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This case occurs at a highly ranked academic medical center, nationally known for the specialized care they provide patients. A separate, multiple-hospital organization owns and operates the hospitals where the medical school faculty teach and practice medicine. The hospital organization employs the nurses and other ancillary staff necessary for the hospitals’ existences. Additionally, the hospital organization owns community hospitals and outpatient clinics where the academic physicians do not practice. The medical school owns a physician practice plan that not only supplies physicians to the academic hospitals but also runs the outpatient clinics where patients are seen in post-discharge. Unified information technology is the dream of the clinical staff. The two organizations have separate user directories, no single sign-on for user authentication, different e-mail systems, and a different EMR for many different aspects of a patient’s care. At the hospitals, there is separate disparate EMR for acute inpatient, anesthesia, surgery, and emergency. The ancillary systems for the transport team, pharmacy, and laboratory are also disparate. The hospital organization has a separate EMR for community outpatient clinics, while the medical school has a separate EMR for academic outpatient clinic care. If patients receive care in the community and academic settings they will have separate, disparate charts in these settings. All these heterogeneous systems feed a clinical repository, which contains reports from the different EMRs from a variety of vendors. Additional discrete data supplements these reports for labs and medications within the clinical data repository. Any user at either institution can log into the clinical data repository in view-only mode.
It is not uncommon for the medical school and the hospital organization of an academic medical center to have separate installations of even the same EMR vendor’s application, which sometimes have interoperability problems. Such an infrastructure occurs from each organization existing as a separate legal and financial entity, and not every hospital patient becomes a physician practice outpatient. This infrastructure arose from the hospital organization’s best-of-breed approach to EMRs at a time when no single vendor existed for all parts of clinical care. Though this method has its shortcomings, each system was chosen because it fit with the workflow for the users it serves. Any impediment on interoperability must always be carefully considered by the organization to assess its potential impact (Monkman & Kushniruk, 2013; Lupino, 2013).