support apps and connectivity. I just wish
that space would mature.” Krouse would
love to enable physicians to connect to his
apps with the device of their choosing. But
there’s more to that than making use of the
EHR easy for physicians, he says. To wit,
his second wish list item is a maturity of
natural language processing software and
technology. That software would enable
data mining of dictated and transcribed re-
ports, freeing up physicians to tell the pa-
tient story in their own version and not be
beholden to discrete data fields. “I would
like to mine data in transcribed reports
rather than telling physicians you have to
document in a certain way and put it in this
box. That is time consuming for physicians.
There is more pressure on physicians to
document more, do more and be paid less.
We want to deliver technology that makes
the process easier.”
Enabling physicians to dictate a prog-
ress note would free up their time. And if
NLP software were more mature, other
staff could use the technology to extract
key data for billing or quality reporting
purposes, Krouse says. That would support
Ohio Health’s foray into population health
management, which requires deep analyt-
ics capability to identify patients with cer-
tain disease states.
Krouse’s other wish list item is only
partly related to technology. “I would like
to deepen clinical collaboration among
caregivers and collaboration among the
workforce,” he says. Ohio Health does offer
some tools, such as Share Point, to enable
that. And better integration of applications
would help too. But the wish is deeply
rooted in culture, he says. “Caregivers have
to open themselves up to unified commu-
nication,” he says. “Ten years ago, hospitals
were hubs. Caregivers and physicians saw
each other in the hallway, the dining room
or during grand rounds. Physicians don’t
come as often to the hospital. But they are
slow to adopt technology that keeps them
well connected. To maintain that culture
of being one big family in one digital space
would require that they would open up
their cell phone numbers or their sched-
ules, or give the broader community ability
to share data with them.”
Toward the goal of fostering collabora-
tion, Krouse envisions one other piece of
technology—social networking platforms.
“We are oriented now the targeted mes-
sage,” he says. “If I have a message, I need
to know who I am sending it to. It is all
about e-mail.” Instead, Krouse wishes he
had a type of social networking tool which
would enable him to broadcast messages
pertaining to a wide audience, and let the
audience opt in when relevant. The tool
might facilitate communications with
patients sharing common disease states
or even staff. “We need to have the tool-
sets align with how the next generation of
the workforce is accustomed to working,”
he says.
Name: Tim Terrell
Title: Chief Information Officer
Organization: Cornerstone Health Care,
High Point, N. C.
Wish List Items: Interoperability,
Cloud Security
Tim Terrell’s holiday list is small, but critical to the future of Cornerstone
Health Care, a 250-physician group prac-
tice. The practice embraced the EHR in
2005, and has been running its Allscripts
system since then to good measure, the
CIO says. But the practice continues to
grow, adding new physicians and merg-
ing other groups—about one per month,
he says. Increasingly, the practices joining
Cornerstone have been on their own EHRs
and the list of vendors in play is long, in-
cluding GE, NextGen, eClinical Works and
Greenway Medical Technologies. As Ter-
rell points out, importing data from other
systems is often very difficult, and in some
cases, impossible. “Having better interop-
erability standards across the industry is
my top wish,” the CIO says. “Every EHR has
its own structure.”
The practice’s core Allscripts EHR is
driven by some standard clinical diction-
aries including LOINC for lab values and
SNOMED for certain clinical values. But
many databases in the industry are not
written to these standards, or if they are,
they are written to different versions. “The
data integration work needed is incred-
ible,” he says. “And sometimes there is no
way to join elements between two sys-
tems.” In those cases, the practice saves
some data as PDF image files, which suf-
fice to meet data maintenance regula-
tions (seven years or longer, depending
on the patient’s age). But the PDF files
lack discrete data, which will only grow
in importance as the practice moves to
population health management.
