One of the more innovative attempts to improve the quality and safety of patient care in hospitals revolves around the implementation of electronic health records (EHR). Numerous studies have demonstrated the efficacy of automating the EHR particularly as it relates to the reduction of medication errors, ultimately leading to adverse drug event reductions and lives saved.

Children's Hospital Colorado has led the way and has been recognized nationally for operating one of the most integrated electronic health record systems in the United States. For any hospital entrusted to care for hospitalized children, an automated EHR is fast becoming the expected standard of care.

Partnering to improve safety
In Colorado, Children's Hospital Colorado, Kaiser Permanente, Denver Health and the University of Colorado Hospital (UCH) have partnered to create the Colorado Regional Health Information Organization (CORHIO). The mission of CORHIO is to improve the safety of patient care by linking patient information from one institution to another even when they are using different computer systems.

For example, if a patient goes to Denver Health and then subsequently goes to UCH, all of the relevant patient information will be at the fingertips of the medical staff evaluating that patient. This could significantly improve their ability to quickly diagnose and treat the patient— an important step forward in improving the communications between providers and increasing the quality of care being provided.

This program, made possible through support from federal and local grants and contracts, went live through a pilot in December and supports a nationwide push to upgrade health information technology.

Program offers a major step forward
The "interfacing" of data between providers represents a major step forward, advancing the safety of hand-offs and reducing the safety risks caused by not having relevant clinical information readily available.

Patient care could be even further advanced through the capability to offer the same electronic interface to primary care physicians in the community.

The federal government has recognized this potential and is now allowing hospitals to fund up to 85% of the cost of installing and interfacing physician office systems with their own computer system. Prior to this shift in policy, the capital dollars required to automate and interface a primary care physician's office was cost-prohibitive.

We are now able to allow physicians to access patient information remotely which would make their decision-making more timely and accurate. Numerous discussions regarding this "vertical integration" are underway between hospital executives and physicians throughout Colorado to select, install and interface the physician's office systems and electronic record with the hospitals.

How Children's is working with community PCPs
Children's Hospital Colorado has participated in such discussions for over a year now with our community of primary care providers and has decided not only to provide vertical integration between their practice and our hospital but also to leap frog into a "horizontal integration" model for those physicians daring to pioneer an even more ambitious electronic health record model.

This approach creates one electronic health record that is neither hospital-centric nor physician office practice-centric. 

Rather, it is patient-centric.

This single health record follows the child from the doctor's office, to any of our locations throughout metro-Denver and to the main tertiary care campus at I-225 and Colfax. All of the child's office information, outpatient and inpatient records are stored on one single electronic health record. We will be one of the first, if not THE first, to integrate all of these components into one single record.

The advantage of such an effort to patients and their families is significant.

For example, if a drug is recalled, the identification of patients taking that medication will be difficult. Even with individual office interfaces, each practice will have to do a computer search and contact those patients themselves. With an integrated health record, Children's Hospital Colorado could run that inquiry on behalf of all those physicians in offices with one database query.

A second advantage is the ability to identify best practices. It has been well-documented that there is significant variation in treatment decisions. If we are going to reduce waste and costs as well as improve the safety and quality of care, we must be able to identify evidence-based best practices and share them.

When computer systems in MD offices and hospitals are interfaced, individual data points can be retrieved but trending comparative analysis cannot be conducted. By utilizing a single health record for the patient, we can identify practices across the region as well as correlate the interventions in the primary care office with those in the hospital. In this latter case, Children's Hospital Colorado is truly partnering with its community physicians to improve patient care.

Our strategic plan calls for the "horizontal integration" of the patient electronic health record. Those early adopter physician practices that join us on this journey will be participating in an innovative adventure that may be the makings of a national model.

And most importantly, together, we will lead the way in raising the bar for improved quality and safety of patient care.