• Background: Sutter is a not-for-profit network of doctors and hospitals serving more than 100 communities in Northern California.
• Challenge: Build an enterprise-wide information infrastructure to tie together business platforms and legacy systems.
• Solution: Deploy Initiate software as its Enterprise Master Person Index (EMPI).
• Results: Sophisticated management of patient identities, early error detection and minimization of future customer data fragmentation.

Sutter Health, a family of not-for-profit hospitals and physician organizations that share resources and expertise to advance health care quality. Serving more than 100 communities in Northern California, Sutter Health is a regional leader in cardiac care, cancer treatment, orthopedics, obstetrics, and newborn intensive care, and is a pioneer in advanced patient safety technology. Sutter has 26 acute care hospitals as well as physician training programs, medical research facilities, long-term care centers and region-wide home health, hospice and occupation health facilities. It has relationships with approximately 5,000 physicians, 38,000 employees and 4,300 volunteers.

Integrating Patient Medical Records in Pursuit of the EMR

Sutter has a tradition of employing advanced technologies to better serve its communities. Over the past four years, Sutter Senior Vice President and CIO John Hummel has led the integration of these technologies to help improve patient care throughout the organization’s network of affiliated hospitals and physician organizations. Mr. Hummel was the recipient of Computerworld’s 2002 “Premier 100 IT Leaders” award and was named one of InformationWeek’s 2004 “Innovators and Influencers.”

Given its organizational size and diversity, coupled with growing customer base of approximately 10 million individuals and multiple IT application platforms, Sutter leadership recognized the need for a sophisticated enterprise master person index (EMPI). One issue facing Sutter was the deployment of an EMPI, a software system critical to the healthcare industry that identifies persons in an integrated healthcare delivery system.

Consider this scenario. A patient from a Sacramento, California clinic is vacationing in Santa Cruz. While there, she breaks her foot and seeks medical attention at a hospital emergency room. The break is severe and requires surgery. Before treatment can be administered, however, the patient must provide her demographic and financial information to the hospital admitting staff since the Santa Cruz hospital cannot access Sacramento’s patient database—even though the same provider operates both hospitals. With data re-entry comes the risk of manual errors, inaccurate information being provided by the patient in a time of distress and customer satisfaction issues. Moreover, treatment is further delayed while waiting for the patient’s medical records, including previous radiology images, to be mailed, faxed, or sent by overnight courier from Sacramento. Without having these medical records at hand, the surgeon and anesthesiologist at the Santa Cruz hospital would not know pertinent information about the patient, for example, if this patient is allergic to certain types of anesthesia or medications.

It was vital to Sutter’s future growth to have a trusted, single view of its patients, no matter where in the Sutter network they may go for treatment. Sutter required an EMPI that could link its entire, vast network with accuracy and flexibility to ensure patient safety, customer satisfaction, and more efficient business operations. The solution also needed to eliminate redundancy and duplication across business platforms. Most important, Sutter needed the flexibility to integrate its EMPI with existing systems from several different vendors, as well as with future technology.

After evaluating several options, Sutter chose Initiate Systems as its EMPI provider-of-choice based on its knowledge, focus, and proven integration with diverse hospital information systems vendors. Initiate software went live at three Sutter-affiliated facilities in November 2003. Sutter also engaged Initiate to provide data assessment services, followed by remediation services, to ensure that all data would be “clean” when integrated.

Developed to work in web-based or legacy system environments, Initiate software supports both system- and facility-level requirements for managing patient identities. Its scalable, service-oriented architecture will manage hundreds of millions of patient records. The software employs a unique data model that does not require enterprise-level standardization of data, which, in turn, reduces data ownership issues that often arise. Initiate software also has a unique multi-entity capability that supports the simultaneous management of identities for different types of objects such as person (patient, next of kin, guarantor), providers and other entities.

Initiate software is currently integrated with Med Series4 (MS4), Emageon PACS system in radiology, and Park City Solutions. Initiate software will also integrate with inpatient and outpatient electronic medical record (EMR) systems as well as the Sutter Health Enterprise Warehouse (SHEW) for managing patient and provider identities. As such, Sutter Health is well on its way to overcoming the complexities of an EMPI within its geographically diverse organization and achieving a robust integrated delivery network to help ensure patient safety satisfaction. When Initiate software is deployed across the entire Sutter network, it will securely manage about 10 million patient identities.

Instead of interviewing patients for demographic information, integration with patient processing systems will enable each affiliate’s registration staff to instantly access a patient’s secure demographic record through the EMPI. This solution will minimize creation of duplicate electronic patient and guarantor records as well as eliminate duplicate physical charts for patients, which has a direct positive impact on patient safety. By providing clean data regarding all tests ordered by all Sutter-affiliated clinicians for a particular patient, the solution also eliminates duplicate tests and procedures that, if performed twice within a certain number of days, may not be paid by Medicare or some insurance providers. Having accurate and readily available customer data in this case supports Sutter’s work toward limiting health care costs today and in the future. Patient safety also is enhanced by ready access to previous data.

Sutter’s technical community has already begun to see time and cost savings. Deploying Initiate software has helped empower Sutter Health to make the following improvements to its IT infrastructure with the goal of achieving a trusted, single patient view:

• Develop standardized search for patient registration areas
• Develop standardized merge procedures for Initiate software
• Establish error tolerance rates
• Concurrently develop/educate Enterprise Reconciliation Unit
• Provide monitoring methodologies for maintaining data integrity
• Provide Process Improvement (PI) initiatives to enable Sutter Health to hold registration staff accountable

• Improved patient and provider satisfaction
• Improved clinical performance

In addition, as the success of the initial implementations of Initiate software spreads throughout the Sutter Health organization, some managers are seeing the value of extending the integration to other enterprise systems. Managers from more and more areas of the business are approaching Sutter’s project manager to discuss how their systems can benefit from integration with the Initiate solution. Some applications included in these discussions include document imaging and data warehousing.

A Recipe for RHIO Success and Improved Patient Care

Although exact measurements are not yet obtainable, Sutter is on the road to delivering even safer, more efficient patient care. As a result of the robust capabilities of the Initiate software, anticipated savings in manpower, time and dollars will be significant through enterprise-wide linking of patient records. Some of the legal and risk management issues that permeate the healthcare landscape, such as compliance with HIPAA regulations, may also be minimized thanks to the quick availability of accurate and secure patient information.

Looking to the future, Sutter Health’s CIO anticipates subsequent file additions to the Initiate software within its network of hospitals, clinics, and other facilities. This will include a module for physician records and Sutter’s Emageon PACS Center, a project that was added after Sutter Health’s leadership saw the value that Initiate could bring to additional areas of the business. Other plans involve launching a provider module. Overall, the continuing partnership between Sutter Health and Initiate Systems has proven to be good medicine for relieving the administrative pains associated with EMPI and data integration solutions.