MEDNET

As the largest integrated health care provider in southeastern Virginia and northeastern North Carolina, Sentara Healthcare already had a network solution from Cox Communications that provided voice and data to more than 120 hospital, clinic and member physician locations when officials decided to get even more ambitious.

The result was MedNet, a private IP-based network designed to be securely accessed by not only Sentara's member physicians and facilities, but also other health care providers in the area to establish a single electronic medical record (EMR) system for patients. Working with Cox, Sentara is establishing itself as an application service provider (ASP), selling individual physicians or clinics monthly subscriptions that enable them to manage patient records and the work flow of their offices via MedNet, providing better quality treatment in the process.

The subscriptions are sold at cost — Sentara is a not-for-profit organization — and the idea is to improve the quality and efficiency of health care by enabling every doctor who sees and treats a patient to not only know that patient's full medical history, but to interact with the record to keep it up-to-date.

“Today, doctors that are not affiliated with Sentara can use an ISP to access a product that we call CareVision, and that portal gives them a limited view of results,” said Betsy Meadows, director of enterprise network services for Sentara.

Doctors can log onto an MD Office portal that Sentara provides and get limited access to test results, discharge summaries, transfer reports and medical images through Sentara's PCAS system, said Elise Spoto, director of physician practice solutions for the company. “But what they see is limited and, for the most part, the EMR is view-only,” Spoto said.

MedNet will enable an EMR to seamlessly move with the patient as they go to different hospitals, clinics or doctors' offices, Meadows said. The primary benefits are for the patient, as doctors can easily see and take into account all existing medical conditions, prescriptions, allergies, etc., Spoto said. This view would include emergency room doctors who may see a patient that is not conscious or is unable to respond, she added.

“The purpose of the solution was to facilitate extension of the technology out to physician practices,” Spoto said. “MedNet doesn't provide value to the hospital. What MedNet will allow us to do in this community is provide a longitudinal patient record. In the big picture, my doctor who treats me in the office and who comes to the hospital has that longitudinal view.”

Doctors can benefit, as well, by gaining access to technology through the ASP model, which is economical and easier to deploy than acquiring the servers, software and IT support that would be required to do this on one's own, Spoto said. Using the EMR to manage office workflow and patient record-keeping can save doctors money and enable them to operate more efficiently.

Sentara began planning MedNet more than two years ago and reached out to Cox, which has been Sentara's voice and data services provider. The two companies have worked in a lab environment to bring together a secure OC-192 backbone network from Cox with Sentara's EPIC EMR system to create the application service Sentara can then sell to non-affiliated physicians and clinics. EPIC is a private vendor of EMRs, in competition with other players such as General Electric.

“We designed the concept, and we went to Cox about two and a half years ago and asked them if they would be willing to work on the idea and develop the program with us,” Meadows said. “We had two objectives: use their facilities for the extension of technology as efficiently as possible and also find a better solution to the cost of extending it to the physician practice. The cost needed to be reasonable to the practice and a fair market value, as well as the most efficient way.”

From the Cox standpoint, its focus on regional networks fits well into serving regional health care authorities, and health care is a critical customer segment for Cox, said Mike Braham, a regional vice president for the company. Cox is able to leverage its fiber backbone to provide permissions-based access to the secure private IP network via any Internet access point, but the company can also upsell doctors' offices to either hybrid fiber/coax (HFC) or all-fiber access facilities, Braham said. Increasingly, doctors are looking to fiber connections at work and are using HFC connections at home to access records and images as well, he said.

The longer-term goal is to use MedNet to link a broad variety of players.

“Cox's MedNet would link in health care providers, hospitals, insurance companies, pharmacies, telemedicine and distance learning — the whole continuum — that would all be able to have a way to pull all of those resources together, to fully exchange this information over this dedicated network and have HIPPA-compliant exchanges of information,” Braham said.

Security and compliance with HIPPA — the Health Insurance Portability and Accountability Act, the federal standard for patient privacy — are critical aspects of MedNet, Meadows said. While the system was set up to facilitate connections with insurance companies — Sentara has its own insurance company as one default player — that part of MedNet isn't being implemented today.

Sentara began its efforts well before the current Obama administration push to improve health care IT and create electronic patient records. But the doctors who participate in MedNet may be able to take advantage of the stimulus money — up to $44,000 per doctor or facility — that will be offered through Medicare payments, Spoto said. It is a complex process, and physicians must show “meaningful use” of a certified EMR system, such as EPIC, to get reimbursed based on a percentage of their Medicare billing starting in 2011. As a “back-end” payment system, the program requires physicians to pay upfront and be reimbursed later.

Sentara has been offering this kind of service to its affiliates since 2007 and expects to bring on the first non-affiliated offices beginning in 2010, Meadows said. The health care provider is able to subsidize the program under a different federal initiative that began in 2006. But that subsidy ends in 2013, and the program needs to be self-supporting by then, with participants paying the monthly ASP fee that covers the cost of the service.

Spotto expects the primary challenges to be on the far end of MedNet's reach, in the doctor's offices, where each office is in charge of its own computers and technology. “Many of these are small practices, and they may be using Cousin Vinnie as their tech support,” she said.

“We expect our challenges to be more application challenges than anything else,” Meadows said.

Cox's involvement in telemedicine is only going to grow, Braham said. He views MedNet as one stake in the ground for what will be a booming industry that connects not just doctors and hospitals but also people in their homes.

“This is a tremendous opportunity as we look forward to future requirements of the boomer nation,” Braham said. “Whether it's helping seniors stay in their homes longer and not go to nursing homes or providing remote diagnostics in rural communities or on a ‘follow-the-sun’ basis, we think there is a tremendous amount of things to be done in this area.”