Outcomes
HealthPartners released an analysis showing that redesigning America's healthcare delivery system to more reliably deliver more personalized and evidence-based healthcare could save up to $2.4 trillion in Medicare costs over the next decade, while improving health outcomes and patients' experience. The article details how workflow redesign and electronic records technology led to significant measured improvements in care.
Kaiser Permanente (KP) earned a perfect four stars for medical care on an annual HMO score card that California officials hope consumers will use to shop for health coverage. The report card rates the state's eight largest HMOs primarily on preventive measures, including what portion of an HMO's enrollees received recommended tests on schedule, such as mammograms, colonoscopies, Pap smears and cholesterol checks. KP executives say they are in a better position to meet measurable medical objectives because the insurer and physicians are part of the same organization. Kaiser also has invested heavily in information technology such as electronic patient records that are readily available to all its personnel.
A recent report by the National Committee on Quality Assurance shows that Kaiser Permanente in Southern California has the highest breast cancer screening rate for women aged 52 to 69. Kaiser Permanente's electronic medical record system, KP HealthConnect, flags the file of each woman who is due for a mammogram.
The use of EMRs, along with e-mail messages, letters and phone calls to patients after a bone fracture can dramatically improve the diagnosis and management of the patients' osteoporosis, according to a Kaiser Permanente study in the Journal of the American Geriatrics Society. This is the largest study to show that electronic medical records improve the continuity of care for osteoporosis.
HealthPartners was selected as the 14th recipient of the National Quality Forum (NQF) annual National Quality Healthcare Award, conducted in partnership with Modern Healthcare magazine. HealthPartners was recognized for its "proactive and exemplary response to the national call for quality improvement and accountability."
Interoperability
Three Epic customers in Colorado recently went live on Care Everywhere, enabling their 1 million patients' medical records to be securely shared with any physician in any of the organizations. This interoperability across organizational boundaries will improve care continuity for the patients these organizations share.
HIMSS Analytics tracks the progress of hospitals toward a paperless state on its EMR Adoption Model. Two Epic customers were the first to achieve Stage 7 in 2009 and hospitals using Epic continue to comprise a large portion of the list.
For the first time a patient had her electronic medical records linked between different organizations via Care Everywhere. Francine Fox's medical records were shared between Talbert Medical Group and Long Beach Memorial (part of MemorialCare). According to Francine's physician, "Care Everywhere enables me to provide timely, appropriate care through better knowledge of the patient's medical history and overall condition. In this instance, I felt more comfortable and confident in taking care of my patient, knowing that I was able to see both her physician office visit and hospital records at the same time."
Excellian (Allina Hospitals and Clinics' name for the Epic product suite) helped an ED physician at Abbott Northwestern hospital provide prompt, accurate treatment to a patient suffering from a stroke. Timing is critical when it comes to treating someone having a stroke, as oxygen-starved nerve cells in the affected of the brain will likely die if normal blood flow is not re-established within three hours. More than two hours had passed between the patient's wife noticing the symptoms of the stroke to their arrival at the ED. "Before Excellian, completing this many tests in less than an hour would have been nearly impossible," the physician says. "It would have required phone calls to many different departments to coordinate logistics and by the time the results were relayed back, it likely would have been too late."
The Institute for Healthcare Improvement (IHI) has recognized MultiCare Health System's Tacoma General and Allenmore hospitals, which operate under one license, as a mentor hospital. Mentor hospitals achieved dramatic improvements in implementing some or all of the interventions in the IHI's 100,000 Lives Campaign.
Patient Engagement
Patients and physicians discuss the effects of MyChart on healthcare at Buffalo Medical Group.
Kirk Kirksey, vice president for information resources at UT Southwestern Medical Center describes their experience with EpicCare and MyChart. He cites increased patient satisfaction, reduced risks of prescription errors, and increased efficiency.
This article examines Geisinger Health System's approach to integration, focusing on its Epic EMR. In addition to an EMR that provides valuable information for improving screening programs for diseases and promoting cost effective care, thousands of patients are able to interact with their physicians through their MyGeisinger patient portal.
C. Martin Harris, MD, Cleveland Clinic CIO and executive director of eCleveland Clinic, told online attendees at the HIMSS Virtual Conference & Expo that healthcare has "lagged behind" other industries in implementing technology that allows consumers to get more involved in their care. However, "the eCleveland Clinic MyChart PHR offers patients '24/7' access to their medical record, 'the same record the physician sees,' according to Harris. In addition to reviewing medical information and requesting prescription renewals, patients can use the MyChart PHR to 'track their health using data-entry flowsheets. For instance, patients with diabetes can track blood glucose measurements."
Researchers at Cleveland Clinic extracted demographic and usage information on more than 60,000 users of the Epic MyChart system in an effort to determine what types of patients will most likely adopt the technology. Researchers determined that there was a relationship between the degree of Personal Health Record use and the number of both actual clinical encounters and diagnoses in the Electronic Medical Record problem list. They concluded that their MyChart portal sees more use from sicker patients who are greater consumers of healthcare.
This study by Group Health Cooperative in Seattle, WA, explores patient satisfaction with various MyChart features. The authors concluded that tight integration between the organization's clinical information system and services offered via their MyChart patient portal may be important in patient satisfaction.
Research
To perform this study, The Cleveland Clinic reviewed 6,159 consecutive outpatients with chronic stable heart failure. Clinical, demographic, laboratory, and echocardiographic data were reviewed from their Epic electronic medical records between 2001 and 2006. The results of the study suggest that anemia in patients with heart failure is under-recognized and under-evaluated.
This study, a 7 year retrospective using all Epic data of about 15,000 patients and about 50,000 visits, showed that about 3 in 4 children with hypertension (based on data in Epic) are not being diagnosed by their pediatric providers (based on ICD-9 codes in Epic). The primary author, David Kaelber, MD, PhD, was able to complete this study in ~100 hours of work with 2 medical school students, and without any budget. He estimates that the equivalent non-Epic study would have taken thousands of hours to complete at a cost of hundreds of thousands of dollars. This study was recognized by the American Heart Association in its list of the
Top 10 Research Advances of 2007.
Researchers developed an enhancement to the EpicCare EMR as used at Harvard Vanguard Medical Associates (HVMA) to assist clinicians with recognizing adverse reactions to vaccines, and to simplify reporting. HVMA's adverse event reporting rate using this feature was almost six times greater than the national rate during the time period evaluated.
Milestones
In this three-part interview with NYU Langone Medical Center CIO Paul Conocenti, Anthony Guerra asks about the hospital's clinical system transition, its low-cost outreach to voluntary physicians and clinical interoperability - among other topics.
President Obama visits Epic customer Cleveland Clinic to learn about the role information technology plays in improving care while actually reducing the costs of delivery.
Officials at Epic customer Beaumont Hospitals say they will bring Epic to more than 300 affiliated physicians by year's end as a result of the stimulus bill signed this week. "The opportunity for us in the stimulus package is to be able to more quickly push this out to the 3,000 doctors that serve our patients," said Beaumont CEO Ken Matzick. "That's where the maximum benefit comes from so that the physician who's in his office is on the same platform as the hospital."
Seven-day-old Ava Thompson was not only born on a very historic election day...she made history of her own. On November 4th, Ava's birth records didn't make it to a piece of paper. She's now the first baby born at Sanford Medical Center who will never have a paper record. Doctors won't be the only ones who will be able to pull up medical records on a computer screen. Parents like Ava's and all patients will have full access through a program called My Sanford Chart.
Epic is the first vendor certified by CCHIT in the Enterprise EHR category (vendors that provide comprehensive and interoperable ambulatory, inpatient, and emergency department EHRs). EpicCare Inpatient is also the first application to receive CCHIT certification under the 2008 Inpatient EHR criteria. Epic's ASAP is one of three Emergency Department products to receive certification.
Kaiser Permanente has completed its inpatient EHR rollout to all 12 of its southern California hospitals, bringing its live hospital total to 22. This gives them more live hospitals than any other non-government healthcare system in the nation. "This milestone reinforces Kaiser Permanente's position as the industry leader in leveraging health information technology to improve patient care and service," said Dr. John Mattison, chief medical information officer, assistant medical director, and director of the KP HealthConnect program for Kaiser Permanente in Southern California.
Mercy Health Center, a facility in the Mercy Health System, went live last week on Epic. The article describes their transition from their Meditech EMR, which "only allowed for a partial electronic record." According to a Mercy press release, "The change to a new computer system will benefit patients because when they are seen at a rural Mercy clinic or emergency location, healthcare providers will be able to work from the same consolidated, continuously updated electronic record, creating real-time access to information."
EMR supporters say they are making healthcare safer and more effective. Doctors don't need to rely on memory to keep up with the latest medical advances. An emergency room doctor and electronic records specialist at Allina noted that they may see 100 different medical conditions, and that "there's no way somebody can remember or keep up on the reading to know what's best for each of those conditions."
While some hospitals have a portion of their patient records and ordering systems computerized, Saddleback Memorial is the first hospital in the county to have a comprehensive, nearly paperless system that physicians routinely use, said Scott Joslyn, MemorialCare's chief information officer. MemorialCare's other four hospitals will follow suit. With the new system, Dr. David Lagrew, the hospital's chief of staff, said he has already seen an improvement in patient care. His patient rounds to high-risk pregnancy mothers have become more efficient. He is no longer searching for patient clipboards or trying to stop a doctor in the hall to catch up on a patient's progress. "It gives you a complete picture of the patient," Lagrew said. "Right there in front of you."
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