EMR 2.0: Mining the EMR for Meaning
The modern electronic medical record (EMR) is a gold mine of data for the health care executive, but that gold too often goes un-mined. At Illinois-based NorthShore University HealthSystem, accessing the mother lode of usable information begins with a database of about two million patients and 100 million transactions. 
Mark R. Neaman, FACHE, president and CEO at NorthShore, has spent millions upgrading hardware and software, and the investment has led to remarkable administrative efficiency. Getting to the next level—call it EMR 2.0—involves going beyond administrative benefits to the realm of patient care.
“Accessing data from the 75 doctor offices we have scattered across the geography allows us to trace influenza viruses by zip code and school system,” explains Neaman, who presented at the 2012 Congress of the American College of Healthcare Executives in Chicago, in March. “As a result, we are able to give early warnings of influenza attacks.”
This type of predictive modeling can influence other areas, including reducing the number of admissions tested for various ailments. “We can test 50% of admissions by looking at people who are most likely to be positive carriers of MRSA, and still detect 99% of the carriers,” Neaman says. “Practically speaking, that is good medicine. Tactically, that saves us hundreds of thousands in laboratory costs by using the power of predictive modeling.”
Research-based data collection is another essential element for executives who wish to take their EMR systems to the next level and into the realm of medical informatics. In the area of pancreatic surgery, for example, a complex specialty with highly skilled practitioners, surgeons often fail to record the proper data.
Reports end up with unnecessary information that does not help physicians, researchers, or patients, while leaving out crucial elements such as the size and location of tumors. “We have developed a workflow in the database through the EMR that forces physicians to make sure every data field is filled out,” Neaman enthuses. “You can’t post to the record until those data fields are filled out.”
Tapping the Possibilities
EMRs at many organizations are already five years old, with many systems mired in the 1.0 era. The good news is that many of these systems can be upgraded to truly enhance the practice of medicine, but the process requires a willingness to evolve, and Neaman is convinced that most facilities can do just that. As head of an integrated health care delivery system, with four hospitals and a 750-physician multi-specialty group practice, Neaman spearheaded an effort to fully implement one of the first EMRs in the United States nearly a decade ago.
“We were able to address the kinds of things coming out of the Institute of Medicine report that showed 40,000 to 98,000 unnecessary deaths, and we’ve had measurable impact there,” Neaman says. “We are able to demonstrate a small but positive economic return on investment even if you didn’t think that quality was important. This past year, we received about $15 million in meaningful use money from the federal government as a part of their evaluation process.”
At the level of patient care, NorthShore also used its database to minimize urinary tract infections by closely monitoring the use of urinary tract catheters. Analysis of the database showed that after 48 hours, the risk of infection went up astronomically.
Falling Through the Cracks
Mark R. Neaman, FACHE, president and CEO at NorthShore University HealthSystem, Evanston, Illinois, knows that multiple data points are useless if no one pays attention. The lack of awareness can happen at even the best facilities, and it’s something that Neaman has worked hard to avoid at NorthShore.
In the case of hypertension, NorthShore was missing too many opportunities and Neaman quickly addressed the problem. “Even after three encounters with blood pressure taken, I am ashamed to admit that one-third [of hypertension] went undiagnosed,” Neaman laments. “It goes into the chart and nobody looks at it. We have since developed tight protocols so that the health system recognizes, responds, and diagnoses the condition.
“We also have electronic medical holds for things such as diabetes,” he adds. “Our goal is to not have patients come into the hospital or the emergency department unnecessarily. We put info such as glucose levels into the electronic system. We use the analytic tools to predict who is likely to get into trouble sooner rather than later.”
In the case of adult immunizations, Neaman’s staff looked into the system and found that it took technicians an average of 38 clicks to navigate the medical record to see if someone needed an adult immunization. “The system was too cumbersome,” Neaman says. “By using the power of data analytics, we moved from 38 clicks down to one click. We gave the job to the nurses, and the nurses are much more apt at navigating the system.”
For those implementing the first stage of EMRs, Neaman cautioned: Build the database right the first time. In the case of individualistic physicians, tell them up front that there will be a standardized database. “Take out as much variability as you can in the reporting, and use standard protocols to make sure you are consistent,” he advises. “Don’t forget to have some fun. Enjoy the journey.”
“Now the data system has a warning when a patient has a catheter more than 48 hours, and if at all possible to think about removing it,” Neaman explains. “We use the database for surveillance, tracking, predictive modeling, and medication administration to understand where mistakes might occur.” Bar-coding technology helps NorthShore get the right medication to the right patient in the right dose at the right time—and in the right format, he adds.
More than 150,000 patients are directly linked to the health system via NorthShore Connect, where they can directly schedule a visit, get lab results, renew a prescription, or have an e-chat with physicians—all things that consumers experience in other walks of life.
“This past year, 40% of our appointments were same day,” Neaman adds. “We use a centralized online scheduling system that is transformational. With things like a secure access portal, you can take your medical record anywhere in the world and directly access it.”
Tracking Repeat Visitors
From a business systems standpoint, Neaman is keen to use NorthShore’s EMR to identify the number of new versus returning patients. Return customers in other industries use three to five times the level of services, and health care is not much different in this respect.
Repeat visitors spread word of their experiences, and retention of these customers is essential. More than 95% of NorthShore patients have used services at least once in the past three years, and their loyalty affects referral and utilization patterns.
Knowing the types of services these patients use can influence crucial hiring decisions. “We know primary care physicians are important, but we’re never sure of their influence system wide,” Neaman muses. “Neurologists are important, but they never admit anybody. If you look at their utilization patterns in terms of MRI and laboratory data, they are a key lynchpin in developing a system-wide approach to providing health care in this state. How do I know that? I have the data to show it.”
Neaman’s reliance on data is firmly based on a relentless real-world approach that has allowed him to successfully guide NorthShore for more than two decades. The lengthy tenure is a monument to the power of evidence-based medicine and a willingness to disregard more than a few sacred cows. “Like many things in our culture, medicine gets practiced because we’ve always done it that way before, as opposed to pulling back and really understanding evidence-based medicine,” Neaman stresses. “Things such as accountable care organizations are going to force us to change the practice of medicine if we’re going to survive the financial challenges.”Greg Thompson is a contributing writer for Health CXO.
Mark R. Neaman, FACHE, president and CEO at NorthShore, has spent millions upgrading hardware and software, and the investment has led to remarkable administrative efficiency. Getting to the next level—call it EMR 2.0—involves going beyond administrative benefits to the realm of patient care.
“Accessing data from the 75 doctor offices we have scattered across the geography allows us to trace influenza viruses by zip code and school system,” explains Neaman, who presented at the 2012 Congress of the American College of Healthcare Executives in Chicago, in March. “As a result, we are able to give early warnings of influenza attacks.”
This type of predictive modeling can influence other areas, including reducing the number of admissions tested for various ailments. “We can test 50% of admissions by looking at people who are most likely to be positive carriers of MRSA, and still detect 99% of the carriers,” Neaman says. “Practically speaking, that is good medicine. Tactically, that saves us hundreds of thousands in laboratory costs by using the power of predictive modeling.”
Research-based data collection is another essential element for executives who wish to take their EMR systems to the next level and into the realm of medical informatics. In the area of pancreatic surgery, for example, a complex specialty with highly skilled practitioners, surgeons often fail to record the proper data.
Reports end up with unnecessary information that does not help physicians, researchers, or patients, while leaving out crucial elements such as the size and location of tumors. “We have developed a workflow in the database through the EMR that forces physicians to make sure every data field is filled out,” Neaman enthuses. “You can’t post to the record until those data fields are filled out.”
Tapping the Possibilities
EMRs at many organizations are already five years old, with many systems mired in the 1.0 era. The good news is that many of these systems can be upgraded to truly enhance the practice of medicine, but the process requires a willingness to evolve, and Neaman is convinced that most facilities can do just that. As head of an integrated health care delivery system, with four hospitals and a 750-physician multi-specialty group practice, Neaman spearheaded an effort to fully implement one of the first EMRs in the United States nearly a decade ago.
“We were able to address the kinds of things coming out of the Institute of Medicine report that showed 40,000 to 98,000 unnecessary deaths, and we’ve had measurable impact there,” Neaman says. “We are able to demonstrate a small but positive economic return on investment even if you didn’t think that quality was important. This past year, we received about $15 million in meaningful use money from the federal government as a part of their evaluation process.”
At the level of patient care, NorthShore also used its database to minimize urinary tract infections by closely monitoring the use of urinary tract catheters. Analysis of the database showed that after 48 hours, the risk of infection went up astronomically.
Falling Through the Cracks
Mark R. Neaman, FACHE, president and CEO at NorthShore University HealthSystem, Evanston, Illinois, knows that multiple data points are useless if no one pays attention. The lack of awareness can happen at even the best facilities, and it’s something that Neaman has worked hard to avoid at NorthShore.
In the case of hypertension, NorthShore was missing too many opportunities and Neaman quickly addressed the problem. “Even after three encounters with blood pressure taken, I am ashamed to admit that one-third [of hypertension] went undiagnosed,” Neaman laments. “It goes into the chart and nobody looks at it. We have since developed tight protocols so that the health system recognizes, responds, and diagnoses the condition.
“We also have electronic medical holds for things such as diabetes,” he adds. “Our goal is to not have patients come into the hospital or the emergency department unnecessarily. We put info such as glucose levels into the electronic system. We use the analytic tools to predict who is likely to get into trouble sooner rather than later.”
In the case of adult immunizations, Neaman’s staff looked into the system and found that it took technicians an average of 38 clicks to navigate the medical record to see if someone needed an adult immunization. “The system was too cumbersome,” Neaman says. “By using the power of data analytics, we moved from 38 clicks down to one click. We gave the job to the nurses, and the nurses are much more apt at navigating the system.”
For those implementing the first stage of EMRs, Neaman cautioned: Build the database right the first time. In the case of individualistic physicians, tell them up front that there will be a standardized database. “Take out as much variability as you can in the reporting, and use standard protocols to make sure you are consistent,” he advises. “Don’t forget to have some fun. Enjoy the journey.”
“Now the data system has a warning when a patient has a catheter more than 48 hours, and if at all possible to think about removing it,” Neaman explains. “We use the database for surveillance, tracking, predictive modeling, and medication administration to understand where mistakes might occur.” Bar-coding technology helps NorthShore get the right medication to the right patient in the right dose at the right time—and in the right format, he adds.
More than 150,000 patients are directly linked to the health system via NorthShore Connect, where they can directly schedule a visit, get lab results, renew a prescription, or have an e-chat with physicians—all things that consumers experience in other walks of life.
“This past year, 40% of our appointments were same day,” Neaman adds. “We use a centralized online scheduling system that is transformational. With things like a secure access portal, you can take your medical record anywhere in the world and directly access it.”
Tracking Repeat Visitors
From a business systems standpoint, Neaman is keen to use NorthShore’s EMR to identify the number of new versus returning patients. Return customers in other industries use three to five times the level of services, and health care is not much different in this respect.
Repeat visitors spread word of their experiences, and retention of these customers is essential. More than 95% of NorthShore patients have used services at least once in the past three years, and their loyalty affects referral and utilization patterns.
Knowing the types of services these patients use can influence crucial hiring decisions. “We know primary care physicians are important, but we’re never sure of their influence system wide,” Neaman muses. “Neurologists are important, but they never admit anybody. If you look at their utilization patterns in terms of MRI and laboratory data, they are a key lynchpin in developing a system-wide approach to providing health care in this state. How do I know that? I have the data to show it.”
Neaman’s reliance on data is firmly based on a relentless real-world approach that has allowed him to successfully guide NorthShore for more than two decades. The lengthy tenure is a monument to the power of evidence-based medicine and a willingness to disregard more than a few sacred cows. “Like many things in our culture, medicine gets practiced because we’ve always done it that way before, as opposed to pulling back and really understanding evidence-based medicine,” Neaman stresses. “Things such as accountable care organizations are going to force us to change the practice of medicine if we’re going to survive the financial challenges.”Greg Thompson is a contributing writer for Health CXO.