Pressure Points This is the sixth in a series of special issues taking a closer look at the factors shaping modern medicine.

Are We Wired for Change?

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URMC’s IT Staff Busy Building ‘Scaffolding’ for Reform


If you want to know more about health care reform, here’s a simple suggestion: Grab a cup of coffee with someone in IT.

See, reform can’t happen on paper. Its ideas are too lofty, too complex. They’re only achievable with smart technologies—and such infrastructure only gets built if a small army of really smart people scramble to help bring the vision to fruit.

Enter URMC’s Information Systems Division, made up of clinicians, programmers, and business people. We sat down with leaders there to scan their to-do lists and get a better grasp of big trends that have them scurrying. Below, we’ve summarized key themes; together, they bring the sea change ahead into sharper focus.

The mammoth to-do list

1. Really, really integrate enterprise applications.

We know, that probably sounds like tech-speak. But here’s the scoop: Ever since launching eRecord, our grand vision has been to improve the patient’s experience with “one patient, one record”—a single, authoritative account of their unique care journey, shared amongst all the providers they interact with (at URMC and beyond).

eRecord has largely achieved this, but not perfectly. Some of our electronic care delivery systems are still niche, departmental solutions; they merely swap data with eRecord thanks to behind-the-scenes programming that stitches two systems together. But as we gradually invest in replacing these departmental solutions with official Epic (the vendor behind eRecord) programs, we’ll enjoy the true integration we’re after.

Specifically, over the next few years, we hope to adopt Epic’s software for OR, anesthesia, and cardiology care (dubbed ORCA), and longer-term, for radiology and transplant services. Perhaps most dramatic of all, Epic’s Patient Access and Revenue Cycle application will replace our two separate patient registration, scheduling, and billing solutions: Flowcast and HBOC Star.

2. Build tools that more deeply engage our patients.

Health care reform, at its heart, wants Americans to live healthier, fuller lives.

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That’s obvious. But it means finding out-of-the-box ways to involve patients and their families in their care. It means redefining “medicine” from something that happens in hospitals and clinics, to solutions that help patients maintain good health right in their own homes and workplaces.

So, what if a diabetic’s finger-stick glucose readings could be ferried, wirelessly, into their health chart, so that a care manager on the other end might be alerted if numbers dip perilously low—or stayed too high? What if that care manger, concerned, could zip off an e-mail, suggesting that the patient start stocking her fridge a bit differently—or up her insulin dosage?

It sounds futuristic, but those are the sorts of cool strategies being baked in to new health technologies, and could be commonplace in only a couple of years. (While we’re on the topic, it’s worth mentioning that the government has spelled out Meaningful Use criteria that measure how well clinicians and patients are taking advantage of these sorts of new tools. If we hit the right marks, proving we’re making “meaningful use” of applications like MyChart, we’ll receive funding to offset the technology’s cost.)

3. Think bigger: Keep whole populations healthy.

This is the game-changer: America is switching gears from thinking of health care as a series of reactive, crisis-type encounters, and instead embracing a big-picture approach that anticipates needs and improves outcomes, striving to keep whole populations healthy. But how do you steward the care of such a broad group? How do you preempt emergencies and stave off disease?

You start by working together across a region. To be blunt, population health management screams for unprecedented cooperation—and requires simple, easy-to-use information technology tools that stretch across the whole spectrum of “accountable health partners,” bringing together employed physicians (like our URMFG faculty practice), independent community providers, skilled nursing facilities, even out-of-town affiliates to focus on one goal: keeping patients healthier at lower costs.

Even with common care management tools, we’ll also need “metric scorecards” (e.g., real-time insights like: How many patients are overdue for mammograms? How many are maintaining a healthy weight?) to guide us as we focus on offering higher quality medicine at a more affordable cost. These kinds of information technology solutions will help affiliates keep a pulse on population-level challenges, and problem-solve, together. They’ll also make for smoother, safer hand-offs as patients travel from one facility to the next.

4. Meet, then exceed, federal expectations.

IT priorities are shaped, in large part, by government pressures to perform well.

That means our IT systems have to help us monitor, measure, and report our adherence to quality standards that, in turn, influence our revenue stream. The big buzzword, here, is value-based purchasing: the Centers for Medicare and Medicaid Services (CMS) wants to reward hospitals that perform best on a constellation of specific quality, safety, and efficiency measures. There are painful penalties, too, for hospitals that underperform in terms of excess, unplanned readmissions, and hospital-associated complications (“never events” like infections, bed sores, and wrong-site surgeries).

To keep a close eye on our data, we need sophisticated yet easy-to-interpret, dashboard-style reporting tools.

5. Squeeze data to its full potential: that is, leveraging “secondary use.”

Reform glorifies smart, strategic savings. And what could be smarter than pioneering ways to reuse the data that technology systems are already so eagerly gathering?

What if the same patient charting tools that help doctors collaborate across a community could also flow into research warehouses, where the info would be de-identified, crunched, and scrupulously studied? And what if that data then gave scientists new insights and predictive power, so they were able to forecast which patients might be destined for chronic conditions—or, which patients might benefit most from certain interventions, or certain medications? Or, most exciting yet: What if your genetic signature could inform your care team of your future health risks, so they could help you shape a lifestyle that might delay or altogether halt that disease process?

Again, it seems like something suited to Tom Cruise in his next science thriller—but it’s actually the stuff of right now. Predictive genomics are alive and well, as doctors unravel genetics to better match types of chemotherapy to breast tumors. In the same vein, we anticipate that e-charting data will begin to influence intervention strategies that can keep patients on healthy pathways…and in turn, trim the national health care tab.

For their help with this article, we tip our hats to Chief Information Officer Jerry Powell, Chief Medical Information Officer Dave Krusch, M.D. and, Senior Director for Clinical Enterprise Information Technology, Dawn DePerrior.

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