The members of the Douglas County Individual Practice Association (DCIPA) make up nearly 98 percent of all healthcare providers in Oregon’s Douglas County. These 145 physicians serve the health needs of roughly 105,000 citizens throughout the county.

Several years ago, DCIPA leaders began developing a bold vision of how healthcare could be delivered to better serve the county’s residents, while at the same time complying with the U.S. government’s mandate for an electronic health record (EHR) and interoperable systems.

"We felt compelled to position our physicians for the future with regard to the changing landscape of health care delivery," said Brent Eichman DCIPA’s chief financial officer. "When we considered some of the industry drivers, such as EHR adoption, interoperability, quality improvement mechanisms and pay-for-performance trends, it was clear that DCIPA members needed an integrated EHR and practice management system that functioned on a community-wide basis."

Blueprint for a Nationwide Master Person Index

DCIPA chose GE Centricity Physician Office Electronic Medical Record and Practice Management solutions for enterprise-wide implementation. However, while the physicians were open to an EHR system, they told Eichman they needed more.

"Our physicians responded that the potential benefits of an EHR is great, but if they could not share information with other primary care doctors and specialists within the community, the value of a de-centralized EHR would be greatly diminished," Eichman says. "They also wanted to be able to easily access and share information at the hospital and other service arenas to enhance the continuity of care in Douglas County."

DCIPA’s leadership team responded with an aggressive strategy of building a community-wide health record network in which each of Douglas County’s 105,000 residents would have a single record that could be accessed, shared and updated by all DCIPA physicians. DCIPA named this community-wide health information network "UmpquaOneChart." Eichman said, "We wanted to make the EHR truly meaningful in terms of driving quality of care and efficiency for all of our members."

Challenge: Enterprise Data Sharing

Making the EHR meaningful for DCIPA meant finding the right EMPI vendor that was secure, reliable, and could share accurate information across the DCIPA community. "One of the most important things about UmpquaOneChart was being able to access the right information, on the right patient, at the right time at the point of care," Eichman says. "So we placed a lot of value on patient identification."

DCIPA selected Initiate software as its EMPI in mid 2006. Initiate’s solution provides independent physicians associations like DCIPA with a more cost-effective model for purchasing the same sophisticated technology that is already used extensively by larger leading healthcare providers. With Initiate, DCIPA can integrate more than 80 disparate databases on more than 30 separate server subsystems to create a single, complete and accurate patient view for each person. The result – enhanced patient safety and improved operational efficiency throughout the organization.

"We needed a way to provide the most accurate, up-to-date patient information to all of our users across all agencies. Initiate software was clearly the best choice," said Ronald R. Preston, CEO of DCIPA. "Plus, Initiate was able to immediately address all of our issues based on their experience with other healthcare organizations."

Eichman explains that the DCIPA network is structured to use Initiate software for patient identification throughout the entire enterprise. Regardless of where the patient receives care in the DCIPA community, the information is entered into the Initiate system, which uses high-level algorithms to validate the patient identity and deliver the information to the correct patient chart within the EHR.

"Initiate software goes through a robust validation process that allows us to verify the identity of each individual," Eichman says. "Once that is done, the rest of the data processing is relatively straightforward. But patient identification is a step that, if you don’t get it right, can cause a lot of problems downstream. That’s why we placed the Initiate system at the center of the network. It takes all of the data streams, identifies the patient associated with that information and gets the information into the right medical record."

"We’re getting a lot of value from the software when it comes to managing disparate data sources," Eichman says. "Initiate Identity Hub software allows us to take data sources that aren’t necessarily like our own and manage them through the Hub."

Enabling Technology for a Single EMR

"Initiate is what I would call an enabling technology for our system, and it makes EHR adoption much easier for our physicians," Eichman adds. "Now when a patient is entered into the UmpquaOneChart, all of that information is available to any other physician or provider in our network, which is about 98 percent of the providers in our county."

To DCIPA physicians, Initiate software is transparent, working behind the scenes, but they definitely see the value. The portability and on-demand access of patient information through a Web interface has resonated well with them."

"We’re getting great feedback from the physicians," Eichman says. "For example, one of the doctors went on vacation, but was able to authorize prescription refills from her laptop in the hotel room. When it comes to sharing chart notes, viewing lab results, and more, they’re finding that we are truly realizing our vision of a connected medical community. They share information in a single patient chart for a single view of the patient."

Increased patient satisfaction is another expected benefit of DCIPA’s connected community. Just as consumers are used to driving up to an ATM anywhere, even miles from their bank, and accessing their cash, they expect their healthcare providers to have similar access to their health records. "Patients want to avoid having to give the same information over and over every time they go for treatment," Eichman says. "With Initiate Systems, our physicians can have on-demand access to UmpquaOneChart and be assured of their accuracy."

Connectivity for the Future

DCIPA is making history as one of the first healthcare communities to truly achieve a connected enterprise by sharing patient data at such a broad level. In the future, DCIPA plans to expand and leverage Initiate software for patient information sharing in the community at large. The organization is considering integration with the county health department, as well as community physical and mental health centers, a cancer center, and local federally qualified health centers (FQHCs).

"Our first goal was a single, consolidated, medical chart for each patient regardless of where a physician practices medicine in Douglas County, so the obvious extension is the broader community," Eichman says. "Initiate software has fully lived up to our expectations," Eichman adds. "We’ve had a very good implementation with not one delay. The Initiate technology has delivered as promised and we are 100 percent satisfied."