CMS eHealth Summit: Driving better care delivery

“Our singular focus has been to keep patients as far from the hospital as possible. That has been key to our success,” said Larry Garber, MD, CMIO of Reliant Medical Group in Worcester, Mass., speaking during a session on how health IT is impacting care delivery and payment reform at the CMS eHealth Summit. “If I keep patients happier and healthier I make more money. We have had some of the highest quality scores in the country.”

“Small changes make big deals in Delaware” since it’s such a small state. “A little ripple quickly becomes a tsunami,” said Margot Savoy, MD, medical director of family medicine centers and youth rehabilitative services for Christiana Care Health System. As the first NCQA-certified patient-centered medical home in the state, that “requires rethinking how you practice care and the way you’re going to deliver care.”  

Kevin Larsen, MD, medical officer for Meaningful Use at the Office of the National Coordinator for Health IT, said he and his colleagues are working to “help support widespread adoption and deployment of health IT in getting to a new kind of healthcare system that promotes value, coordination and health.” MU as a program is just a start, he said. “It’s a way to help assure that some key attributes are present in practices and in communities across the country. Health IT is one of the change agents of my time. It’s been slower in healthcare for lots of good reason but when you see it happen it is truly transformative.”

Another key to Reliant’s success, said Garber, is a single EHR with “extraordinarily good patient engagement tools. Tightly integrated into that EHR are data analytics and reporting tools as well as a robust rules engine. We can rapidly elucidate knowledge and turn that right back into the workflow of how we care for patients.” That only works, he said, when providers have access to all information on patients, which is why Reliant has put a lot of effort into its region’s health information exchange.

The medical group also loads its patients’ claims data directly back into the EHR weekly and prescription claims are loaded on a nightly basis to populate the medication list and for population health maintenance. Mammograms, colonoscopies, immunizations, diabetic eye exams and more show up in the record. “When I get an alert [the patient] truly is overdue for something so I can focus energy on making sure they are taken of.”

Meanwhile, Christiana is in more of a transition stage, said Savoy. The organization is working on preventing physicians from spending time trying to find the right place for the right data element. “Physicians spending time during visits both listening to patients and making sure data are in the right spot is a really difficult thing to do. The data is there and exists in a lot of EMRs but getting it back out is a challenge. It’s not nearly as simple as it should be. Once we figure that out things will change and we can use information to make the lives of physicians and patients better.”

Larson cited providers who are leveraging data they already have on utilization and care outcomes to identify people with a history of high utilization or likely to have a high utilization in the near future. Through retrospective and prospective analytics, they can target interventions at groups that have big care gaps. For example, assessing patients’ likelihood of falling and how much assistance they need “has helped us do planning and keep people living healthy at home with the right amount of supports. Plus, we can scale this across a practice or regional setting.”

Larson also is seeing more sophisticated tools where people can use this data to assess likelihood of certain conditions, such as cardiovascular risk. “We are starting to think in new ways of how to use our data.”

Regarding future health IT innovations, Savoy said, “What vendors say and what they provide are not the same thing. Things that should be very simple get made very complicated when handed off to the vendor.” She said her organization recently upgraded its ambulatory EMR which turned two to three pages of patient instructions into six pages full of information patients don’t want to read and don’t care about. Her specific instructions were at the very end and feedback indicated that most patients were just throwing out all of the paper. Her patients are asking for text messages rather than having to log into a portal. “From a patient perspective, things don’t match what’s already in their pockets” like smartphones.

“Consumers are going to drive the next round of innovation,” said Larson. He predicted a registry system where patients can track their own response to treatment for conditions that require frequent tweaks in treatment and shared tools that allow both patients and physicians to use data to drive good decision-making. “That gets the whole system more knowledgeable because we can then aggregate and understand which therapies work and for whom.”