Beyond Meaningful Use

SETMA has invested more than $300,000 in data-mining software that it has embedded into the EHR to monitor nationally recognized quality metrics and HEDIS measures, which are used by more than 90% of health insurance plans to demonstrate that their members are receiving quality care. The medical group can now audit its performance on these measures on a daily basis. Next, it will use evidence-based medicine to define quality goals and then use the data-mining software to ensure their treatment protocols are being followed and used appropriately. Lastly, SETMA plans to use the data to change physician and patient behavior to yield better outcomes.

SETMA's public reporting, disease management, and EHR measurement tools are available at no charge at www.setma.com.

Electronic health records need to enable providers to evaluate themselves, be able to audit providers who are not inclined to improve themselves, and report those findings to external agencies and the public, Holly says. That way, "people can start picking providers based on those who are giving the best quality of care based on measurement sets that reflect quality of care in various settings."

Physicians are still concerned about sharing all of this data, acknowledges Simon E. Prince, MD, president of the medical staff society for North Shore University Hospital in Manhasset, NY, and partner in a five-member physician practice. Prince's medical group will be one of the first to take advantage of North Shore-LIJ's 85% subsidy for EHRs. "We can get a state-of-the-art EHR at a rock bottom price and qualify for stimulus money," he says. His group opted for the larger subsidy, because "it is only a matter of time until this data is out there anyway," he adds.

Easing physicians' fears about how the data will be used and conveying the real motivation behind North Shore-LIJ's plan is a huge challenge, says Dowling. The health system has to break down physicians' hesitancy about working closely with hospitals. "There is a little bit of ambivalence sometimes about what the real motivation behind this is," he says. "'Is the hospital trying to do something to us?' rather than thinking 'What is it doing with us?'"

To get physicians onboard with the plan, Dowling emphasizes that the investment is about quality, not technology. "Organizations have to look at this as one way to share information, use clinical protocols, and be more transparent so that the industry can demonstrate better outcomes and improve care for patients."

Physicians are in love with their iPhones and all of the apps that can connect them to their patients. But as these applications evolve, organizations will need a way to track what information the physician sees. "Right now you can't assume that certain labs have been checked, so when there are critical values those phone calls still need to be made," says Maureen Swick, RN, PhD, vice president of patient care services at Saint Peter's University Hospital in New Brunswick, NJ.

Organizations need a way to automatically document in the EHR system when a physician accesses and views information on his or her iPhone or BlackBerry. Only then will the technology save the nurses' time making multiple phone calls, says Swick.

—Carrie Vaughan

Home health devices will play a pivotal role in improving outcomes for patients and reducing healthcare costs. From a patient care perspective, if they don't have to constantly leave home to interact with a healthcare provider or if it is easier for them to access their record, it is a more patient-friendly approach to care, says Maureen Swick, RN, PhD, vice president of patient care services at Saint Peter's University Hospital in New Brunswick, NJ.

Saint Peter's is in the process of partnering with the Visiting Nurse Association to provide home health monitoring devices throughout their community at adult living facilities and adult community centers. Patients with chronic conditions like congestive heart failure who are part of the program will be able to enter information such as their weight and the evaluation can take place electronically. "The nurse is right there, so if the patient has any questions or if a modification needs to be made to their diet or medication, the nurse can intervene with them," says Swick.

"Most patients with CHF are usually readmitted within first few weeks of discharge, so by having this type of technology and ongoing monitoring out in the community, it definitely reduces chances of being readmitted," she says. From a quality of care standpoint, it makes sense to provide these devices, but now with the potential for declining reimbursements based on readmissions, organizations have another incentive to help patients monitor these types of disease states more closely at home or within the community.

Right now providing such services is tough for healthcare organizations to afford, says Ludwig Johnson, vice president of information services at Middlesex Hospital, which has the largest home care agency in Middlesex County, CT, and provides disease management programs under its charity care offerings. "From a financial perspective it is probably not the best thing for us to do, but from an operational perspective it makes a lot of sense," he says. "A big part in what we are going to be doing in the future is having those devices and providing care in places external to the hospital or even a nursing home."

But the ability to connect wireless and home monitoring devices to EHRs is coming faster than the workflow to support it, says Michael Oppenheim, CMIO at North Shore-LIJ. "If my pacemaker is transmitting a problem, how do we manage the workflow and process it through a midlevel and bring it to the physician's attention swiftly."

—Carrie Vaughan

Maureen Swick, RN, PhD, is looking forward to the day when technology enables her to spend more time at the bedside, communicating and educating patients and their families rather than chasing down lab results and making multiple phone calls to physicians.

Electronic health records, mobile devices, and smartphones will help enable a much more coordinated and less redundant approach to care for patients, says Swick, who is the vice president of patient care services at Saint Peter's University Hospital in New Brunswick, NJ.

Swick explains that physicians can save valuable time by accessing the patient record from their office or PDA at the same time nurses are electronically documenting medication at the bedside and social workers are electronically documenting conversations with family members in the patient record. "[Clinicians] will have access to the total patient care experience," says Swick.

Having electronic access to patient information makes it easier for everyone to do his or her job, agrees Michael Oppenheim, CMIO at North Shore-LIJ in New York. If a patient comes into the emergency department and doesn't know what antibiotic he is on, it handicaps the physician because it's a key piece of information, he explains. But if the physician can access that information electronically, he knows right away what medications to avoid prescribing.

"When you take it to a more social, interpersonal level—hopefully we are all driven by providing the best care—it creates a unity and sense of community," says Oppenheim.

—Carrie Vaughan