Health IT Summit: Reliant shares EHR optimization strategies

BOSTON--A large multispecialty group with more than 300 providers, Mass.-based Reliant Medical Group is able to take on financial risk for 80 percent of its patients thanks to its cutting edge work to optimize its health IT.

Larry Garber, medical director for informatics at Reliant Medical Group, shared some of its strategies and experiences in integrating health IT to improve care, health and lower costs during the iHT2 Health IT Summit on May 14.

Garber said Reliant’s structure is built on a solid foundation of EHR systems, patient engagement tools, clinical decision support and health information exchange. The group rolled out its EHR in 2007. “One of the key things is it wasn’t just turned on. We prepopulated it with 15 or more years of data when going live,” he said. In all, the system was prepopulated with 100 million records, including 22 years of laboratory results, 16 years of transcribed visits and 15 years of imaging notes, he said.

“It’s all very integrated,” Garber said of its health IT. All radiology reports, with embedded images, are loaded within the EHR. Even EKG data is stored directly in the system for easy clinical access.

In the area of home monitoring, 200 patients currently receive blood pressure cuffs. In the past, patients had to call into a nurse to record readings. Now, blood pressure data get loaded through the cloud, with batch reports sent directly to a nurse. “It’s an efficient process of engaging patients that makes it easier for everyone.”

One particular standout capability is Reliant’s connection to St. Vincent hospital. “Thirty seconds after ED registration, Reliant’s CCD [continuity of care document] is automatically loaded into the ED’s EHR,” he said. When a patient enters the ED, they check to see if that person is a client of one of their physicians. If so, the physician receives an ADT immediately through the health information exchange, and then it is automatically loaded into the EHR.

“The information is right there so the physicians don’t have to go looking for it,” he said.

Reliant holds at-risk claims data—including medication lists, immunization, allergies, etc.—for 80 percent of its patients, which are all loaded into the records. “We know the full history. And if it doesn’t show the results, it tells me where they are. The alerts are smart,” he said.

For example, he recalled a young patient in Florida who couldn’t recall whether he had received a tetanus shot two years earlier when admitted to the ER. Looking into the HIE, the physician was able to confirm that he received a shot. “We know more about patients than they know about themselves,” he said.

In the areas of clinical and business intelligence, Reliant extracts data nightly from its data warehouse to run analytics reports to identify patients needing extra monitoring or care management. This information loads directly into the EHR, where the user receives it on the front end, he said. 

Reliant also has worked to improve note creation, so the computer can prepopulate portions of notes with historic information. Also, to help unburden physicians, many individuals can add to a note, including the patients themselves through a portal, a nurse while triaging a patient over the phone, a medical assistant when setting up a patient in a room, a transcriptionist and scribes.

For example, a medical assistant can enter the chief complaint, allergies and medications, preferred pharmacy, pending medications that need renewals, full social and family history, vital signs and rooming note, and load the physician’s note template and paste the last summary information into the notes.  “There is great value in patient safety,” he said.

To fine-tune alerts, Reliant also prioritizes how abnormal a lab result is so physicians are appropriately notified and not overloaded.

Also, in the area of medication refills, Reliant uses the logic in CDS so a medical assistant with minimal training can pen a prescription. “It pulls in information, and tells the medical assistant how many refills should be put in there, so when the physician gets it, it gets done in one click,” he said.

Overall, Garber said Reliant has spent $24 million over the past three years on a number of improvements.

"It took six or seven years to get a return on investment. Now we are making far more money," he said.