"That's a major conceptual shifting," says Michener. If DHI can develop a common health record, he says annoyances such as medication lists will become a thing of the past. Such a health record could update and share medication lists across multiple providers.
"We're actually looking at a wireless community in which health related data is shared—with permission—freely across the health system," says Michener. "It's a rethinking of healthcare. Chronic disease is a major problem in healthcare. You can't just deal with this in the hospital and medical setting. You have to include the churches, schools, the health department, and the workplaces in the environment."
In addition to the Duke data, the project teams determined that they want to collect information from non– health system sites such as workplaces and schools (with permission) and upload the data to a single database.
"There's still a lot of work to be done, but the whole notion of having a plan that the community embraces is just such a good thing," Harris says.
Implementation phase begins
In the past, Duke used its EMR data to implement successful changes in the community, such as developing common management plans for childhood asthma that immediately lowered emergency room visits.
Some of the project team interventions will move just as quickly, whereas others will happen over time. For example, the cardiovascular disease interventions will be in place in a matter of months, due in part to the strong cardiovascular department at Duke.
"On the other hand, obesity is probably the most difficult area to intervene on," says Michener. "I think we'll see the schools, the health department, and the county moving fairly aggressively to see what they can do about childhood obesity. The outcomes of that may take longer to measure."
According to Reese, the interventions the DHI team members implement to reduce obesity will likely set off a chain reaction, since obesity plays a role in so many chronic illnesses, particularly diabetes.
Each of the 10 project teams received $100,000 to help them accomplish their work. Funding came from grants from the National Institutes of Health and Duke Medicine. A key feature of the project is that they are not asking for new money to implement the changes; however, several of the teams have collected enough data to seek additional funding.
According to Michener, the project is about taking the money that the United States spends on healthcare and reallocating it so that it's more effectively used to prevent diseases. The recent passage of healthcare reform and the possibility of grant funding may lend some support to the DHI project.
Michener states that the health reform legislation sets aside funds for projects like DHI's.
He believes the project has the potential to become a role model for the entire country. DHI is in the process of sharing its project's best practices at conferences and through published papers.
"If all this does is make Durham healthier, we'll be happy; but that's not the point," says Michener. "The real point is to figure out how to make healthcare better. Over the next year or two, we'll be coming up with outcomes to tell whether our great ideas actually do make a difference. We think they will, but we have to prove it."