Los Angeles County’s Department of Health Services is installing a new countywide electronic health record system that officials say could end up being a model for other health care organizations across the country.
An L.A. County Civil Grand Jury report examined the initiative this summer, assessing how EHR implementation and integration of EHR systems and data among county departments could set the pace for development of a countywide health information exchange for both private and public providers.
L.A. DHS Faces Unique Challenges
Los Angeles DHS is the second largest public health system in the U.S. and serves nearly 10 million residents, according to the report. Robert Bart, CMIO of the department, said DHS includes four traditional hospital-based facilities — Harbor-UCLA Medical Center, Los Angeles County-University of Southern California Medical Center, Olive View-UCLA Medical Center and Ranchos Los Amigos National Rehabilitation Center — as well as several offsite clinics.
Data from DHS’ EHR system operating in six primary facilities cannot be shared with other providers.
“The simple task of transporting a patient from a DHS hospital to another hospital can be highly inefficient and cumbersome,” the report noted. “Paper medical records are photocopied while transport ambulances may sit idling” and, “in some instances, the receiving hospital may not have complete medical information about an incoming patient because all the paper records may not have been forwarded,” the report added.
This “silo effect” will be eliminated with the implementation of a countywide EHR system, according to the report.
Fixing a Fragmented System
DHS began work on its EHR system — called the Online Real-time Centralized Health Information Database, or ORCHID — in May 2013. The system is being created by Cerner.
By launching a “uniform, standardized and fully integrated” countywide EHR system, the agency aims to:
- Comply with requirements to attest to the meaningful use program;
- Improve patient safety and care quality;
- Make DHS more competitive in the health care industry;
- Replace the county’s “fragmented and obsolete” health record system; and
- Support outpatient care restructuring as part of health care reform.
The new EHR system also will include a master patient index, with unique identifiers for each patient, according to the report.
“The movement to an [EHR] system is important to DHS for reasons that go beyond the usual factors as to why modern medical groups are adopting [EHRs] … having one system will bring us together as a single integrated system,” DHS Director Mitchell Katz said.
The new EHR system will be “a single source of truth so that we can have a single medical record for each person that receives health care at DHS,” Bart said. “It will be a huge improvement in patient safety and we hope also in … employee satisfaction and patient satisfaction.”
So far, the first two steps of the design and building of ORCHID — a system review and system validation — have been completed. Cerner now is adding hardware, software and infrastructure to support the system. Unit system integration and user acceptance testing are expected to begin soon and wide-scale training of staff was slated to begin last month. Bart said “a large number of … physicians, nurses, therapists, admission registration staff [and other stakeholders] have been involved in the building and designing of the solution.”
He said the “go-live” dates for EHR implementation will be ongoing, with about one launch date every three months — beginning Nov. 1 with Harbor-UCLA Medical Center and a few of the comprehensive health clinics. The department already has begun initial training for staff at Harbor-UCLA and has gotten “encouraging” feedback, Bart added.
The implementation originally was set for Aug. 1. Bart said the federal government’s decision to delay ICD-10 conversions was a factor in the decision to change the timing. Bart said the delay “kind of gave [DHS] an opportunity to sort of re-examine things as well as some of the internal operations that we had.”
The county Sheriff’s Department, Probation Department and the Department of Mental Health also offer patient care and have separate EHR systems. “Currently, these departments have limited ability to share each other’s patient information electronically,” according to the report.
Bart said DHS is “working on a health information exchange to connect these medical records so that there can be appropriate movement of health information so that we can deliver care in a more effective and efficient way.”
A Model for Others
Bart said the department’s new health IT efforts are essential to keeping the county up to date in care delivery methods. “For DHS to be able to transform care delivery and transform the reimbursement for care delivery, we need to move on to this type of modern platform in order to stay current and in order to support the changes that the Affordable Care Act is asking of health care delivery in the U.S.,” he said.
Bart hopes the county’s EHR implementation project “will be a model not just for California, but also for other county, city or state government health care delivery organizations.”
“We want to be able to set an example that being able to have a modern technology infrastructure to support health care and leveraging that — both at the individual level and the level of the population we care for — will result in improved quality of care, improved efficiency of care … and improved efficiency for those who are delivering care,” Bart said.