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Michael Dowling: Advancing Care Coordination Via HIT

Carrie Vaughan, for HealthLeaders Media, December 2, 2010

 "The demands of the future are going to require much more holistic services. So we have to be able to be prepared to do this."

In our annual HealthLeaders 20, we profile individuals who are changing healthcare for the better. Some are longtime industry fixtures; others would clearly be considered outsiders. Some are revered; others would not win many popularity contests. All of them are playing a crucial role in making the healthcare industry better. This is Michael Dowling's story.

Michael Dowling wants to ensure North Shore-Long Island Jewish Health System is viewed as an innovator in the industry, an organization that is at the cutting edge and sets the standard by which other healthcare organizations are judged. Dowling has been the president and CEO of North Shore-LIJ since 2002, and his 10-year goal for the organization is for it to be in the top metric in terms of quality, patient satisfaction, and care coordination and recognized as an organization that puts quality and patient safety at the center of everything. "You want to be in a situation that when people come to North Shore they get the full complement of services, easily coordinated, with total transparency and communication. Where people leave at the end of the day and say, 'That was a great experience,'" he says.

To that end, Dowling is taking steps that place North Shore-LIJ at the forefront of many health reform initiatives, such as the push for electronic health records and the development of accountable care organizations.

Technology is a core component of North Shore-LIJ's strategic plan, Dowling says. "There is going to be increasing focus, properly so, on measuring quality and making sure that we provide the ultimate in safety. There is going to be more focus on care coordination, which is managing the care of the patient not just when they are in the hospital for three days, but managing the continuum when the patient is in different locations. There is going to be a lot more focus on transparency, and it is almost impossible to be able to handle any of this without a strong infrastructure and whole continuum of services, as well as a very robust electronic health system and IT system."

So North Shore-LIJ, which has 14 owned hospitals and a workforce of more than 42,000, announced in September 2009 that is investing $400 million to integrate EHRs in the practices of employed and community-based physicians, and other facility physicians. The health system is offering to subsidize up to 85% of the software and operating costs of an EHR system for roughly 7,000 affiliated physicians through two different subsidy options. Doctors who choose the connected model will receive a 50% subsidy (as permitted by law) for all of the costs associated with buying, operating, and using the EHR for five years.

The integrated model provides an 85% subsidy that includes all of the above, plus physicians would agree to collaborate on the development of and follow clinical care guides that are built into the system and based on nationally recognized standards of care for certain disease states like diabetes and congestive heart failure. Under this model, the community doctors would also agree to report their performance data related to those parameters back to North Shore-LIJ on a monthly basis so that the health system can aggregate that data to determine the impact the program is having on the community.

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