With just a click of the mouse on their computer desktops, physicians at the Mayo Clinic’s three sites can access a patient’s electronic medical records in mere seconds, regardless of which location provided the patient treatment.

That means medical records are readily available for a Mayo patient seen in Rochester, Minn, even if they seek follow-up care while wintering in sunny Scottsdale, Ariz, or Jacksonville, Fla. In turn, a specialist in Rochester can review the test results of a patient seen in Jacksonville or Scottsdale for a second opinion or to deliver a specialized course of treatment.

Previously, Mayo physicians had to pick up the phone and call for patient records once they learned about the patient’s treatment history at another site. After more departmental phone calls and record searches, the information would arrive by fax.

“What this actually does is save physician time,” said David Anderson, Mayo Clinic’s customer relations manager of information technology in Arizona. “It gets the medical information to the physician ahead of the appointment. There have been many kudos from physicians [because] it has helped them improve patient care.”

This unified medical records platform came about after Mayo Clinic President and Chief Executive Officer Denis Cortese, MD, pondered the possibility of the health system becoming one cohesive unit despite its geographic distances. Mayo has more than 3,300 physicians, scientists, and researchers and 46,000 allied health staff who collectively treat more than a half million people each year at its three sites. About 5% of Mayo patients, around 25,000 per year, are seen at more than one location.

Cortese asked physicians at a 2005 leadership meeting: “What does it mean to be one Mayo Clinic?” He told them he had the ability to access each site’s EMR with just a click of a button on his computer. What if every physician could access these records as well?

The physicians rallied behind the idea, but the reality of such a technology wasn’t as easy as the concept. Unfortunately, each location has its own EMR platform and the information could not necessarily cross over. It meant developing a program that could deploy three separate EMR systems without the software conflicting. And then there was the challenge of installing, maintaining, and upgrading each of those systems. In addition, Anderson said more than 3,000 physicians would have to be trained to use three different EMRs.

“The system was not easily replicated,” Anderson said. “It would be very labor intensive, very costly, and very risky.”

As Mayo’s IT experts began examining how to converge, they realized each site had existing technology to offer the project. Arizona had a view-only medical records browser that ultimately was used as the model for a new Web-based program. And when they realized physicians didn’t need every detail of every medical record, they designed it to act as a collector of key data from each of the three sites. The read-only system prevented the danger of medical records being altered, and its simplicity made it a valuable tool at a minimal cost, Anderson said.

The program developers also implemented Jacksonville’s composite document viewer that could read image documents in various formats, which meant the various existing document formats didn’t have to be converted.

“We achieved synergy by using technologies that existed at each site rather than reinventing them,” Anderson explained.

Software architect Troy Proudfoot began developing the OneView prototype in July 2005. The project was broken down into four phases, including a readiness review before the first phase was rolled out in March 2006.

A physician advisory team had agreed on the most desired information, which was then prioritized incrementally. Physicians wanted access to documents such as patient demographics, transcribed reports, problem lists, medication allergies, radiology and lab reports, cardiology reports, surgery notes, pathology reports, image documents, and family medicine notes. IT team members at each site collected the medical data and integrated it into the new structure.

“We designed the system to interface with some of those data providers at each site,” Proudfoot said. “What OneView brought together is access to clinical information that is stored in other disparate databases.”

Mayo’s OneView was born, and Cortese’s vision of “One Mayo” was realized.

“A physician will bring up the Web-based application, and enter a medical record number or a patient name that will go out and do a search to our master patient index,” Anderson explained. “It has patient information, medical records, and demographics in all three EMRs.”

The patient-specific information is returned to OneView, and, after it is verified, the system searches every data source and brings up an index of all available documents for that patient. OneView gathers 1,500 different document types in 50 categories. Physicians and staff simply open a folder list and click on the document they want to view. The system then retrieves the medical record.

“It’s a very patient-centered application,” Anderson said. “It’s not a database. We don’t store documents in OneView. It’s an index.”

Proudfoot said OneView has front-end security and an audit log to identify users and protect patient privacy. Sensitive documents, such as records about psychiatric disorders or infectious diseases, have an extra level of security.

“The entire system runs behind the firewall within the Mayo network,” Proudfoot said. “When [someone] queries for a patient, we know it and log it. We require them to authenticate with an ID and password and a valid reason for trying to access the information.”

“Our most critical guiding principle was security of Mayo clinical records. It was imperative that it be maintained,” Anderson added.

Because the new technology interfaces with existing EMR systems, implementing OneView had no additional impact on the workload of medical records departments, Anderson said. It also is user-friendly and required no more training than a quick reference sheet and an FAQ.

“It’s very intuitive. We did not have to train a single person on how to use it,” Anderson said.

With OneView in place, Anderson and Proudfoot said the overarching strategy at Mayo Clinic is to have a single EMR across the entire health system. It’s the Holy Grail of the project and will require system-wide standards for data, processes, and nomenclature.

“This is kind of a bridge technology so we can develop the single EMR,” said Anderson, who in February joined Mayo Clinic’s Chief Medical Information Officer, Keith Frey, MD, as they presented OneView at the Healthcare Information and Management Systems Society (HIMSS) annual conference in Orlando, Fla.

Anderson and Proudfoot credit the project managers at each site for rising to the unprecedented challenge of creating a unified system with OneView. They had been tasked to bring 2,100 physicians online, and they achieved that within the first year. But once allied health staff learned about the project, they too wanted to access it. Today the system has about 30,000 users.

“Everybody just really stepped forward and knew how important this was to the organization and especially the patient,” Anderson said.

Verina Palmer Martin is a contributing writer for Axis Imaging News. For more information, contact .