Digital Health Newsletter – Winter 2017-18
As the end of the year approaches, we often become reflective and projective, asking ourselves, “What have I accomplished this year?” “How will next year be better?” Personally, I always wonder how a year that seemed to start so slowly disappeared so quickly. I also wonder how to avoid gaining weight over the holidays — my “Holiday 10”! That being said, I want to wish all of you a fabulous New Year. But do not drink too much eggnog — there is much work ahead of us!
We grew tremendously this year and over the past few years. Our numbers continue to rise, and we are acquiring land, breaking ground on new buildings, and expanding across the city. Since 2011, when we first launched the GE Centricity Electronic Medical Record (CEMR) system, student enrollment doubled, staff numbers have increased, and the number of physicians has increased. And all the while, the budget for digital health stayed constant. When some people complain about network speed, security measures, and our EMR, one of the things I ask is, “What are you willing to give up to improve these services?” “More money, more problems” may have been a popular refrain from the ‘80s, but without an increase in funding to match personnel growth, we struggle to meet the needs of an ever-expanding organization.
A reasonable query at this juncture is, “Where is he going with all this?” Over the past two years, I have tried to outline where we are in relationship to the market, locally and nationally. As an organization, we made progress in several digital health spaces. In this short period of time, 100 percent of our Meaningful Use (MU)-eligible providers have met their benchmark measures. This has allowed us to begin transitioning from volume to value (#Journey2Value) with several commercial Healthcare Effectiveness Data and Information Set (HEDIS)/Star programs. We are piloting innovative technology to improve the patient and provider experience, such as palm scanners for identity verification, virtual scribes, and mobile hospital billing. A collaborative project led to the rollout of Phreesia, an online and in-person kiosk designed to streamline check-in and improve patient fee collection.
All of this progress sets the bar even higher for where our journey will continue to take us in 2018 and beyond. For the first time, we shall engage in an Accountable Care Organization (ACO). This allows us to benefit from not only the typical fee-for-service (FFS) model, but also to share in savings based on the efficiency, cost, and quality of our care. If we do nothing, then we lose nothing. However, if we can harness the wins we created over the past years and catalyze them to improve patient scheduling, care coordination, and process-outcome benchmarking, we stand to gain financial benefits, as well as improve our overall standard of care.
Much of this change requires coordinated clinical and administrative leadership to standardize operations and claim efficiencies. This process also catalyzes our recent investment in an enterprise data warehouse (EDW). The EDW is expected to:
- Create a centralized data warehouse (single source of truth)
- Provide reliable internal data and analytics
- Guide participation in clinical contracts, such as ACO risk models
One reason to centralize data is to enhance operational performance. How many times have you wanted a report only to be told, “Put in a request, and it will take two to three weeks.” With an EDW, we can start to democratize and better manage our data to ultimately better serve our patients. Using an EDW to centralize data will reduce resource-hours currently spent managing and emailing manual spreadsheets across campus. The use of Business Objects and Tableau in one online location is fundamental.
If done right, alongside clinical operation standardization, the EDW has the ability to optimize financial and clinical reporting and increase operational efficiency toward future sustainability. Optimizing clinical and claim data together allows us to have stronger outcome prediction, make informed decisions in risk contracting, and improve consumer engagement.
Of course, nothing worthwhile is ever easy. There will be challenges, from the usual assortment of naysayers and stakeholders wedded to legacy ways and legacy tools. This boils down to our culture and how we approach change and growth. Both the ACO and EDW challenge our organizational competencies in care coordination, informatics, consumer behavior modification, medical management, and cost controls. We will need to focus on purpose and not just profit; move away from hierarchies and into networks; transmute from controlling structures to empowering structures; and go from constantly planning (ad infinitum) to experimenting (fail quickly). We need to embrace privacy, but understand that only through transparency can we truly move forward (see graphic below). The question is, are we up for the challenge? I believe we are.
As the video linked above shows, much of our desktop and daily activities have either disappeared or been subsumed by our mobile phones (or tablets). The same can be said of the health care landscape over time. Once upon a time in El Paso, either a physician worked for the university or “put up a shingle.” Those days are rapidly evolving. Texas has the highest number of urgent care and free-standing emergency rooms (ERs) in the nation, and this trend has not escaped El Paso. Patients are faced with an ever-increasing number of options for care. With increasing health care costs and rising deductibles, patients are choosing to stay home and turn to homeopathic remedies. Once upon a time, insurance companies only paid for care. Now they are opening their own primary clinics to capture and manage their costs and quality.
These changes will require more financial risk and better care documentation to justify higher reimbursement. They also require practice modifications and reductions in unnecessary variation, as well as innovative thinking to compete and ensure we continue to give the best care to every patient, every time.
Data Is King
Over the next few years, a steady refrain from the health care community will be, “We need the data.” Data is going to become the currency of health care. This is already the case in other industries where Facebook, Google, and Amazon — just to name a few — are essentially personal data brokers that commoditize bytes of human information into billions of dollars.
In health care, data — disease states, medications prescribed, hospital visits, pharmacy visits, ER visits, the list goes on and on — is being used to determine how to staff hospitals, where and when to build urgent care and emergency rooms, and how insurance companies will pay for all these services in health care.
At a recent Medical Group Management Association (MGMA) conference in California, a speaker stated, “Predictive analytics is now a business necessity for health care … most of us are still stuck in the world of Microsoft Excel, which has limitations on the amount of data it can process. The right technology and infrastructure can make all the difference.” This need to understand health care data has led the American Medical Association (AMA) to launch the Integrated Health Model Initiative (IHMI), a platform it says will help move the health care industry toward a common data model and pioneer a shared framework for organizing health information. Early participants in the project include Cerner, IBM, and Intermountain Healthcare.
As an academic health sciences center, our data has historically been fragmented and uncorrelated, hidden behind multiple layers of bureaucracy. It is only when the data becomes liquid and moves efficiently and securely that a true patient-centered, longitudinal care system can be created. On a local level, the Paso del Norte Health Information Exchange, known as PHIX, is a nonprofit organization created to share health information between health care providers in the community. Our EDW project will do the same for us internally, and with our own direct health care partners, allowing us to improve patient care, streamline operational efficiencies, and become more data-driven. This approach to understanding our data is seen in collaborations that we are making with the American Psychology Association (APA) and others to create data registries specific to our patient population. This allows us to create our own regional and specialty-specific clinical quality measures, instead of using some of the cookie-cutter measures we adhere to presently.
In Other News
- Dynamic Doc/Dragon go-live: University Medical Center of El Paso (UMC) will be going
live with the physician documentation system Dynamic Documentation, alongside the
Dragon dictation system, Feb. 26. Superuser training will begin in January with subsequent
user training in February. This is an exciting step in the Cerner rollout for UMC.
- KLAS: Thank you to all who responded to the recent KLAS study. We are awaiting our
results and will share them when they are available.
- Transmountain Interoperability: One of the initial hopes for the Transmountain Campus, and a primary driver for using the Cerner system on that campus, was the hope for interoperability with The Hospitals of Providence Transmountain Campus across the street. Unfortunately, over the past year, there have been glitches. I am glad to announce that, with help from executive leadership on both sides, Tenet Corporate has agreed to create a CommonWell connection using Resonance technology. We hope that this will allow patients seeing physicians at our Transmountain Campus to have their hospital records fully integrated into our ambulatory record. This project kicks off in February and is expected to be fully functional in the summer of 2018.
Digital Health Team Updates
- The Clinical Information Systems (CIS) team is working on a major upgrade of the CEMR
system to EMR 9.12. This upgrade will bring a host of optimizations and improved provider
usability to the system. CIS will be working with Dr. De La Mora and the Clinical
Informatics Advisory Group (CIAG) to ensure clinician involvement and usability testing.
The upgrade is tentatively scheduled to go into effect in the second quarter of 2018.
- Have you ever been on call in the hospital and needed information from CEMR, only
to discover the system is down for improvements? Well, now, there is an app for that.
It is actually a website, but the CIS team has created an EMR downtime site where
clinic information can be viewed when EMR is offline. The site will be available during
downtimes. The link will be sent out shortly.
- One-hundred percent of TTUHSC El Paso’s eligible providers met CMS MU requirements
in 2017, for the second year in a row! Please respond to connection request emails
from the Office of Clinical Informatics (OCI) so that they can attest on your behalf.
- OCI is working with billers/coders and clinical champions in 2017 to ensure our clinical quality is documented to insurance payer standards. There will be a number of ongoing Billing Refresher Workshops into 2018.
Digital Health Bytes
- Artificial intelligence (AI) is coming for radiology – read here and here
- Blockchain 101 and the future of health care – read here and video here
- Health care combat zones 2018 – read here
- It’s the patients’ data – read here
Please feel free to contact me with any questions regarding our role in the digital transformation of health care.