Health Affairs

Editor’s Note: John Toussaint of ThedaCare (photo and bio above) is a participant in today’s National Press Club briefing on meaningful use of health IT, cosponsored by Health Affairs and the Health Industry Forum at Brandeis University. The post below highlights salient points of Toussaint’s presentation and supplements his discussion.

On August 5 at the National Press Club in Washington, ThedaCare, a system of four hospitals, 25 ambulatory clinics and a large outpatient behavior health center in Northeast Wisconsin, announced it will meet all current meaningful use standards by the end of 2011 through extensive training of both employed ThedaCare physicians and independent community physicians. ThedaCare believes these guidelines are important in defining how electronic health information can improve healthcare in Wisconsin and throughout the country.

Sponsored by Health Affairs and Brandeis University, the event included many leaders representing insurers, providers, pharmaceuticals manufacturers who described what they are going to do differently based on the recently published “meaningful use” guidelines. Patients also shared their experiences related to the benefits of Electronic Health Records (EHR).

How are Systems Implementing Meaningful Use?

The implementation of these guidelines is complex, and ThedaCare has invested about $2.5 million annually in staffing and operating EHR since 1996. Despite being listed among the “Most Wired” organizations in America  for the past nine years, ThedaCare is still implementing some components of the EHR, like computer physician order management (CPOM). We are working to educate and engage physicians about the necessity of the EHR in managing patient care more effectively. The goal is to convince physicians the EHR and CPOM are simply further tools to drive continuous improvement.

The difference at Thedacare is that we combine the EHR tools with the ability to fundamentally redesign care processes, and then use the EHR to support those changes. The fact is we have a long way to go before all the clinical care processes can be redesigned. We don’t want to transition from a wasteful paper process to the same wasteful process, only now electronic.

In our experience, physicians more readily embrace EHR and its accompanying changes when paired with a new design and care process that clearly delivers better, efficient care. EHR is an important aspect of our redesigned Collaborative Care inpatient unit, for example. The unit has produced zero medication reconciliation errors for three years in a row, with close to a 30 percent reduction in cost. Doctors decide the merits of EHR based on final outcomes data like this, which shouldn’t be much of a surprise. We have taken our time to implement components of the EHR to be sure that it supports this critical work.

The EHR is a tool and, as with other important tools like stethoscopes and CT scans, an appropriate set of clinical care processes and training is required to enable better patient outcomes. This is ultimately what meaningful use is attempting to deliver, and we are eager to move forward to meet its standards.

Putting a Powerful Tool to the Right Use

A CT scan, for example, can be critical in determining whether a patient with abdominal pain needs surgery for a ruptured intestine. However, if the patient has poorly functioning kidneys and a CT with contrast dye subsequently sends the patient into full blown kidney failure, what might have been a powerful enabler instead has a negative impact. Clear understanding of the process of using these enablers appropriately and reliably is required for improved patient outcomes. The same holds true for EHR.

Thousands of our patients at ThedaCare have complete access to their own EHR. As a patient myself, I love that I can access my lab results, refill medications, schedule appointments and email my doctor. The EHR has increased the effectiveness of my office visit for me and the physician. When you combine the EHR with radical redesign of the clinical care process, magic starts to happen.

EHR and Delivery Redesign Go Hand-in-Hand

ThedaCare’s Kimberly clinic, where I receive care, has redesigned the care process by changing the roles and responsibilities of everyone in the office. They enlisted front line nurses, doctors, and technicians to think about how the process could be better, identifying waste and improving it. As a result of their work, I’m checked in within 10 seconds, never waiting more than 5 minutes (the waiting room is almost always empty). I have a medical assistant do the EHR intake information in the exam room, and then draw my blood. Fifteen minutes later, my lab results show up on the exam room computer and, by the time my doctor is done examining me, he has all the information he needs to create a complete plan of care with appropriate medication changes, follow-up appointments scheduled, and anything else deemed necessary.

The EHR also allows prescriptions to be sent to the pharmacy or a physician’s note to be sent to a referral provider electronically. In other words, it supports the care redesign process, which is what delivers a better patient outcome both clinically and from a customer service standpoint. The fact that I can review lab results onsite with my doctor, instead of waiting for a follow-up call is a perfect example. Now we don’t have to play phone tag for days. If the medication needs to be changed, it’s changed on the spot and my problem is immediately solved. ThedaCare has shown that these process of care changes have significantly improved blood pressure and diabetic control in our overall patient population.

Our experience confirms we need to both radically redesign the care process and implement an EHR to support the new process. Together, the two have the potential for big impacts on improving patient outcomes and we believe the doctors will agree.

This entry was posted on Thursday, August 5th, 2010 at 12:09 pm and is filed under All Categories, Health IT, Hospitals, Physicians. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.