AMDIS: Innovation and commercial EHRs

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BOSTON—“Medical logic modules are the motor of our EHR,” said Kenneth Ong, MD, MPH, CMIO of New York Hospital Queens, speaking at the AMDIS Fall Symposium. The facility has focused on clinical decision support interventions to improve quality through the use of 229 modules, he said.

Ong said he spoke with someone from a Texas facility that has 800 separate rules. The problem with that, however, is that they all have to be maintained. With that volume, facilities need to question whether it’s worth the trouble to build them.

Another challenge is the misalignment of quality measures, Ong said, which has affected his facility’s efforts to maintain its stroke center of excellence status. The hospital spent $200,000 to analyze its clinical quality measures but they can’t use the system because the Centers for Medicare & Medicaid Services’ measures are different than both the state of New York and the American Stroke Association’s Get with the Guidelines’ measures.

Andrew Karson, MD, MPH, internist at Massachusetts General Hospital in Boston, discussed Partners HealthCare’s migration to a commercial EHR and how that will impact the best of breed system the organization has had in place for many years.

“There are lots of niches with innovative silos and there are a lot of silos. That is expensive to maintain,” he said.  Several factors drove the decision to implement a new EHR including the shift from volume to value, risk sharing that requires tighter coordination and integration of care delivery, personalized medicine and heightened demand for healthcare reform from all sectors of the economy.

Partners’ new eCare Structure involved a process redesign. “Partners institutions each have had a robust set of activities to make processes better.” The goal is to take those best practices and converge them with the offerings of the new EHR. To facilitate that effort, Partners has several teams, including clinical informatics. This team is focused on clinical decision support, knowledge management and terminologies. “We’re going to be looking at our processes and taking the best of both worlds and think of how to do this in a timely way.”

Partners also is in the process of establishing an Innovation Council which is in the process of defining itself and determining how to stimulate external and internal innovation, how to disseminate new ideas and how to fund them. Another newly established group is a prioritization framework subgroup focused on how “PIRC”—priority, impact, readiness and complexity. “As people propose innovative ideas, we want to think how to prioritize to support our mission and create value. How complicated is it to execute in our environment?”

Karson said Partners is “at the very early stages of our journey with this commercial EHR and attempting to innovate mainly through process redesign. We’re attempting to innovate mainly through process redesign, fostering innovation and prioritizing efforts.”

When asked about physician engagement and usability, Ong said department chairs are part of the clinical decision support committee which allows for their participation from the beginning of an effort. Karson said that many of Partners’ homegrown systems were built by the providers using them. “In the new environment, we’re hoping to have usability testing labs because if something is not usable, it’s torture for everybody.”

Both speakers said healthcare delivery organizations would be well served by a private-public partnership that created a website posting various interventions. It could explain where rules have been used and the associated outcomes, Ong explained. “It would be good to have a place that we can all go to and share this information. We should all be using our vendors to learn from other customers. We need to learn from each other outside and above our vendors.” The effort is full time and takes a whole team, he added.

Karson said Partners is working on having clinicians own workflow redesign and “make them advocates of change. We’re trying to set the stage for that.”