Thursday, June 22, 2017
A Good Reminder Of The Basics Of System Implementation. Great Read.
This appeared a little while ago.
June 15, 2017
A decade ago, Kaiser Permanente installed the nation’s most comprehensive electronic health record (EHR). The decision was made by the health plan and medical group together. Due to the large size of our organization, implementation was challenging and expensive: The process took two years, and the cost at the time was estimated to be around $4 billion. But there is no question that the price tag and the effort required to train and motivate physicians and staff were worth it. The information the EHR provided, combined with our data analytics and integrated medical care delivery system, has helped us save countless lives.
Across the United States, few physicians have access to a comprehensive EHR that contains all of a patient’s medical information (regardless of how many doctors have provided care) and communicates care gaps and potential medical errors before they happen. As difficult and expensive as it may be to integrate this kind of system across a community, doing so is the best way to maximize quality of care for all patients. For health systems that want to make the investments in time and capital needed, here are some important lessons our experience taught us.
In the late 1990s, and again in the early 2000s, we tried to design and build our own EHR. Both efforts failed, costing us close to a billion dollars each time. A major issue was the approach we used: To gain physician acceptance, we tried to accommodate the unique preferences of every specialty. For example, rather than having a single diagram of the body that every clinician would use to document the location of a patient’s problem, ophthalmology had its own diagram focused on the eye, while ENT had a different one for the face. As a result, a primary care physician had to review and incorporate two sets of data, sometimes with contradicting information, for a single problem.
After two failures, we made the decision to purchase a single system, EPIC, whose philosophy was not to customize the applications but to maximize the combined functionality of the system for all. In addition, we worked with the company to develop an in-patient suite fully integrated with the outpatient modules.
There will always be customized applications that are more desired by a single specialty and more specific to its practice, but the power of the EHR derives from the totality of the information it provides. Patients benefit the most through the sharing of information across specialties, rather than the depth or ease of documentation within each. Unlike many office-based stand-alone systems that focus on a single clinician’s needs, a comprehensive EHR begins with the totality of the patient, and communicates their information to every physician who provides care.
When the same data is presented to all physicians, they can spot and address any gaps, regardless of whether they work in a primary or specialty department. For example, consider high blood pressure, the most common cause of an ischemic stroke, as a quality measure. According to the CDC, it is controlled across the country only 55% of the time. In contrast, in The Permanente Medical Group (TPMG), success is achieved 90% of the time. The reason is that every physician is aware when a patient has this problem, and they can communicate easily to clinical colleagues when additional therapy is needed.
Outside of large multispecialty medical groups that are paid on a capitated basis, one of the biggest challenges with EHR adoption is convincing physicians of its value. Many of the current EHRs were designed predominantly for coding and billing, rather than clinical practice, and they often don’t connect seamlessly with the EHRs in surrounding doctors’ offices. So rather than making patient care easier, they end up slowing clinicians down.
Our experience inside TPMG has been different. While our physicians found entering data into the EHR cumbersome, they could also immediately see the advantages for their patients. Rather than having to wait for a patient’s records to arrive from their colleagues’ offices, they could access the information immediately. Instead of having to search for radiologic studies, they could access the studies as soon as they were complete. And instead of having to mail medical information to other physicians about next steps in the treatment process, they knew it would arrive immediately; as a result, they could be confident their patient would not fall through the cracks.
Lots more here:
Well worth a browse to remind yourself of the basics we all need to keep in mind.
Posted by Dr David More MB PhD FACHI at Thursday, June 22, 2017