 |
By Brian Patty, MD
Vice President and Chief Medical Informatics Officer
HealthEast Care System
For HealthEast, the journey to meaningful use is merely continuing a journey to quality that began in 2005. Since much of that journey has been focused on creating an electronic health record (EHR), we've been able to leverage a successful governance structure and hard-won cultural improvements, including the results from our efforts to align physicians with our quality goals.
The First Leg of Our Journey to Meaningful Use
When we discuss quality with the medical staff, everyone's first association is core measures, which are critical to reimbursement. But it's also important to recognize that employee satisfaction, the patient experience and operational efficiency are also core to demonstrating quality. In 2005, we realized the need to increase our focus and become the flagship for quality in our area. Ultimately, our medical staff came up with our rallying cry: HealthEast would be the "Benchmark for Quality in the Twin Cities by 2010."
As part of that project, we began benchmarking clinical performance at each of our three acute-care hospitals against other regional hospitals. After performing consistently at or above target, the "Benchmark for Quality" initiative will come to a close at the end of this year — just in time to focus on meaningful use. But the same purposeful, three-pronged approach that helped us achieve and sustain our goals will remain in place:
1. Process adherence
2. Hardwiring quality
3. Physician engagement
Process Adherence
Process adherence is spearheaded by the HealthEast Quality Institute led by Craig Svendsen, MD, our chief medical quality officer. The Quality Institute prioritizes clinical improvement projects based on their impact on the six Institute of Medicine (IOM) aims – patient centeredness, safety, efficiency, timeliness, effectiveness and equity – as well as cost. Each project requires:
 A physician champion to ensure its success
Approval by our board of directors, executive committee and physician leaders
Project details, including description and drivers, applicable IOM aims and other
improvement opportunities, locations and metrics
Identification of contributors, including project leader, team, clinical council, executive
sponsor and clinical nurse specialist
Because the meaningful use objectives also incorporate the six IOM aims, we have been able to leverage the same process.
Hardwiring Quality
When properly deployed, IT in general and tools that support clinical decision making in particular can greatly reduce the burden on clinicians. As head of the HealthEast Informatics Department, I work closely with Dr. Svendsen's team to ensure we do everything we can to reduce the cognitive burden on our providers. For example, we deploy a myriad of tools to support decision making:
Documentation templates for clinician, multidisciplinary and nursing documentation as well
as patient self assessments
Relevant data presentation for ordering, documenting, tracking and reporting
Order facilitators such as single-order completers, consequent orders that should follow an
initial order, order sets and active guidelines
Disease management facilitators including multi-day and multi-visit protocols
Reference information, both context sensitive and context insensitive
Reactive alerts and reminders that highlight errors of commission and omission during
order entry and that provide result notification
For each project, we look at everything in our library of tools and ask: "Which tool can we use to achieve these metrics?" If we're not hitting a project metric, we ask ourselves if there's something deployed that we can tweak, or if there are other tools we should be using.
Physician Engagement
Efforts to hold physicians accountable for quality goals also date back to 2005, when HealthEast restructured the medical staff into clinical councils. We made this change in order to react more nimbly to state healthcare reform requirements.
We established 15 councils that handle all the responsibilities of a traditional specialty department – peer review, credentialing and ongoing performance evaluations – but each is also aligned with HealthEast's quality goals. The councils report to the Quality Institute, which is staffed by physician executives.
Over time, council leaders have assumed accountability for the clinical improvement projects. These projects range from development and monitoring to defining goals and metrics, holding medical staff accountable for quality and driving the IT adoption necessary for success.
On to Meaningful Use
Our approach to achieving meaningful use comes down to naming the goal, quantifying what we're trying to improve, and deliberately pursuing it. In the case of meaningful use, the objectives, measurements, and even the IT are already prescribed. Still, there are many decisions that each organization will have to make in order to garner the adoption levels necessary to achieve each goal. After six years of success in improving quality, we are confident that our approach will provide a solid basis for achieving the next leg of our journey — meaningful use.
Dr. Brian Patty came to the HealthEast Care System in 2005 as the chief medical informatics officer (CMIO), after four years as the medical director of Fairview Clinical Information Services (FCIS) in Burnsville, Minn. As CMIO, he is responsible for championing clinical applications and the use of technology to serve patients, and leads computerized physician order entry (CPOE) and electronic health record (EHR) implementations system wide. Dr. Brian Patty is a fellow in the American Board of Emergency Medicine, American College of Emergency Medicine and American Academy of Emergency Medicine. Patty is also a member of AMDIS, AMIA, HIMSS, Hennepin County Medical Society, and the Minnesota Medical Association.
 |
|
|
