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Tuesday, Mar 19, 2024
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Medical Marketplace

A federal mandate requiring hospitals to install electronic medical record systems has not only streamlined the collection of patient information, it has opened up new markets for innovation in San Diego County and created a new field in health care.

Rick LeMoine, chief medical information officer for Sharp HealthCare, said hospital EMR systems have increased the demand for highly skilled staff with expertise in computer information systems. As a result, schools are now offering training in what is being called clinical informatics.

The mass of health data also has proved a goldmine for entrepreneurs.

“The moment you become digital, it opens up huge other industries,” said Jonathan Mack, program coordinator for University of San Diego’s Hahn School of Nursing and Health Science’s graduate program.

But the nationwide launch of the EMR system has had its kinks.

New Challenges, New Opportunities

The health care industry has been slow to install EMR systems for a number of reasons, say experts. Chief among them are concerns about patient confidentiality, the costs to install the systems and resistance from staff.

However, the federal Centers for Medicare and Medicaid Services launched an initiative in 2011 called “Meaningful Use” as part of health care reform that incentivizes hospitals to install EMR systems by awarding money to organizations that meet certain requirements. In short, the mandate demands providers show that they are meaningfully using their EMR systems to improve patient care.

Once the EMR system is installed and operating, the hospital must demonstrate that it is meeting federal standards for meaningful use each year to receive an incentive and avoid penalties.

Meaningful use has galvanized hospitals to go completely paperless, creating new jobs, new challenges and new business opportunities.

New Jobs

Sharp HealthCare entered the game much earlier than most hospitals, installing its first EMR system in 1984 and going paperless in 1985. The hospital system upgraded to a Cerner Corp. EMR in 2008. Cerner is one of the top two EMR providers in the country; the other is Epic Systems. Hospital EMR systems provided by companies like Epic and Cerner allow quite a lot of customization depending on the hospital’s operations, and require in-house maintenance not provided by EMR companies.

“There’s a lot of day-to-day things with a complex system like an EMR,” Lemoine said. “There’s always reports to be run for people, fine-tuning of some of the parameters, changes people would like to see.”

Of Sharp’s 16,000 employees, 520 now work in information systems. About 70 of those jobs are in the new field of clinical informatics.

This new demand at Sharp is typical of the growing career opportunities available in health care informatics, Mack said.

“The skill level for managing the old systems was quite low, you didn’t need a coder or a programmer,” Mack said. “Now, all of a sudden, you have these complex electronic medical records and you have no staff that can manage them.”

A clinical informaticist combines knowledge of health care, hospitals and patient flow with information systems and computer science.

“These EMRs have to be integrated into the workflow,” Mack said. “That means you have to have a clinical informaticist that knows how to look at workflow and then build the screens.”

Learning to Share

Once hospitals have installed EMR systems, they face another challenge: sharing that information with each other.

San Diego Health Connect is providing a solution and nearly every hospital in the county is on board. SDHC is a nonprofit association launched from the 2010 San Diego Beacon Grant awarded from the Office of the National Coordinator The grant created a central hub that allows the electronic exchange of patient information, such as test results, imaging data, allergy information, medications and medical care summaries.

“(By using San Diego Health Connect,) if someone goes to the emergency room at UCSD and cannot communicate, the emergency department physician can instantly look at that patient’s records from Scripps, Sharp or any other San Diego-based doctor,” said Dan Chavez, executive director of SDHC. “The ED physician may then find out that the person is currently being treated for a chronic disease. This information might be critical for the ED physician to know, but unless patient records are shared between medical systems, that information may be overlooked during a precarious juncture in the delivery of care.”

Chavez said sharing medical records also prevents patients from paying for tests they’ve already completed at another health care institution. And he said San Diego Health Connect strictly adheres to the federal Health Insurance Portability and Accountability Act of 1996, also known as HIPAA, which governs the release of medical records.

A central hub for patient information opens opportunities outside of hospital systems, as well.

“With an electronic medical record for every patient, we have created a whole new industry,” Mack said. “Not just for EMRs, but for subsystems.”

These subsystems include companies developing medical devices, mobile health technology and wearable fitness gear that measures personal health metrics.

The beauty of a patient record “central hub,” Mack said, is that companies developing tools for health care can connect to one source instead of many, saving time and money. Companies can maintain or expand their reach without establishing new contracts and building new interfaces with each individual hospital system.

“The health information exchange is a unique place for startups to develop apps,” Mack said. “The gizmos that collect clinical data at home really don’t need to go to the hospital anymore; they can go to the information exchange instead.”

To date, the health information exchange in San Diego includes Kaiser Permanente, the Naval Medical Center, Rady Children’s Hospital San Diego, University of California, San Diego and Veteran’s Affairs. The exchange also has seven local hospital systems in testing, including Sharp Healthcare, Tri-City Medical Center, Palomar Health, Scripps Health, and 12 local clinics.

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