Need to innovate driving change in health care IT

CHANGING TIMES: Syeda M. Sayeed, right, using a laptop to review patient information with Dot Graff at Coastal Medical. / PBN PHOTO/NATALJA KENT
CHANGING TIMES: Syeda M. Sayeed, right, using a laptop to review patient information with Dot Graff at Coastal Medical. / PBN PHOTO/NATALJA KENT

It was big news in June when Partners HealthCare in Boston decided to abandon its own “homegrown solution” for IT software infrastructure in order to purchase an integrated software system from Epic, a privately held company based in Verona, Wis., with revenue of $1.2 billion in 2011.
Partners, begun as a partnership between two prestigious academic medical centers, Massachusetts General Hospital and Brigham and Women’s Hospital, is considered a national trendsetter for health care innovation. Both flagship hospitals were ranked in the top 10 best hospitals by U.S. News & World Report in July, with Mass. General earning the top ranking.
Dr. David Blumenthal, the chief health information and innovation officer at Partners, told Providence Business News that the decision was made after a comprehensive review. The hospital’s current software system, he explained, “might perform well in one department, but it couldn’t knit the process across numerous facilities.”
Partners came to the conclusion, Blumenthal continued, that the Epic software package was “best for us, because it was a strong, integrated, single electronic health-information system. It created a platform on which we could innovate going forward, meeting our needs because of its integration, so that there will be one record for every patient.”
Blumenthal, who served as the former head of the Office of the National Coordinator for Health Information Technology, said the new software system will position Partners for the future demands of health IT, population management and analytics. “That’s what we were looking for – a system to take us into the era of high-performance computing, as hospitals and providers take on more risk for quality and cost dimensions.”
Here in Rhode Island, both Lifespan and Care New England, the state’s two largest hospital networks, are paying careful attention. Lifespan is considering making a similar move, according to Gail Carvelli, a Lifespan spokeswoman. “It’s too early to talk about it now,” she said, indicating that Lifespan was in the process of evaluating different potential vendors. The challenge, according to Dennis D. Keefe, president and CEO of Care New England, is how to develop the analytics capability to measure population health in the new global payment world and, at the same time, create a unified platform of electronic health records.
“No one has this figured out yet,” Keefe said, pointing to the experience of Partners in Massachusetts. “They probably had the most highly developed information technology system, all developed in house, all developed to meet the challenges of the future,” he told PBN. “Partners recently said that they are blowing that all up, they are getting rid of it, and they are going to Epic as their new platform, because they were not able to keep up [with the data flow].”
In Rhode Island, Keefe continued, the IT software system is fragmented on the physicians’ side, with five or six physician-based software systems that do not talk to each other and do not talk to the inpatient hospital systems. It is also fragmented on the hospital side, he said. “You have currentcare [the statewide health-information exchange] sitting in the middle, and it really cries out for a solution as we go forward. That has to be the focus of our efforts.”
Keefe added: “I would say this about the Rhode Island Quality Institute, the great thing is, we are all around that table, the health leaders in Rhode Island. Shame on us if we can’t figure this out. We have a lot of work ahead of us to realize the vision of a truly integrated health care technology system.”
To Dr. G. Alan Kurose, president and CEO of Coastal Medical, the decision by Partners to choose new integrated software makes sense. “It has value to enable everybody to be on a common platform, with the ability to retrieve relevant clinical information from different settings of care,” he said. Coastal Medical is one of the health care innovators within Rhode Island, having been recently designated as a “shared savings accountable-care organization” by the Centers for Medicare and Medicaid Services. Earlier this year, Coastal signed a new shared savings contract with Blue Cross & Blue Shield of Rhode Island where improvements in quality and cost containment will be shared between the health insurer and the group medical practice.
The development of new metrics to benchmark outcomes in the new global-payment world requires an analytics engine to perform population health analyses, in addition to the need for an integrated, unified platform for patients’ electronic health records, according to Kurose.
“There is a distinction between clinical data and claims data,” he said. “The work that needs to be done is to marry the two together.”
Currently, Coastal providers employ tablets in their work with patients. Kurose said that he was very satisfied with eClinicalWorks, the software vendor that handles Coastal’s internal software system and has helped to set up patient portals to enable Coastal members to access secure results from laboratory tests, set up appointments and interact with primary-care staff through personal devices. However, in developing the analytical capability needed for shared savings, Kurose said Coastal was beginning to explore third-party analytics vendors.
On an organization level, he said, what they want “is the clinical information available at the point of care.” From the patient level, what they want is access to information in real time. “If a patient’s blood is drawn, [he or she] loves to be able to see the results on their home computer that night,” Kurose said.
Kurose admitted that much of the design of IT software systems in health care has been driven by the needs of providers and hospitals. “What patients want, what they can and should and would need, will probably drive this in the future.” &#8226

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