information about the patient, but then to take action then can toggle into the underlying systems -- for example, by accessing the ePrescribing module of Cerner's EMR without the need to enter another password. One important aspect of this integration is that it preserves context, pulling up the record for the appropriate patient as the user toggles from one application to another, bypassing login screens and layers of menus.
At least that's how it works in the demos. UPMC currently has 75 or so active users of the system, which it initially piloted in its cardiology department and is expanding for use by hospitalists.
"Our clinicians are asking us for stuff all the time," says Vivek Reddy, chief medical information officer of UPMC's Health Services Division. Doctors' frustration with EMRs has given them an unfair reputation as Luddites, Reddy says, when really their frustration is that EMRs replicate paper processes that were broken to begin with. Instead of merely hustling to keep up with government regulation, the thrust should be "let's actually do something interesting," he says.
Apps such as Fluence are at least beginning to get at "what we always wanted and what we always thought the EMR would eventually do," Reddy says. Left to their own devices, EMR vendors treat innovation as a matter of adding a button here or a button there, he says. Rather than having to dig through screens and tabs of information, clinicians want software to "highlight things that need attention and bring them to the forefront."
Mining ailment combinations
Elsewhere, UPMC has started a venture called Evolvent, which it cofounded with the Advisory Board Company, aimed at perfecting the business model of an integrated health system and the preventative care discipline for controlling costs known as population health management.
Another new venture UPMC is involved in, Health Fidelity, emphasizes the use of natural language processing software to sift important details out of unstructured medical records such as physician notes. Health Fidelity was an independently formed Silicon Valley startup, but UPMC came in as its biggest investor and helped recruit its CEO. Health Fidelity already had an initial product under development, but with UPMC's help is preparing for a bigger push to commercialize it.
The goal of Health Fidelity's data mining is to identify what in Medicare lingo is known as Hierarchical Condition Categories, or combinations of ailments that can be used to identify high-risk patients. By identifying them, "we can focus on that person" and prevent their conditions from getting worse, Shrestha says. Health Fidelity is an example of automation simplifying what had been a labor-intensive process; UPMC was already sending people to doctors' offices to try to identify those high-risk patients, he says. "We thought we were doing a great job until we saw what was possible," Shrestha says.
A parallel effort for inpatient care is UPMC's clinical document improvement initiative, aimed at improving the structured data available for analysis and quality reporting, as well as accurate insurance coding so UPMC can get reimbursed properly for all the care it delivers. Here, the emphasis is on combing through EMR data to find records that are incomplete.
For example, a patient record might show a high body mass index without that patient having been specifically coded as being obese. A nurse reviewing the record can query the doctor electronically and get him to confirm -- with a click of a button or two -- that the record should indeed be coded as suggested. UPMC said the result has been at least a $32 million boost in money collected for its services.
Through a joint venture with GE Healthcare, UPMC is working on a next-generation digital medical imaging system that also integrates the process of ordering radiology studies and documenting the reason for them. The imaging desktop software addresses a range of specialties, including radiology, cardiology, and pathology, as well as support functions such as IT and scheduling.
One goal is to reduce the number of unnecessary images produced -- and doses of radiation delivered to patients in the process -- by eliminating duplication and making sure everyone has an incentive to improve health outcomes rather than just accumulate more images. On a technical level, GE and UPMC are trying to simplify the storage and organization of those images with a vendor-neutral architecture. The development team consists of 40 people in Pittsburgh, half from UPMC and half from GE, backed up by another 300 GE Healthcare employees.
Yet another branch of UPMC technology investment is focused not on the hospital or the doctor's office but on remote care. Although telemedicine experiments have been going on for a long time now, UPMC sees the potential for broader consumer adoption as mobile technology allows video consultations and secure messaging from a smartphone or tablet. It could help get people with non-emergency conditions out of the emergency room. As chief medical officer Reddy puts it, the vast majority of patient ER visits boil down to a simple question: Is this serious or not? Often, answering that question doesn't require an in-person visit.
"I dream of a day when 85% to 90% of healthcare isn't done inside of a healthcare place," Reddy says. "That's scary to some people, but I don't understand why it's not already like that." In no other part of our lives but healthcare, he says, does technology move so slowly.
UPMC says it's dedicated to making it move faster.
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