Before coming to Hershey, Dykehouse served as CIO at UCLA Medical Sciences and Froedtert Health System, an academic partner of the Medical College of Wisconsin. He guided the implementation of each organization's EMR and has more than 25 years of experience in IT management.

Dykehouse is also a member of the College of Healthcare Information Management Executives. He recently talked to the Business Journal about how Penn State Hershey's EMR integration is going.

Q: What parts of the EMR transition has Hershey completed, and what parts remain to be implemented?

A: The EMR is implemented and being used across Penn State Hershey Medical Center. Our level of automation in the hospital is among the best in the country. We're actively extending the EMR to our outpatient practice sites, and that effort is approximately one-third complete. This deployment is expected to be complete by 2014.

What have been the biggest challenges along the way?

Typical of any transformational change of this magnitude, the EMR and workflow represent a major change from the past. This requires a great deal of training and support for the clinicians and other users of the EMR system. Learning and adopting the new system for use in clinical areas is the greatest challenge, though that's not unique to Penn State Hershey.

Is the path to total EMR integration clear at this point, or are there still major issues yet to be addressed?

The path and commitment to EMR integration is clear for Penn State Hershey. We are confident in our thoughtful, ongoing evolution in deployment, adoption and desired integration.

From Hershey's interactions with smaller practices and other hospitals, how far along in the EMR transition process would you say they are? How does that affect Hershey?

Although most hospitals are moving forward with EMR implementation, some hospitals and many small practices are either not moving to an EMR at all or are only starting this journey. This affects Penn State Hershey only if we wish to share electronic records with those practices or hospitals. For such institutions, we will need to accept the paper medical records as we have done in the past.

When do you think America's health systems as a whole will be fully functioning with EMR?

It will be years or even decades before the entire American health system is functioning with an EMR. There remain thousands of small or individual physician practices, especially in remote areas, that have not or will not move to an EMR.

Do you have any figures on how much Hershey expects the total transition to cost? Can you put that in perspective for us?

The total cost to the capital and operating budgets is estimated around $150 million for the past seven years of effort. Based on comparisons with other academic medical centers, this is a typical cost.

Is the process of transitioning to EMR linking medical and payment records? Should people be worried about being denied treatment or being given inferior recommendations because of what's in their payment history?

Absolutely not. Medical treatment and care, whether delivered with or without an EMR, is delivered independently of an individual's payment history. With an EMR, patients should see greater coordination of care between care settings, e.g. physician clinic visit, emergency room, hospital stay, etc.

How is the patient experience changing because of EMR? How are Hershey patients responding so far?

Patients at Penn State Hershey Medical Center should see improved coordination of care and communication of their medical history between care settings and appointments. We are also beginning the rollout of the Patient Portal to provide patients with access to their medical records, appointment history, medication refill requests, etc. This has already been very well received.

Reaching for effective EHR

Backed by federal American Recovery and Reinvestment Act dollars, a nonprofit organization has been working to help thousands of Pennsylvania medical practices use electronic medical record systems effectively.

It’s a big job.

The organization is PA REACH — Pennsylvania Regional Extension and Assistance Center for Health Information Technology. Its services are subsidized for eligible providers, particularly small primary health services, which it says “have the lowest rates of adoption of EHR systems, and the least access to resources to help them.”

Tracy Koval and Pam Wilshere of the Pennsylvania Academy of Family Physicians & Foundation are both local subcontractors for PA REACH.

Koval reported that, at the end of July, 5,527 practices in the eastern half of the state were signed up for free help. Of those, 3,739 had implemented an EHR system, and 2,115 had met the first set of “meaningful use” requirements.

“Mostly what I’ve experienced is they are gritting their teeth and doing it because they have to,” Koval said. “It’s a lot of work, and it takes a lot of time. Usually the implementation process from the time they start until they’re actually using it proficiently is about nine months.”

But afterward, she said, “They would not go back — let’s put it that way.”

There’s also a financial incentive, as qualified Medicare providers can earn up to $44,000 per provider over a five-year period, if they reach meaningful use each year. For Medicaid providers, the maximum is $63,750. Meaningful use consists of specific objectives that eligible professionals and hospitals must achieve to qualify for the incentives.

Wilshere noted that those financial incentives do not apply to all medical practices. Legislation introduced to expand the incentives to behavioral and mental health and substance-abuse practices has not progressed.

“Incentive money isn’t the end-all, but it certainly does help,” Wilshere said.

On the large end of the health care provider spectrum are hospitals. In an Aug. 9 online chat with CPBJ, Carolyn Scanlan, president and CEO of The Hospital & Healthsystem Association of Pennsylvania, said there has been significant progress on that front.

“Thirty-nine percent of hospitals in PA are fully electronic, and 50 percent are partially electronic,” Scanlan said.