In January 2011, UK HealthCare became the first organization in the U.S. to get a bonus Medicaid check for Meaningful Use. Years earlier, in 2003 and 2004, the health system took the then-daunting step of installing computerized physician order entry at a time when the Leapfrog Group was touting CPOE as one of its four key "safety practices."
"The very first thing we did on the inpatient side was CPOE," Steltenkamp says. CPOE usually is one of the toughest pieces of clinical IT -- the medical staff at Cedars-Sinai Medical Center in Los Angeles rebelled against a poorly implemented system in 2003 -- but UK HealthCare got it done and has been refining it for years.
But the order sets at UK had gotten unwieldy. "We have too dang many," Steltenkamp says. So UK is updating its technology as a beta customer of Elsevier's InOrder cloud-based system for creating and managing order sets. For example, the health system had nine order sets related to stroke care across its main UK Chandler Hospital, the adjacent Kentucky Children's Hospital and the UK Good Samaritan Hospital. It has condensed those to two. A pediatrician who practices part-time, Steltenkamp sees her clinical background as helpful in understanding how to cull order sets and build useful ones backed by proper medical evidence.
As a CMIO, her challenge is to apply data to deliver actionable knowledge at the right point in the workflow to help clinicians make "judicious decisions," she says. Steltenkamp looks at the multitudes of clinical data UK HealthCare has compiled and deems it "untapped."
-- Neil Versel
The need for practical health IT was one reason the University of Pittsburgh Medical Center in 2010 created its Technology Development Center, with Kaul as president. The other was the chance for UPMC to cash in when it helped hone a new technology. TDC finds a problem UPMC faces and makes an equity investment in a startup trying to solve it or creates a joint venture with an established vendor. UPMC's edge, Kaul says, is that it can provide insight into the problems vendors can't get on their own.
TDC is investing in three main areas: visualization to help physicians make sense of data; collaboration to help groups involved in care use the same data; and data transformation, such as projects with Nuance and Optum to use natural language to pull insights from verbal notes. Kaul also is looking at decision support systems for potential investments.
-- Chris Murphy
In 2005, Reliant Medical Group (then known as Fallon Clinic) decided to switch from a homegrown medical record system it had used since 1992 to Epic electronic health records. The company's leadership knew the value of historical data and wanted to keep its records. So Garber personally mapped more than 100,000 terms used in the legacy system to Epic terms. "It took a year off my life," Garber says with a laugh. "But it was absolutely worth it." Reliant transferred more than 100 million records, such as lab tests and medications. Reliant got its modern EHR, but with data as if it had been on Epic for 15 years.
Garber is an internist who spends about a quarter of his time practicing medicine and the rest as director for informatics at Reliant, the 250-physician group where he has worked for 27 years and which is part of the Atrius Health Group of practices.
In retrospect, Garber sees three pillars that were critical to the Epic rollout: value, meaning all stakeholders get something out of moving to the system, since it did take a lot of money and time; usability, which meant spending a lot of time on interfaces and workflows so the EHR helps in the care of patients; and trust, which came from factors such as getting many clinicians involved in the implementation and relying on staff instead of consultants to implement it. Clinicians including Garber spent three weeks at Epic's Wisconsin HQ to become certified, as did in-house IT pros.
Today Garber is putting a major emphasis on automation and connectivity -- what he calls "hassle free" health information exchange.
For example, there are the interfaces Reliant built with five hospitals, so that when patients are discharged, their follow-up instructions and medications are automatically sent to physicians with an alert. A decision support system looks at new medications and sends an alert three days after discharge, flagging possible tests -- say, a potassium test if the patient was prescribed a diuretic.
In addition, if the patient is 65 or older, the physician's staff gets a message to schedule a follow-up visit, since those visits have proven effective in preventing readmissions. This kind of automation "is the key to health information exchange," Garber says.
Reliant in the coming months will start using the Mass HIway HIE, which will allow interfaces to be built once and used for many area hospitals.
When Garber isn't practicing, he sits near fellow members of a team focused on applications. While big decisions go to a governance committee, many changes and fixes happen based on quick conversations among that small team. Garber hears a lot about analytics, and he doesn't doubt the importance of looking at historical data. But "what's most important is to get the actionable data right to the front lines," he says. At Reliant that means loading claims data into the EHR, since that might show a person got a tetanus shot while on vacation in Florida that otherwise wouldn't hit the record.
-- Chris Murphy