February 2, 2010.
After three years, with more than 1,400 physician and office staff users, more than 300 physicians on disparate interoperable connected EMRs and more than 1.4 million patients in the system as of January 31, 2010, Sandlot has released a detailed case study of its first health information exchange (HIE) implementation, SandlotConnect® North Texas.
The company has since gone on to offer its uniquely patient-centric HIE solution nationwide to physician organizations, health care communities and governments.
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Case Study | SandlotConnect in North Texas
Sandlot Delivers the First Health Information Exchange to the Tarrant County Area
Sandlot, LLC is a wholly owned subsidiary of North Texas Specialty Physicians (NTSP), a 600-doctor Independent Practice Association (IPA) in Fort Worth, Texas. Sandlot provides information technology services including a health information exchange (HIE), physician portal and integrated electronic medical record (EMR) application services to NTSP physicians. The purpose of the Sandlot HIE is to create and provide physicians with access to a shared patient-centric record that includes their patient’s in-patient, reference lab, radiology imaging and ambulatory visit and encounter details.
NTSP has invested in its own enterprise HIE and interoperable ambulatory EMR applications to improve quality of care by enabling easier access to information across providers from many different systems and locations.
Background
As an IPA, NTSP manages risk contracts on behalf of its independent physician members. NTSP also provides other member services including clinical management programs and back office business services. For many years, NTSP used the coding and reimbursement information that was stored in a claims database to generate patient profile reports so the doctors could review the efficiency of their coding. It is critical to the success of NTSP and its physicians that the proper coding is done on all diagnoses and procedures in order to obtain optimum reimbursement. Obviously, this was a cumbersome process and NTSP began researching EMR systems to allow for electronic coding and also the ability to share patient information amongst the doctor community.
In 2006, NTSP’s board of directors, executive team, and physician leaders participated in a strategic planning process that determined the need for establishing a clinical health information infrastructure that would allow their physicians to continue to practice independently but function in a more integrated fashion from both a financial and clinical perspective. It became apparent that a technology investment would be required that would support the broad scale automation and sharing of their patient’s records in order to allow NTSP physicians to remain independent yet have the ability to function as a “virtual practice.” NTSP needed to automate the practices with EMR applications and ensure that patient information was accessible to all participating physicians for improved patient care.
Later in 2006, Sandlot, LLC was formed as an IT Services company by NTSP. Sandlot brought the enterprise HIE to life for NTSP and now offers all its physicians hosted Ambulatory EMR options. Since that time, Sandlot has been successful in implementing integrated EMR applications for 200 physicians, a physician portal to more than 400 physicians, and has integrated other independent practices with their own third party EMR applications into the HIE.
Solution
Sandlot developed an interoperable enterprise health information exchange (HIE) they’ve named SandlotConnect®.
SandlotConnect uses Healthvision’s Enterprise Exchange (e²) solution powered by Cloverleaf®. The e² solution provides a clinical results and clinical summary aggregation service whereby discrete data that is routed within each clinical document can be stored in a patient-centric data repository. The data from all clinical documents is parsed into a patient-centric data repository that allows for an aggregate clinical document to be built, based on custom rules, from the most recent patient data and then routed to the appropriate provider at transitions of care. Additional data sources can be provided to the patient-centric repository for inclusion in the aggregated clinical document. This Central Data Repository (CDR) approach offers Sandlot key strategic advantages over other HIE solutions.
One of the deciding factors for Sandlot’s selection of Healthvision was its CDR approach to data management. “We felt the CDR approach to data storage allowed for a much more efficient use of data especially when pulling into a consolidated view versus a federated model,” said Telly Shackelford, chief executive officer for Sandlot. “Healthvision not only supports both the CDR approach and the federated approach, but they also have the depth of experience in the healthcare industry that we needed in an interoperability partner to support our needs long term.”
This interoperability solution provides the backbone to the Sandlot HIE and allows the exchange to create the complete picture of a patient’s health record. Physicians can connect to the Sandlot HIE using one of the following methods:
- Physician Portal (provided by Healthvision’s Clinical Portal and Exchange) – for those physicians without an EMR and not ready to implement one, the portal provides a complete view into their patient’s records including both detailed and summary patient views, secure messaging and alerts that notify the physician of key clinical results or event changes on their patients, and support for both sending/receiving of clinical documents (CCD/CCR) between the portal and EMR physician office users.
- ASP-hosted EMR Applications (connected via Healthvision’s Cloverleaf Integration and Identity Services) – NextGen and Allscripts EMR applications are both offered in an ASP model and are fully interoperable with the Sandlot HIE. Results from both hospital and external facilities are consolidated into clinical documents (CCD/CCR) and are easily shared between different EMR applications and with the physician portal users.
- Physician-owned EMR (connected via Healthvision’s Cloverleaf Integration and Identity Services) – for those practices who already own an EMR application, a connected EMR option is available to provide the same results, delivery capabilities and clinical summary exchange services as the ASP-hosted EMR applications.
Results
The Sandlot Enterprise HIE is currently connected to five hospitals, two reference labs (Quest and LabCorp), 11 imaging centers, and the 600+ NTSP physicians. There are currently more than 1.4 million unique patients and a total of 1,400 enabled physician and office staff users who are connected to and access SandlotConnect to view their shared patient records.
This HIE allows physicians to make more accurate decisions quickly because they are able to view a patient’s entire medical history in one location with one simple request. Where traditionally, physicians would have to make individual requests to various health care providers visited by the patient, Sandlot aggregates this information into a consolidated view for the physician.
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About Sandlot
Sandlot is an innovative healthcare solutions company, founded by practicing physicians and focused on how technology, process and people can work together to advance the quality of healthcare. The company’s flagship offering, SandlotConnect® Health Information Exchange, is a comprehensive solution that delivers on the one elusive promise of HIEs — broad and sustained adoption by healthcare professionals. SandlotConnect reinvents HIE to make it so valuable and easy to use that it becomes essential to every practice. Sandlot team members spend as much time on the high touch aspects of HIE as on the high-tech — with strategic support to the community as it creates exchange partnerships and with hands-on training and assistance to clinicians as they join the exchange. Once the system is online, Sandlot helps manage the HIE on a day-to-day basis to keep it always on, secure, and up-to-date. Sandlot is able to quickly implement this breakthrough solution for communities, medical groups and state-wide initiatives. The company remains dedicated to ongoing adoption and utilization wherever SandlotConnect is used.
