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Robert V. Stanek
President and CEO |
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January 2010
Imagine a world where that your medical records are always available…and constantly updated. That means the X-ray you had two weeks ago, the blood test you took two days ago, and the medication changes that your physician just made two hours ago are all part of your medical record.
Imagine the creation of a system that supports the decision-making of your physician so that he/she is “hard-wired” to the hundreds of research findings and clinical trials and new ways to treat different conditions that arise constantly. Imagine a world where evidence-based care is the norm.
Catholic Health East is doing more than imagining this world…we are in the midst of planning it…and building it….one process at a time. Supported by advanced information technology, we are in the process of transforming the way that we provide acute care to patients throughout our health ministry.
The landmark 2009 Governance-Management Conference (Mission Possible: Building the Bridge to Person-Centered Health Care) brought hundreds of CHE clinicians, board members, Sponsors, and leaders together to learn about and plan for the evolution of our health system into a person-centered health care system…focused on respecting and responding to individuals' preferences, needs and values.
As described at that conference, CHE’s journey to person-centered care would take time; our ministry committed to working together to “build the bridge” to person-centered care over the next few years. Among the key components of the bridge detailed at that meeting were IT Enabled Information (this referred to storing and accessing data from multiple sources, monitoring data, using data in evidence-based care and clinical decision making) and the development of electronic medical records.
The Journal of the American Medical Association defines evidence-based health care as “…the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. Evidence-based health care requires integration of individual clinical expertise and patient preferences with the best available external clinical evidence from systematic research, and consideration of available resources.”
“Doctors, after all, are human beings,” says Tom Garthwaite, MD, CHE’s chief medical officer and one of the champions of the health system’s movement towards evidence-based care. “Their own personal experiences cannot help but make a lasting impression upon each physician, and could understandably influence the way that physician treats similar patients in the future. But because different physicians have different experiences, there is an enormous variation in the way that doctors treat patients…even for patients who share the same diagnosis.”
One of the provisions of the American Recovery and Reinvestment Act of 2009 incentivizes the adoption of certified electronic health records (EHRs) by offering bonus payments for hospitals participating in Medicare or Medicaid if they become “meaningful users” of certified EHRs. Why is the government providing these incentives? Together with all of the health care reform efforts that are being contemplated, the belief is that the massive adoption of EHR nationwide is critical to reducing costs and improving quality.
While CHE hospitals were already on the path towards implementing evidence-based care models and electronic health records systems, the opportunity to take advantage of ARRA stimulus money to help fund this enormous investment in information technology systems and staff proved to be an incentive for Catholic Health East to “fast-track” its implementation schedule.
CHE’s journey towards evidence-based care and the development of a “paperless” medical records system via the use of electronic health records will cost our hospitals an estimated $300 million over the next ten years. Now, if we move our internal timetables up to introduce this technology and become “meaningful users” by the government’s target date, we estimate that CHE facilities will be eligible for about $100 million in ARRA stimulus funds. That is an incentive that we all agreed we needed to pursue.
To have any chance for success, CHE’s leaders needed to all be “on board” with the Vision for change. All RHCs needed to work together to clinically transform our ministry to meet the needs and expectations of our patients….and to provide person-centered care…using evidence-based care concepts…while committing to work towards a paperless health system.
In September 2009, RHC CEOs, chief medical officers, and chief information officers were invited to a meeting at which the “game plan” for this massive, multi-year initiative were explained in detail. The group agreed that, in order establish evidence-based care as the “norm” throughout CHE, specific measures, assessments and tasks needed to be established and accomplished. Among these were core measures, technology assessments, standardized documentation, order sets, and computerized provider order entry (CPOE).
Change of this magnitude requires time…and the commitment of many individuals. One of the first highly visible “commitments” was the November 10-11, 2009 meeting that was dubbed “Decision Day”. Over 120 colleagues from across the system came together for ‘Decision Day’, an important get-together where the group reviewed key decisions that we wanted to ‘make together’ that would drive our enterprise model for evidence based care. There were breakout sessions for the Steering Committee, for clinical content (order sets and care plans) and for clinical process improvement and workflow.
On December 9-10, 2009, physicians and other clinical colleagues from throughout CHE met to initiate and actively participate in the order set design process. The 38 physicians present represented six specialty areas: internal medicine, emergency medicine, general surgery, cardiology, OB/GYN, and orthopedics. Other participating clinicians included nurses, pharmacy, physical and respiratory therapists, as well as a representative from spiritual care. Twenty order sets were developed over the two-day session; several additional “virtual” planning sessions were scheduled to run through early 2010 to enable the groups to complete their order sets.
The plan is to configure order sets for common procedures in these six specialty areas that can be built, configured, and tested during most of 2010; the first “go live” is currently scheduled for November 2010 at St. Mary Medical Center in Langhorne, PA.
Sound complex? It certainly is…but the rewards for our patients and colleagues are almost incalculable. The promise of a better, safer, higher quality, person-centric health system calls us all to commit ourselves to change. And by striving to achieve these goals – which are key components of the health care delivery model we envisioned in our Vision 2017 – we are truly taking giants strides towards our achieving our Mission of being a transforming, healing presence in the communities we serve.
Sincerely yours,
Robert V. Stanek
President and Chief Executive Officer,
Catholic Health East
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