Patient-Centered Care: Building the Connected Healthcare Enterprise

Clinical studies have long proven that patient-centered care reduces variability, improves quality in clinical practice and patient outcomes and reduces cost. This is the shared goal of healthcare’s Triple Aim: Simultaneously improving the health of the population, enhancing the experience and outcomes of the patient, and reducing per capita cost of care for the benefit of communities. Achieving the Triple Aim is no small task, as health leaders tell us. Clinical Innovation + Technology spoke with CIOs and health IT leaders from four leading health systems that are making IT the enabler of better care and patient engagement, with a constant eye on the bottom line. Hear what the experts have to say, including: John Foley, CIO of University Hospitals in Cleveland; Arlyn Broekhuis, CIO of Sanford Health in the northern and Midwest tier of the U.S.; Gene Thomas, CIO of Memorial Hospital in Gulfport, Miss.; and Linda Womack RT(R), the executive director of imaging services at John Muir Health in northern California.

CIO Priorites: Connected Healthcare

It has been said that every health system is different; unique in strengths and structure. But as healthcare evolves, the similarities are building and converging. Converging, too, are the priorities of today’s CIOs and clinical IT leaders. Together they rally around shared priorities that support the Triple Aim, such as:

• Overseeing health system growth, mergers and acquisitions;
• Consolidating IT systems and vendors;
• Managing medical images across all ‘ologies;
• Building analytics;
• Interoperability;
• Information security; and
• Enhancing the user experience for physicians and patients.

In a series of four case studies, our CIOs and IT leaders show us how they have put strategies into action. They share, first hand, their goals, game plans, solutions and successes.

Cleveland University Hospitals: Setting Strategies and Priorities

University Hospitals (UH) in Cleveland has made it a priority to unite caregivers and information. This $3.5 billion health system is focused on providing comprehensive community-based care and growing the system via acquisitions and physician employment. IT is at the center of the strategy.

“We’re focused on a growth mandate,” says Foley, who took the CIO helm two years ago. “Specifically, we are expanding and leveraging our operating platform especially in the face of reimbursement reductions. We need to find effective ways to share clinical data, enabling a community view of care, medical records and clinical information across a broader platform. Whether it’s UH-employed, affiliated or independent physicians, connecting the community is a major part of our agenda. We also need to give patients full access to data to try to improve their care and the well-being of the community. Those connections need to be made easily.”

The UH community is a large one. The system’s 1,032-bed, tertiary medical center, University Hospitals, is an affiliate of Case Western Reserve University. UH also includes University Hospitals Rainbow Babies & Children’s Hospital, University Hospitals Seidman Cancer Center, part of the National Cancer Institute-designated Case Comprehensive Cancer Center at Case Western Reserve University and University Hospitals MacDonald Women’s Hospital. More than 25,000 physicians and employees constitute University Hospitals and its partnership hospitals. Annually, UH performs more than 4.5 million outpatient procedures and nearly 63,000 inpatient discharges.

Along with growth, UH has a whole new strategy in IT. Instead of using systems that push information from one hospital and physician to the other, UH is employing personal health records and patient portal technology that encourage patient engagement, allowing patients to view results, request medication refills and appointments, and send secure messages to their physician. UH currently engages more than 56,000 of its patients through the UH Personal Health Record. 

For the physician, the EMR interface needs to be seamless, transparent and easy to navigate. “If the system is not easy to use, we won’t capture the patient data we want. Our physicians are realizing that more digital information, including images, means a more complete picture of the patient’s care,” Foley says. Direct links to Sectra PACS from within the EMR allow physicians to immediately view an image. Physicians also may view the high-resolution image by following a link to the radiology system.

To further enhance PACS connectivity, UH also is building a vendor-neutral archive (VNA) that allows them to store all medical images, including radiology, cardiology, gastroenterology, dermatology, ophthalmology and orthopedics, in one place for easy access.

“Being vendor neutral is key to image management,” Foley says. “Our large image database now stores multiple types of images without relying on a proprietary image viewer.” It also offers a business advantage: part speed, part throughput and part physician satisfaction. The VNA also is essential to UH’s growth initiative through acquisitions.

Simplification and consolidation of technology also is an important part of the UH IT strategy.  “The ultimate goal is to have every facility in our system using the same technology. We could then leverage that support structure to further innovate our systems,” says Foley. Simplification and more effective communication between systems also frees up staffing and reduces maintenance.

It’s a challenge to make the complex simple. But UH is answering the call. The overall goal is patient-centered care. “We need a complete picture of patient health,” Foley says, “from one access point for the physician and another for the patient. It has to be done, and done well.”

Northern and Midwest U.S. Sanford Health: Optimization Across a Large Rural Enterprise 

Offering comprehensive patient-centered care, optimizing its EMR for physicians and clinicians, information security, and standardizing IT platforms are the top 2015 priorities for Broekhuis, CIO of Sanford Health, a health system that has tripled in size over the last four years. Data warehousing and expanding the patient portal also top the list.

“We are focused on [EMR] optimization for physicians, nursing and revenue cycle,” Broekhuis says. “We are taking the electronic health record we have been implementing for more than 10 years and making it hum. Making it more efficient for clinicians and making it better for patients. Making it work better for the organization.”

“We always have to stay focused on security, too,” Broekhuis adds. “It is an overarching goal that touches everything we do. We have a security plan that we update on a regular basis. It is front and center, all the way up to our CEO, having that as a top priority.”

Sanford Health is an integrated health system headquartered in the Dakotas and is now the largest rural, not-for-profit healthcare system in the nation with locations in more than 300 communities in nine states. In addition, Sanford Health has developed international clinics in Ghana and Mexico. Sanford Health includes 43 hospitals, 243 clinics and more than 1,400 physicians in more than 80 specialty areas of medicine. With more than 26,000 employees, Sanford Health is the largest employer in North and South Dakota. The health plan manages 100,000 covered lives. Total operating revenue for the organization was $3.4 billion last year.

An Epic EMR has been central to growth. Sanford Health began deploying the system a decade ago. Today the depth of the deployment is significant: 1,400 physicians are using the system across 37 hospitals.

Across the enterprise, the Sanford team is seeking to more tightly integrate the variety of IT systems they have. Simplifying and standardizing IT systems is the goal. “The fewer [IT] systems and the fewer vendors we work with the better off we are,” Broekhuis says. They are working to bring consistency to applications such as radiology PACS. They run three PACS, but seek to standardize on one.

“We need consistency. It would be in our best interest to have one PACS, not three. There are many reasons to make this transition including better integration and ease of sharing images across our health system. Standardization of applications is definitely our strategy, and we are most of the way there because we have [our EMR] everywhere.”

Image-enabling their EMR and tighter integration is a driver in providing clinical images to physicians across the health system. Via their three PACS, links to images are embedded within the Epic EMR, launching directly into a PACS-based viewer. “As an integrated health system, one of our goals is always to find best practice and to use that across our entire health system. This is an advantage for our physicians, having the access they need. Having images available to all clinicians is vitally important in the PACS world,” he says.

Data warehousing is another item on their 2015 priorities list. Being fairly new to data warehousing, the health system is getting the base platform established and getting consistent data into it. “We just know it is a must for where healthcare is going to be able to do reporting across our entire health system,” he says.

The last initiative comes full circle and back to the patient. Optimizing and maximizing their patient portal is another key project at Sanford. “We are now live with mobile video visits from our patient portal,” Broekhuis says. “We are one of the earlier systems to do that with the EMR. We need to push our applications and offer what patients need and want.”

Gulfport, Miss. Memorial Hospital: Harmonizing Images and the EMR

Memorial Hospital in Gulfport, Miss., has long been a progressive investor in medical imaging, EMRs and advanced surgical techniques. Their strategic decisions are based on six core strategies: customer satisfaction, growth, work environment, finance, quality/patient safety/IT and strong hospital-physician relationships. Another factor weighing heavily on decision-making is their location on the Gulf Coast of Mississippi less than a mile from the water. “That’s why we went remote to host our data,” says Thomas who took the CIO helm about 3 ½ years ago.

Memorial Hospital is a not-for profit, multi-specialty medical complex, jointly owned by the City of Gulfport and Harrison County since 1946. It is one of the most comprehensive healthcare systems in Mississippi, licensed for 445 beds, including an inpatient rehabilitation unit, a behavorial health facility, satellite outpatient diagnostic and rehabilitation centers and more than 80 Memorial Physician Clinics. They are the largest provider of care on the coast between New Orleans and Mobile, Ala.

Patient-centric care is a priority at Memorial. The center of the enterprise is the Cerner EMR that went live in June 2014, standardizing the health system on one EMR vs. the three they had previously. The EMR unites caregivers and administrators and allows data access for patients to play a larger role in their own care. “We focus on the patient and his or her care,” Thomas says. “The data are pretty clear that you get benefit in terms of being more efficient and improving care. Focusing on quality gives you benefits of healthier patients, better patients, lower cost and more throughput.” It also means building a solid and full-functioning personal health record.

Stabilizing and optimizing the EMR and all the systems feeding information to it including PACS, are top of mind for Thomas as is running on maximum efficiency. Memorial has been a long-time Sectra PACS user, as well utilizing Sectra enterprise storage for radiology and cardiology. PACS images and enterprise storage are remotely hosted. Physicians access PACS images via an embedded link in the EMR. “Images are patient-context driven, so when the physician clicks on it, it launches Sectra [PACS]. This replaces access via a physician portal [that we used] before integrating PACS with the EMR.” Cardiology images are in Thomas’ sights in the future.

“The impact for physicians has been huge,” he says. “They can be in the EMR, talking to the patient or doing their own review or doing their own charting, and click and see the images and the reports. They tell me the access is intuitive. That is an advantage.”

Patients have seen a difference, too. “As soon as you walk them through an image, it’s a lot easier for them to understand what’s taking place.”

Building the right foundation for analytics is another of Thomas’ priorities. “My priority is enterprise analytics, clinical, clinical decision support, financial, revenue cycle and supply chain management,” he says.

The ED is one area Thomas sees analytics paying off, in terms of improvements in clinical care and financial savings. “We have 70,000 ED visits a year. With analytics, we want to use the data to look at what resources, human and financial, we are expending [for unmanaged patient conditions]. We want to intelligently identify those patients we can engage with to actually make a difference in their care, and costs, too.”

Reducing cost of ownership is another initiative Thomas is focused on. Specifically, trying to reduce the number of systems and integrations across the Memorial enterprise. “The reasons are clearly financial. The fewer systems and vendors you have, the fewer you have to manage. It means lower total cost of ownership over time because you are reducing the number of relationships, the number of vendors, the number of staff you have to have to manage multiple systems.” Reduced dollars makes sense.

Northern California John Muir: Small, Mighty and Connected

Transformation is never a word to be underestimated in healthcare today. A few years ago, John Muir Health set out on an initiative to use technology to transform, system-wide, the way they work. Patient-centered care was central to change, with the system and its C-level and IT leadership dedicated to investing in technology, people and processes to make it easier for patients to navigate the system. They brought in an EMR and sought to make care more robust, operationally efficient and affordable, says Womack RT(R), the executive director of imaging services and a long-time clinical systems leader.

The health system also set out to offer a single patient record across all caregivers within the network. A patient portal links patients to caregivers, streamlining registration and scheduling and offering easy-to-use online access to clinical information. They established IT infrastructure to allow information sharing with outside healthcare organizations via health information exchange. And, a single patient identifier allows for better coordinated care by removing confusion in patient identification.

John Muir Health is a small, independent health system in northern California known for very high quality healthcare in a state dominated by mega systems. The three-hospital community system, formed in 1997, includes a behavioral health hospital, a level two trauma center, and an acute care hospital.

“John Muir’s philosophy is offering the ultimate patient experience,” Womack says. “Along with safety, patient experience and affordability and the high quality we’ve always had. The Triple Aim: that is our priority.”

Access to and engagement by the medical staff stands out for patients, too. As does integrated patient care like we see with physicians teaming to offer advice via tumor boards. Patients also are more engaged with their care experience. “We need to give them the tools they need, whether it be utilizing our EHR to make appointments or utilizing technology to do call reminders,” Womack notes. “We used to struggle, we just didn’t have the technology in place.”

To expedite patient care, physicians across the John Muir system can access clinical images and reports via the EMR. Images are integrated into the EMR via a hyperlink. Quick access allows them also to achieve national patient safety goals, such as communicating critical results as well as medication reconciliation and patient identifiers.

The physician clicks on a hyperlink inside the EMR to launch the Sectra PACS viewer. Physicians have full access to EMR data as well as images, prior studies and reports. Womack is working on the next step: access to images outside of radiology. “You’ve got all the other ‘ologies that want to store their images, but the problem is many of them haven’t been as stringent as radiology in having a  unique identifier, or an accession number that has not only the accession number, but the patient name and demographics. Basically, they lack demographic or HL7 data attached to the images. They want to put it in the EMR, but to do that, they have to set parameters.”

Once the parameters are established, choosing the right viewer is next on the list. That will be part of a vendor neutral archive project Womack is working on. Having a VNA allows interoperability between hospitals and gives patients more choices in their care. Womack sees a lot of unnecessary tests now due to patients transferred into John Muir because they are unable to get prior studies. “That contributes to the rise in healthcare because now you’re doing unnecessary studies,” she says. “That’s where VNAs help since they have that backbone for interoperability with other organizations.”

Health systems like John Muir also are looking to simplify by reducing the number of IT systems they use and, thus, the integrations they need to manage. “If we can limit the number of interfaces, the data will be richer and we can limit the people it takes to manage the data.”

But it all comes back to patients, Womack says. “Patients are getting smarter about healthcare.  They’re looking at the quality ratings before they make decisions on where to have surgery. We [as health systems] need to listen more to the patient. Patients are getting fed up with the excuses and fed up with why can’t we do it. We need to offer that transparency and interoperability. That needs to be a goal.”

Conclusion

Goals are being achieved and exceeded for sure. Patient-centered medicine is thriving in these innovative health systems and hospitals. But the job is far from done, the experts agree. CIOs, clinical leaders and their teams continue to push the limits of the integrated, interoperable and secure IT-powered healthcare enterprise. They are making EMRs more accessible, user-friendly and asset-rich—and data tied to systems, not vendors. They are unlocking data silos so caregivers can immediately grab resources they need such as images from radiology, cardiology, pathology, orthopedics and many more. Department insight and knowledge are now enterprise tools. Analytics elevate healthcare data into intelligence for patients, populations and healthcare administrators. Health IT leaders also are consolidating data, healthcare providers and amassing intelligence. Collectively, these leading health systems are achieving the Triple Aim: improving the quality of healthcare, enhancing the patient experience and managing and reducing costs of care. As innovators, their quest for truly connected healthcare continues. It is through experience that we gain insight, and through communication that healthcare will continue to improve. One patient at a time.