CIO and chief medical information officer share lessons learned on electronic health records, embedded intelligence, risk reduction, and personalized medicine.
Consult with your doctors early and often. That's not just good advice for patients; it's what Stephanie Reel, the top IT officer at Johns Hopkins Medicine, says healthcare technology leaders must do to master intelligent medicine.
Speaking at this week's InformationWeek Healthcare IT Leadership Forum in New York, Reel, head of IT at Johns Hopkins Medicine since 1994 and Chief Information Officer at the University since 1999, said the institution's success in technology innovation is directly attributable to its habit of involving clinicians in IT projects. That point was backed up by Dr. Peter Greene, Johns Hopkins' Chief Medical Information Office, who joined a panel discussion I led exploring "What's Next In Intelligent Medicine."
There have been plenty of innovations at Johns Hopkins Medicine, a $5 billion-a-year organization that includes a renowned medical school, five hospitals, a network of physician offices, and massive research operations. The institution was among the pioneers of electronic health records (EHRs) through a clinical information system deployed in the early 1990s. The effort succeeded, Reel says, because it was initially supported by half a dozen clinicians who worked with IT to develop the system.
This interdisciplinary group has since grown to include about 75 people, and it still meets every month to "listen to the people on the front lines who are trying to make a difference," Reel said.
Johns Hopkins' clinical information system has evolved to embrace the latest EHR technologies, and it has also become the foundation for what Johns Hopkins calls "smart order sets." These order sets have built-in checks, balances, and analytics to ensure that appropriate procedures, tests, and protocols are followed as appropriate for each patient.
Among the hundreds of smart order sets now in use at Johns Hopkins, one guides decision on appropriate regimens for diabetics. Hundreds of variables and possible recommendations are preprogrammed into the order set, but the right regimen is determined though the combination of known patient history, up-to-the-moment clinical measures, and feedback provided by doctors on a series of questions conditionally asked by the system based on known patient data and the clinician's answers to key questions.
Smart order sets are developed by specialists and extensively studied by peer-review groups before they are embedded into patient care workflows. "The challenge is that you have to do a lot of custom work that isn't included in off-the-shelf EHR products, so you can't take on everything," said Greene.