AMNews: Nov. 12, 2001. Major connection: Hospital links physicians to online clinical information ... American Medical News

Major connection: Hospital links physicians to online clinical information

A small Indiana hospital is giving doctors Web-based access to hospital-based data.

By Tyler Chin, AMNews staff. Nov. 12, 2001. Additional information

Today, physicians with admitting privileges at Major Hospital in Shelbyville, Ind., can remotely access patient records stored in the hospital's information system from their home or office as long as they install certain software on their computers.

The speed of those connections is adequate for downloading text-based or alphanumeric-based data. But Major Hospital wants to expand data physicians can access to include bandwidth-hogging radiological images as well as wave patterns and other data directly from medical devices over the Internet. Physicians won't have to install any special software on their computers anymore; they will be able to access patient data from anywhere as long as they use computers equipped with browsers and Internet access.

To deliver Web-based access to clinical data while ensuring privacy and confidentiality, the 89-bed hospital owned by the city of Shelbyville, population 18,000, and county of Shelby, population 43,000, decided that it had to own an Internet service provider. So, last August, it acquired three local ISPs, merging them into a new ISP called LightBound.

"We needed to have quite a degree of control over the hardware and software to maintain the security and integrity of the system," said Tony Lennen, the CEO of the hospital, located about 20 miles southeast of Indianapolis. "We felt that the best way for us to do that was to have control over an ISP."

Like Major Hospital, hospitals nationwide are implementing or exploring giving physicians Web-based access to hospital-based clinical information. Such access is a vital component of their business strategy to recruit and retain physicians.

By winning physicians' loyalty, hospitals hope that doctors will be more likely to refer patients to them instead of their competitors, said Mitchell Morris, MD, vice president of First Consulting Group, a Long Beach, Calif.-based health care technology consulting firm.

"If I got two hospitals in town and one of them offers the service first, I can make virtual rounds," said Dr. Morris, a former gynecological cancer surgeon and chief information officer at M.D. Anderson Cancer Center in Houston. "That improves my quality of life as a doctor because I don't have to travel as much. So when a patient asks me which emergency room to go to, I'll say, 'Go to that hospital, because I'll be able to check the results on the computer at my house.' "

Keen competition for physicians is why efforts to deliver hospital-based data to them over the Internet are becoming common, said Ron Johnson, a health care information technology consultant in Danville, Calif. "Hospitals cannot exist without patients, but doctors control the patients ... so the hospital-physician relationship is key for a hospital."

Few hospitals and health systems, however, have bought an ISP to give physicians access to clinical information, Johnson said, adding that he is unaware of any hospital that has done so.

Hospitals and others in the industry have talked for years about electronically hooking up with doctors to improve care and drive efficiencies. But those efforts haven't gotten very far because of privacy, cost, the lack of technical standards, the complexity of technology, physician resistance and other hurdles.

But because the Internet is a technology that is pervasive and is based on standards, it lets organizations disseminate information more easily and less expensively than before. That is why hospitals nationwide are extremely interested in providing Web-based access to physicians, Dr. Morris said.

"My estimate would be that 5% [of hospitals] have accomplished some form of remote access to clinical information, but 5% of 6,000 hospitals is a pretty good size number," he said.

As they move in that direction, hospitals are struggling with the decision of whom to give access to, Dr. Morris said. Many have initially chosen to give access to employed physicians because it's easier to roll out those systems to them than to outside physicians.

One reason why is that the latter requires hospitals to install more complex and costlier technology to ensure that community physicians have access only to the records of patients they referred to the hospital, and then only with the patients' permission, Dr. Morris said. "It gets a little bit stickier, because then you've got to track which patients gave permission and restrict access to information just for that one patient."

Still, hospitals, especially tertiary facilities, are giving community physicians remote access to data because patients "may be miles and miles away, and you want the home doctor to be involved in the care," he said. "When something happens in the middle of the night, that's who the patient goes to see." But if outside physicians admit few patients into a hospital and aren't involved in their care there, it may not make sense to give them remote access, Dr. Morris added.

Potent marketing tool

Major Hospital wants to make its hospital information system from Medical Information Technology Inc., known as Meditech, accessible over the Internet because it believes that will give it a competitive edge.

By helping doctors, Major Hospital also is helping market itself to them and their patients.

"What I've been trying to sell our local patients on is, 'Wouldn't you rather have your doctor have access to your information at night rather than having him rely on his memory to take care of you?' " CEO Lennen said. "I don't see how it cannot help our business."

Major competes with several hospitals within a seven-county area -- including Indianapolis' largest systems -- and "anything we can [do] to improve our market capture within our individual counties means a lot to each of us," Lennen said. "One percent market share here for ... inpatient and outpatient would be worth at least $500,000, so the more we keep the better we do obviously."

The hospital also plans to make money and increase brand awareness by offering online services such as Internet access, Web site hosting and design for physicians and residential customers and businesses. The ISP gives Major a cheaper and more effective advertising platform than other forms of advertising, Lennen said.

Major also plans to use revenue from online services to residential and business customers to fund its health data access initiative. Once it demonstrates that it can do so securely, Major will offer to create such networks for other hospitals using the Meditech system in Indiana. Eventually, it plans to offer secure health network services to any hospital in the country.

"If we do this right, we could sell ISP-related services to other health care providers because we will have a proven track record," Lennen said. "This can be a multimillion-dollar business down the road."

To minimize the risk, the hospital company partnered with local telecom and energy companies to buy the ISPs. Each partner contributed $350,000 to the venture. Lennen declined to specify how much the partners paid for the ISPs, but said the cost was substantially lower than it would have been two years ago because of the steep plunge in the valuation of Internet businesses.

By buying the three ISPs, Major Hospital eliminated a potentially disastrous blow to its operations and ambitious business plan, he said. The local ISP market was ripe for a shakeout. If Major had the typical pay-as-you-go arrangement with an ISP and that ISP went out of business, its operations and business plan would have been severely disrupted. Now, Major Hospital doesn't have to worry about that happening because it is the one that controls the ISP, Lennen said.

He believes that the strategy Major Hospital adopted makes sense and would recommend it to other hospitals as well as physician groups.

But some observers don't believe that it makes sense for hospitals or physician groups to buy an ISP to fully control security and privacy. "They don't need to do that to have control over those things. Maybe that's what [Major Hospital] was thinking, but it's just not necessary," said First Consulting Group's Dr. Morris. He said it would be cheaper for providers to pay a monthly fee for Internet access, buy products from their hospital system vendors or hire consulting firms to make their system accessible over the Internet.

Strategically, however, Major's board of directors and senior executives believe they made the right move.

"We really don't know what the future will hold, but this positions us for some of the things people are talking about down the road," said Doug Carter, MD, an internist in a three-doctor group in Shelbyville and the only physician on the hospitals' board of directors.

The hospital's ultimate goal is to make records accessible over the Internet to patients, Lennen added. "Every survey I've seen says that patients want their records to be distributed [electronically], but they are very nervous of the security aspect. We felt we had to have control of that to invoke that strategy [later]."

While physicians are taking a wait-and-see attitude toward patient access, they don't have any qualms about getting Web-based access to those records themselves.

"It's marvelous," said Chris Loman, MD, a family physician at a five-doctor group in Shelbyville. "It basically gives me the ability to get more [quality] information than I already acquire but differently, faster and from more locations. I'll be able to download not just reports or x-rays but also get the image. If someone at the unit calls me and says, 'We have a funny rhythm,' I'll be able to look at that rhythm as they are looking at it."

ADDITIONAL INFORMATION:

Web snapshot

About 97% of physician and provider organizations in a recent survey said they had a Web site and that their use of the site was growing in all the following functions.

Patient scheduling
Using in 2001: 8%
Plan to begin using in 2003: 42%

Communication with physicians
Using in 2001: 19%
Plan to begin using in 2003: 40%

Patient health assessment tools
Using in 2001: 20%
Plan to begin using in 2003: 33%

Patient access to medical records
Using in 2001: 2%
Plan to begin using in 2003: 29%

Purchasing of supplies
Using in 2001: 11%
Plan to begin using in 2003: 26%

Managed care transactions
Using in 2001: 11%
Plan to begin using in 2003: 21%

Source: 12th Annual HIMSS Leadership Survey sponsored by Superior Consultant Co. and Dell Computer Corp.

At a glance

Name: Major Hospital
Location: Shelbyville, Ind. (outside Indianapolis)
Licensed beds: 89
Number of physicians: 115
Annual inpatient visits: 3,000
Annual emergency department visits: 17,000
Annual outpatient visits: 70,000
Annual revenue: $50 million
Main business lines: Hospital, home care, occupational medicine, durable medical equipment company, retail pharmacy, nursing home pharmacy and physical therapy clinic
Additional business line: Owner of LightBound, an Internet service provider

Source: Major Hospital

Weblink

Major Hospital, Shelbyville, Ind. (http://www.majorhospital.com/)

LightBound, Major Hospital-owned ISP (http://www.lightbound.com/)

TECHNOLOGY