Riding the HITECH Tsunami

2nd Annual CHEF Health IT Event Explores the Intersection of Quality and Information Technology by Pam Chwedyk

Can healthcare quality improvement and health information technology (HIT) get married and live happily ever after? How can hospitals use electronic health records (EHRs) to transform the quality of care delivery and increase patient and physician satisfaction? And will Chicago’s hospitals and physicians be ready to play when Stage 1 of the HITECH Act’s “meaningful use of EHR” requirements kicks off in January 2011?

These are just a few of the intriguing questions explored by a panel of experts at Chicago Health Executives Forum (CHEF)’s 2nd Annual HIT Event, “Bending the Curve: The Critical Intersection of Quality and Health IT.” Held November 11, 2010 at the Mid America Club in downtown Chicago, the event drew a crowd of nearly 150 CHEF members and other industry leaders for an information-packed evening that also featured networking, an EHR vendor fair and the opportunity to earn continuing education credit from the American College of Healthcare Executives (ACHE).

But the main attraction was the panel presentation, designed to “take the meaningful use (MU) discussion to the next level.” Moderated by Louis H. Diamond, MD, Vice President and Medical Director at Thomson Reuters Healthcare, the panel covered everything from the role of quality improvement within the context of the HITECH legislation to demonstrations of how two pioneering Chicago-area healthcare systems are using EHRs to create a “culture of quality” throughout their organizations.

The Policy Perspective
Dr. Diamond, a nationally recognized leader in the development of public policy around patient safety, quality measurement/reporting and payment reform issues, led off with an overview of “what the health system reform (HSR) landscape looks like.” Introducing himself by joking, “I’m from Washington, D.C., and I’m here to help you,” he offered recommendations for managing what he called “the big tsunami” of overwhelming legislative changes that will hit the healthcare community’s shores beginning in 2011.

“Health system reform,” Diamond emphasized, “is not an event—it’s a process.” He cautioned against “only concentrating on one aspect of HSR. The total plan [laid out in the HITECH Act] has multiple dimensions. It’s not just about adoption of HIT, it’s not just about MU.” For example, he believes “performance measurement [by organizations like the National Quality Forum] will be exploding. There will be more outcome measures, more composite measures and more patient experience measures.”

Calling the intersection of the two formerly parallel worlds of HIT and quality “a fundamental shift in the way our entire community has been functioning,” Diamond tendered this advice: “Engage yourselves in understanding these issues and build them into your plans. Use the National Priority Partnership’s six national priorities and the Department of Health & Human Services’ Strategic Plan as a framework. And as all this change occurs, achieving excellence within the walls of your own organization is extremely important.”

The CMS Perspective
Also there to help was Susan Hahn Reizner, Esq., CCEP, from the Chicago Regional Office of the Centers for Medicare & Medicaid Services (CMS). She explained that the basic vision of the agency’s new Administrator, Donald Berwick, MD, “is that CMS be a major force and a trustworthy partner for the continual improvement of health and healthcare for all Americans, not just Medicare and Medicaid beneficiaries.”

Hahn Reizner, who has a lead role in implementing CMS’ EHR incentive program under HITECH, noted that the agency has taken steps to help private sector healthcare providers overcome challenges and barriers to EHR adoption. For instance, CMS has established HIT Regional Extension Centers to work with “priority primary care providers”—such as small physician practices and rural health clinics—that may need extra help in implementing EHRs.

Hahn Reizner also offered some predictions of what the intersection of quality and HIT might look like when the incentive program enters Stage 2 in 2013. “We’ll be looking for continuous quality improvement at the point of care. [There will probably be] more robust requirements around health information exchange (HIE)—not just testing the feasibility but actually exchanging health data. But Stage 2 won’t take us out on a new tangent,” she added. “Each stage of MU is designed to build incrementally, based on what we’ve learned from the previous stages. We want to ensure that we factor in providers’ experiences with EHRs as well as the evolution of the technology.”

The Success Story Perspective
Meanwhile, down in the trenches, two of Chicago’s top integrated healthcare delivery systems—Oak Brook-based Advocate HealthCare and Evanston–based NorthShore University HealthSystem—have moved far beyond mere EHR adoption and are now taking HIT to the next level to drive innovative quality improvement initiatives. As panelist Joel S. Shoolin, DO, Advocate’s Chief Medical Information Officer, put it: “We’re trying to marry quality and HIT together to create what we think is the best level of care possible.”
Unlike many of the providers in the audience—who answered “no” when Diamond asked if they were “ready to actually play in 2011”—these two players are so far ahead of the curve that they were rolling out their EHRs years before MU was even a gleam in Congress’s eye. NorthShore, the first provider in the U.S. to reach the highest stage of EHR adoption as identified by the Healthcare Information and Management Systems Society (HIMSS), has “basically had no paper charts at all since 2003,” according to Chief Information Officer Tom Smith. Advocate, the only Illinois health system to earn a prestigious Top 10 national quality rating from Thomson Reuters for 2009-10—and whose Advocate Good Samaritan Hospital in Downers Grove was recently honored with a 2010 Malcolm Baldrige National Quality Award—first embarked on its EHR journey in 2004.

Advocate, whose extensive delivery network includes 12 hospitals, more than 5,000 employed and independent physicians and over 200 sites of care, is focusing on a process called clinical integration to create a consistent, unified quality improvement and performance measurement program throughout its entire enterprise. “We’re trying to align the healthcare system, the hospitals and the physicians together [through the EHR] to make sure we can all agree on the way we’re providing [the highest quality] care to our patients,” Dr. Shoolin explained.

Advocate has been particularly successful in getting its physicians engaged in its quality improvement mission. Three-fifths of its doctors currently participate in the Advocate Physician Partners (APP) program, designed to “get [our] physicians aligned to make sure they’re doing things that make sense from both an organizational and a patient-care perspective,” Shoolin said. “We’re all in this together, it’s not oil and water, [the integration of quality and HIT] fits together very nicely. We all see the value of what we’re doing to provide the best possible care.”
But Does It Really Work?

At NorthShore—which includes four hospitals, more than 2,000 staff physicians and a 650-physician group practice—the focus is on quality innovation through HIT. And that strategy is already achieving measurable results in increasing physician buy-in, patient satisfaction, organizational efficiency and cost reductions. According to Chief Quality Officer Kenneth Anderson, DO, “The question is: How do we harness this technology to use it in a way that will be most effective in really changing the face of how we deliver care on a day-to-day basis?”

From the physician engagement standpoint, Dr. Anderson continued, quality innovation means using the data that’s already warehoused in the EHR to provide doctors with meaningful tools and methods “that will be useful for changing the clinical care patterns of their practice.” He cited such examples as quality data mining, predictive modeling and streamlined clinical decision support tools that minimize workflow interruptions. “This aspect of innovation really seems to light our physician population on fire,” he concluded. “They’re innovative thinkers already, so when we give them the keys to the ignition, they’re ready to drive.”

But perhaps the most impressive HIT success story at NorthShore is the way the health system is engaging its patient population through its EHR patient portal, NorthShoreConnect. Smith estimates that 50% of patients in the EHR are actively using the site to send secure email messages to their physicians, view their test results, request prescription refills, pay their bills, and more—all online and accessible 24/7. And while the portal is not a personal health record (PHR), it does have some ability to collect data—e.g., from home-testing diabetes patients.
Besides making things more convenient for patients, NorthShoreConnect adds value for the health system as well. “It saves us time and money,” Smith said. “[The portal is now handling] 20,000 online patient transactions a month that would have previously required at least one phone call to our offices, and often multiple calls. It’s taking all those phone calls off the front desk, so that the doctors aren’t interrupted. Many of our physicians answer patient inquiries from the portal at night when they get home.”

The portal is also paying off by making NorthShore’s patients happier, added Mimi Broeker, Vice President of Medical Informatics. “Our patients love the fact that they can access [their medical information] at their convenience, whenever they want,” she said. “They like having the ability to ask for a refill, ask for medical advice and email their physician to schedule an appointment. Increasingly, patients are demanding more information and faster turnaround [of things like test results]. It’s their information and they want to have access to it as soon as possible.”
Pam Chwedyk is a Chicago writer and editor specializing in healthcare communications. She can be contacted at pam.chwedyk@gmail.com or www.linkedin.com/in/pamchwedyk.