of Community Health from ARRA, which contained a provision to give health care providers financial incentive, starting in 2011, to implement "meaningful use" of EMR technology. Starting in 2015, penalties will be imposed on providers lacking such technology.

The evolving process of working toward "ubiquitous" access to patient care data is complex, involving IT professionals, attorneys, compliance officers, privacy officers, clinicians, and others, says Cantrell. "The idea of having information available to other providers can feel uncomfortable at first, not for the IT people necessarily, but from other perspectives. Patient confidentiality, privacy, and security aspects are the biggest issues to work through. Legal issues can be a bigger challenge than technical ones."

Team member Jodi Tarpinian is on point to manage Emory's HIE and its interactivity with GaHIN. "Because we were the first to join, we often are asked to participate in discussions about privacy policies and procedures, what to put in contracts, data-use agreements, cultural differences among different organizations, and so on," she says. "It is an iterative process and takes time to build consensus."

Another Cantrell team member, information architect Julie Marquardt, faces a different set of complex issues to work through. She is responsible for Emory HIE on-boarding of physician practices in the Emory Healthcare Network. Currently, there are more than 50 different EMRs to assimilate or replace, and the task likely will take three to four years. "When you've seen one EMR, you've seen one EMR," she says.

Some niche specialty practices, for example, have EMRs that are super content-friendly to that specialty but lack generic interoperability with other EMRs. In the final analysis, each EMR will have to be meaningful-use certified to connect to the Emory HIE.

The fact that the Centers for Medicare and Medicaid Services recently identified Georgia as one of the leading states in health information exchange is thanks in no small part to the efforts of Cantrell and her colleagues. "We were late in the game," she says, "but we learned from earlier states' mistakes and from what they did well."

New window for health for Mexicans in the Southeast

Karen Andes

The Rollins School of Public Health recently signed a partnership agreement with Atlanta's Consulate General of Mexico for Rollins faculty, staff, and students to provide consulate visitors with health education and service linkage through a program called Ventanilla de Salud (VdS), or a Window to Health.

The majority of people of Mexican origin who live in this region are under 40. Keeping this young population healthy is at the heart of the new effort.

The program has a large target audience. On average, more than 1,000 people visit the consulate each week to renew passports and other personal documents. VdS will reach additional people served by the consulate's mobile unit, which travels weekly to towns in Georgia, Alabama, and Tennessee and also serves about 1,000 people per week. The region comprises one of the largest Mexican Consulate jurisdictions in the country.

This summer, four students from public health, nursing, and the National Institute of Public Health in Mexico are doing summer practicum experiences at the consulate to provide health education and referrals for clinical services and sources for health insurance. They are working with the program director, RSPH alumna Brianna Keefe-Oates, to develop a survey to capture health data on consulate visitors.

"It's a big job," says Karen Andes, VdS director and RSPH faculty member (global health). "We want to collect data to describe this population in comparison with major health surveys in the United States and Mexico."

Results from the VdS survey will be used to compare rates for chronic conditions such as diabetes and cardiovascular disease with other Mexican populations. The survey also will help determine what proportion of Mexican nationals and their families have access to health insurance, by immigration status. As Andes notes, gathering health information on undocumented populations is difficult, in part because people come and go quickly and prefer to stay under the radar regarding their status.

VdS builds on the success of the Latino Health Summit held two years ago at Rollins. The summit was sponsored by the Hispanic Health Coalition of Georgia and marked the release of the 2012 Georgia Latino Health Report, prepared by Andes with a team of Rollins students. The report was funded by the Healthcare Georgia Foundation and documented the health status and outcomes of Georgia Hispanics based on publicly available data. In time, the health data generated by the VdS survey will help expand health reporting to other states.

Developing a proteome atlas for Alzheimer's

Allan Levey

Emory's Alzheimer's Disease Research Center (ADRC) has received a five-year, $7.2 million NIH grant to discover proteins altered by Alzheimer's, in an effort to identify new therapeutic targets.

Much research on Alzheimer's has focused on two proteins—beta-amyloid and tau—without yielding a single effective therapy. Researchers plan to identify thousands of proteins and determine which ones play central roles in disease development.

"We have developed a proteomics strategy that will allow us to discover the hundreds or thousands of protein changes that occur in the very first stages of Alzheimer's disease," says principal investigator Allan Levey, Betty Gage Holland Chair of neurology and director of Emory's ADRC. The goal, he says, is to pinpoint proteins most central to the network of changes in the brain, most likely to trigger the disease years before onset of symptoms, and most promising as new targets for preventive therapies.

Emory will lead a group including five additional ADRCs. The project is supported as part of $129.5 million in funding for Alzheimer's coming from both the NIH and industry partners. Read more.

Leading innovation in pharmacy services across Emory Healthcare

Julie Temples

In April of last year, when 13 different information and operational systems at Emory Saint Joseph's Hospital (ESJH) were synchronized with those at other Emory hospitals, all system changeovers were overseen by implementation strategy managers, or "ISMs," as they like to call themselves. For pharmacy, that ISM was Julie Temples.

Temples, assistant director of pharmaceutical services, is based at Emory University Hospital Midtown (EUHM) but supports pharmacy IT-related initiatives across Emory Healthcare. The past several years, she says, have seen major changes in pharmacy services here, with increasing reliance on standardization and enhanced technology, all with an eye toward enhancing patient safety. "We have implemented or upgraded standardized electronic systems across the enterprise for ordering, dispensing, and charting medications," she says.

Most recently, for example, Temples was one of several project leads to implement the Cerner Millennium barcode system to use in charting medications. Now, when a nurse administers a drug, he or she must first scan the patient's armband and then the medication barcode, which ensures what Temples calls the five "rights": right patient, right drug, right dose, right route, and right time. Preparing for this on the back end, she says involved barcoding thousands of drugs.

Emory Johns Creek Hospital (EJCH) was the first EHC "test-of-change" hospital to implement the Cerner system because EJCH already had experience using a barcode system. Emory Saint Joseph's, which also had a barcode system already in use, went next.

"We learned a lot from those experiences," says Temples, who says the Cerner system is now in place at EUHM, EUH, EUOSH, and Winship.

For implementing the system that allows physicians to order medications online, EJCH and ESJH in turn benefited from lessons learned at the other EHC hospitals. "We had been doing CPOE [computerized physician order entry] for five years at all our other facilities when we introduced it at EJCH and ESJH," says Temples.

"Teams were created with a physician champion and nursing and pharmacist leads to consolidate preprinted paper orders that varied from doctor to doctor into more standardized electronic order sets," she says. "Doctors can still add to or customize their own electronic orders," she adds.

While the need for standardization is obvious in a system where clinicians and patients move from facility to facility, Temples is quick to point out that standardization also requires flexibility. "The hospitals don't all provide exactly the same procedures or share the same patient population," she says. "This is all about helping our clinicians and optimizing their ability to provide safe care."

However complex, lengthy, and even painful the process of converting to an online system may be, Temples says, one thing is certain: no one would want to return to the old paper-based systems.

Temples has been at Emory since 1980, when she came here as a newly minted registered pharmacist. She reports to Amir Emamifar, EHC associate administrator, with a dotted line to Dee Cantrell, EHC chief information officer. Every day here is an adventure, she says, "especially working with so many wonderful people in different facilities and being part of continually improving services for our patients and clinicians."

WLA 2014 fellows tackle conduct, culture, and cohesion

Wright Caughman

Each year, Woodruff Leadership Academy (WLA) fellows participate in a semester-long program of monthly seminar sessions and leadership exercises. They form teams to address various issues facing the Woodruff Health Sciences Center (WHSC). These teams, which represent a variety of backgrounds, professions, and functional areas, identify opportunities to enhance WHSC's mission delivery, culture, and brand.

The three 2014 WLA project teams evaluated the efficacy of the Emory Pledge as a tool for building a positive culture, examined the concept of cultural fit and how it may benefit Emory's hiring process, and explored ways to overcome silos within WHSC to lead to a greater sense of cohesion, collaboration, and culture of pride within the organization.

Pledge efficacy—Team Oath Takers explored best practices from leading organizations that have successfully used codes of conduct to build a better culture. They then conducted focus groups and surveys of WHSC employees to see how our implementation of the Pledge compares with these benchmark institutions.

Hire hard, manage easy, better health—Team PRIME explored the concept of cultural fit, which occurs when organizational and employee goals and values match. The team reviewed Emory human resources data, literature, and industry best practices to learn if WHSC would benefit from integrating cultural fit into its hiring process.

OneEmory—Team Catalyst surveyed nearly 2,000 employees across many functional units of WHSC to determine their understanding of WHSC components, mission areas beyond their own, and institutional size and scope, in an effort to identify and overcome institutional silos.

The three teams will be presenting their projects and recommendations this fall at a series of events that are open to the entire Emory community. We'll share the dates and locations in a future issue of Health Sciences Update.

Each year's class of WLA fellows puts extraordinary time, energy, and thought into crafting meaningful final projects with real potential to advance the WHSC's tripartite mission, and this year has certainly been no exception. Congratulations to all the graduates of this highly rigorous and prestigious leadership program, past and present.

Please direct questions and comments to evphafeedback@emory.edu.

In Brief

EUH ICUs achieve zero rate for central line infections in May

Carolyn Holder

May was the third month in the current fiscal year in which central line infections in Emory University Hospital's nine ICUs have totaled zero, a remarkable achievement, considering the severity of illness of EUH ICU patients and the sheer number of "line days" they represent. "Each ICU has seven to 20 beds, and almost all these patients have a central line," says medical ICU clinical nurse specialist Carolyn Holder, who oversees the central line-associated bloodstream infection (CLABSI) committee at EUH, along with oncology clinical nurse specialist Renee Spinks.

Patients with central lines, which provide access for administration of medications and fluids, are much more vulnerable to infection than those with peripheral lines in the hand or arm because central lines are inserted directly into a major vessel. "Many ICU patients also have suppressed immune systems," says Holder.

Holder and her colleagues attribute the zero rate in part to the work of CLABSI "champions," nurses trained specifically in dressing changes and other maintenance of central lines. These nurses guide other staff in following a "maintenance bundle," or set of best practice interventions that have been shown to improve outcomes. Clinicians who insert central lines, she says, likewise follow an "insertion bundle." 

New home for Hope Clinic

Emory's Hope Clinic, the Emory Vaccine Center's epicenter of research and development of vaccines against chronic and infectious diseases from influenza to HIV, formally celebrated its move from downtown Decatur to more expansive facilities on Winn Way with an open house and ribbon cutting on June 12.

"We had grown and evolved significantly, and our prior space was no longer meeting our research and program needs," said Mark Mulligan, director. "Our new home offers a comfortable and welcoming clinic for our study volunteers and expanded facilities and lab space for our staff and translational researchers." 

Metabolic camp milestone

Next week marks the 20th year for Emory's Metabolic Camp, where adolescent girls with inherited metabolic disorders like PKU or MSUD learn to take over lifelong responsibility for managing their own diets and health. In addition to providing health education for campers, the camp serves as a forum for students, genetic counselors, and medical, nutrition, and nursing providers to meet and learn from these patients.Thirty campers are attending this year, including one from Madrid who was the first patient in Spain to be diagnosed with PKU. Two camp alumni, currently training to become metabolic dietitians, are returning to camp as volunteers. Read more.

Notable

Maha Lund has been appointed director of the medical school's physician assistant program. She comes to Emory next month from the Massachusetts College of Pharmacy and Health Sciences in Boston, where she was program director of the Department of Physician Assistant Studies. More info.

Elizabeth Downes

In September, nursing faculty member Elizabeth Downes will be inducted as a fellow in the National League for Nursing Academy of Nursing Education. In addition, nursing faculty Melissa Pinto and Tami Thomas have been accepted as fellows in the American Academy of Nursing.

Linda McCauley, dean of nursing, has been appointed to the Institute of Medicine's Membership Committee, which is responsible for planning policies and procedures for election to the IOM. Read more.

Craig McCoy, CEO of Emory Johns Creek Hospital, has been named interim CEO of Emory Saint Joseph's Hospital.

Lary Walker (neurology and Yerkes) received a 2014 MetLife Foundation award for his Alzheimer's research. Read more.

Save the date

June 20: Emory's Center for Women is inviting all female faculty and staff to a "wine down," 4-5 p.m., Cox Hall. More info.

Sept 27: Registration is now open for the Winship Win the Fight 5K. Event info.