Connecting a Community through Clinical Information Technology

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Connecting a CommunitythroughClinical
Information Technology

• Marc Pierson, MD
• Whatcom County, WA
• PeaceHealth

Relationships are the currency of healthcare.
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Whatcom County, WA

• A story of collaboration among hospital, payer,
  and physicians
• Pop. 170,000 one hospital
• Vision of seamless care and measurable outcomes
  since 1990
• Quality focus, IT to support quality for patients
• Right info, right place, right time

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Secure Healthcare Wide Area Network (CHIN?)

• HInet (http//www.hinet.org)
• Secure community-wide healthcare intranet
• Essential all physicians, many other providers,
  hospital, skilled nursing facilities
• Created by practicing physician lead partnership
  of hospital and payer
• User funded, LLC, breakeven (after 3 years)
• Medical records, registries, medical knowledge
  resources
• E-mail
• Help desk
• Antivirus
• Standards (security, technical)

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EMRs

• Community Health Record (CHR)
• PeaceHealth
• IDX LastWord (CareCast)
• gt90 all labs in county
• gt95 all image results, and now images
• All hosp, ED/Amb Care/Hosp clinic data
• Specialists reports
• Nephrologists
• GEs Logician
• One FM group
• Global Health One
• One multi-specialty practice

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Chronic Disease Registries and Decision Support
Infrastructure

• Community Health Record as front end
• IDX LastWord (CareCast)
• Analytical databases as back end
• Web query presentation layer
• Conditions
• Diabetes
• Asthma
• Anticoagulation
• Congestive heartfailure

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Patient Health Record

• Shared Care Plan ( http//www.patientpowered.org
  )
• Supported by RWJF
• Patient designed for self management and
  communication
• Invite providers, family, friends
• Includes
• Patient preferences, goals, plans, actions
• Medications (linking to EMRs supported by AHRQ)
• Diagnoses
• Linked to Healthwise
• Medical history (in Oct., 04)
• Future--Test results?
• We are committed to standards for
  interoperability
• Continuity of Care Record as future standard?
• 450 users in Whatcom
• Available to entire county this winter. State?

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Medical Knowledge Resources

• MDConsult
• UpToDate
• Micromedex

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Developmental Goals, Objectives, Strategies

• Values made explicit
• Patients, outcomes, decision support
• Long term focus
• Community, patients, seamless care
• Community focus
• Inclusiveness, citizen focused, all providers
• Developed by key stakeholders
• Ownership and governance
• Defines the limits of participation
• Relationships are the currency of healthcare.

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Engaging Community (leaders)

• All stakeholders and functions represented in
  planning and governance--permanently (now
  patients involved in PHR)
• Physicians
• They get their own slide, see next slide

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Engaging Physicians

• "Elected" physician leader from their ranks
• System compensates leaders
• Key opinion leaders organized for visible input
  and dialogue about vision, capabilities and
  limitations, sequence, near term plans, and
  timelines
• Very open dialogues at every opportunity in their
  meetings
• Lots of strategic discussion early with opinion
  leaders,
• then more general audience when you can speak
  from shared perspective, using names of
  stakeholder opinion leaders
• Minimize cost to users (in time and money)
• Maximize benefits from their perspective
• Get the users what they want FIRST
• Support for process work and learning is
  essential
• Invest and build value before asking for payment

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Getting Organized

• Be very clear about
• Vision, values, goals
• Who is going the spend the money?
• Who are the stakeholders
• Get senior leaders committed and engaged
• "THE KEY STRATEGY, for several years"
• "Joint venture with others for the WAN
• Take long view, get all future customers involved
• Joint decision making for EMR
• Make use of EMR safe by shared ownership or
  neutral third party
• US health care is Balkanized
• Direct patient design of PHR (patient health
  record)

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Develop successful collaborative relationships
and partnerships

• Identify stakeholders and their opinion leaders
  (be careful with technophiles)
• Be in respectful dialogue with all stakeholders.
• Involve them as much as they can tolerate.
• Focus upon agreements and common interests
• Displace or manage competitive framing
• Go to them, in their place of business, their
  homes
• Show respect and recognition--how important they
  are to you and to this work.
• Get peers to communicate--doctors, nurses,
  managers, patients
• Create safety and balance of power
• Never make a profit (break even, nonprofit or
  foundation)
• No exploitation, no possibility of perception of
  exploitation
• Balkanization--never forgotten, never forgiven
  injuries
• Government and payers are not in favor--try
  something else.
• They could and should provide support and funding
  but not sole leadership or sole ownership.

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Next Scope of Work

• Get three EMRs connected with PSI
• Interfaces, etc.
• PSI Patient Safety Institute
• E-prescribing for the whole community
• Embed evidence based medicine into the work flow
  and into the EMRs
• (With physician order entry)
• Enhance real time decision support
• (With physician order entry)

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Four Suggestions

• Support standards for EMR interoperability
• Make statewide connected medical records possible
  by supporting PSI
• Patient Safety Institutes technology
• Make the 90 day rule WAC align with HIPAA, no
  more restrictive
• It limits practical ability know how to improve
  care at the community levelChronic diseases
  require this kind of community level information
• Explore the Shared Care Plan as a statewide
  patient health record

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Contact Info

• Marc Pierson, MD
• Work [phone]
• mpierson_at_peacehealth.org
• Web sites
• http//www.wwpp.org/users/0000002/
• http//www.patientpowered.org
• http//www.wwpp.org