Saturday, April 09, 2011

An Interesting View on Where EHRs Fit in Health Sector Improvement.

In my browsing last week I came upon this really interesting blog.

http://healthsystemcio.com/2011/03/28/intermountain-healthcare-and-ehrs/

Intermountain Healthcare and EHRs

Posted by Dale Sanders on March 28th, 2011

Dale Sanders, CIO, Cayman Island Health Authority

Before we go too far in assuming that you need an EHR to achieve what Intermountain has, in terms of lowering costs and improving clinical outcomes, it’s worth drilling down a little further. It is Intermountain’s billing, registration, and case mix systems that enable much of what the organization achieves … and virtually every healthcare provider and system in the US already has a computerized case mix and/or billing system of some kind.

Intermountain Healthcare garners oodles of much-deserved credit for delivering better healthcare at a lower cost than the average US healthcare organization, and they also receive credit for the role that their EHR (primarily the HELP system), plays in that achievement of better care and lower cost. But it was data from their financial and case mix systems that was the backbone of their process improvement culture, not their EHR.

Instead, the Intermountain EHR environment played a major part in showing all of us what could be achieved with sophisticated computerized decision support — not necessarily system-wide quality and cost-of-care process improvement. Through EHR applications like Storkbytes for fetal monitoring, the ARDS weaning protocols, the ICU glucose manager, and the particularly noteworthy Antibiotic Assistant, the industry learned that computers could be programmed to assist and benefit the delivery of care at the point of care. That’s a much different use of computers and data than, say, reducing the number of elective inductions, hemoglobin A1C rates, or readmission rates for patients with congestive heart failure or MI across the entire healthcare system of 23 hospitals and 100+ clinics.

The reality is, Intermountain’s EHR is not pervasively adopted, yet. The further you travel away from LDS Hospital and the new Intermountain Medical Center, the less likely it is that you will find Intermountain’s EHR being fully used. But … every facility uses a commonly-adopted billing and registration system.

Brent James and his team of incredibly capable data analysts have long relied on nicely structured case mix data to drive Intermountain’s quality vs. cost analysis — ICD codes, CPT codes, NDC codes, APR-DRG, admissions data, mortality data, charges, reimbursements, etc. It wasn’t until the early 2000′s that Intermountain managed to pull large quantities of data from the HELP and HELP2 systems in such a way that the analysts on Brent’s team could benefit from EHR data.

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Without this highly-structured and goal-driven organizational structure, data will flow like water to a land without crops — nothing will change, nothing will grow.

All of this is not suggesting that EHRs don’t have their value at Intermountain or the rest of the industry — they certainly do. What it does suggest is that you don’t need to wait for an EHR to achieve what Intermountain has largely achieved in maximizing quality and minimizing costs at the systemic level. You can go a long way down that path with the right organizational structure, highly capable data analysts, an enterprise data warehouse and boring old billing, registration, and scheduling data.

Dale Sanders served in various capacities during his eight years at Intermountain (1997-2005), including Director of Medical Informatics for Intermountain’s largest region and chief architect and project manager for its Enterprise Data Warehouse.

First, if you are wondering about the Cayman Islands go here:

http://en.wikipedia.org/wiki/Cayman_Islands

Intermountain Healthcare is a legendary US health system for its use of evidence based approaches to the improvement of the quality and safety of patient care.

I found what Dale Sanders says about what can be done with basic data sets really very interesting. People like Brent James have shown us what to look for and Dale is saying we already have a lot of what we need in many hospital systems.

Taking the steps and making the information they already hold more valuable should be a pretty high priority I believe for all in such roles.

David.

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