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Michael Dowling: Advancing Care Coordination Via HIT

 |  By cvaughan@healthleadersmedia.com  
   December 02, 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.

The health system began rolling out this program earlier this year, and it is being well received among physicians, Dowling says. More than 500 physicians committed to implementing the EHR before November 2010. "I've always looked upon this as a multi-year effort," says Dowling. There is a lot of education to be done, he explains. "When you stand up and say that we want to enhance our IT system and put in EHRs, everyone will say yes. But then when you sit down and explain what all that means it gets more difficult, because it is not just about technology. You have to change work processes."  "Everybody knows that we have to manage the coordination of care better than we have done before, so the IT issue is very central to our overall strategy," says Dowling.

Dowling is also positioning the organization to be able to provide all services throughout the continuum. They are expanding their outpatient, long-term care, sub-acute care, and rehab programs. The health system also has established programs for home care, hospice, and palliative care, as well as a transportation network. "Patients don't fit into neat boxes," says Dowling. "We tend to put people in little silos and deal with parts of the individual instead of the totality of the individual. 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."

Dowling views ACOs as having the ability to manage care and take responsibility for cost and care of the patient over the continuum. Or to take responsibility for a cohort of patients—like all patients with diabetes or a heart failure. "We'll be paid more based on quality outcomes—not what we do, but based on how well we do it," he says. Fundamentally, ACOs will be able to track patients across the continuum, be able to monitor outcomes, be able to share information, be able to transfer information from one location to another, be able to measure quality, and reduce the annoyance that patients currently suffer by having to repeat things over and over again, Dowling explains.

As a result, there will be more of an emphasis on the concept of interdisciplinary teamwork. This is going to be a challenge for the education systems because the health industry has to educate people for interdisciplinary action rather than educating people in silos, says Dowling. "We are very good at educating people in silos and then telling them after they graduate that they have to work in teams."

To fill in this educational gap, North Shore-LIJ has developed programs and partnered with others. "We have tens of thousands of people who go through training in our organization every year," says Dowling. North Shore-LIJ also works very closely with medical schools by creating its own programs, and it has partnered with Hofstra University to establish the Hofstra North Shore-LIJ School of Medicine, which will open in 2011. "At the end of the day it is the people who make the difference and who understand that they are not working in individual silos," says Dowling. This often appears as one of the soft issues and not that serious, he says. "But, quite frankly, you can have the best technology, but if you don't have the right people, it just won't work." 

The opportunity for improvement is extraordinary and leadership is essential to making it happen, says Dowling. Senior healthcare executives and health systems have to be accountable for outcomes and the continuum of care, he says.

"Leadership is about believing there can be a better future and making sure you move your organization in that direction," says Dowling. "If we do that, I think we'll have the opportunity to change how care is delivered and people will believe that they are getting true value for their healthcare in terms of quality."

Carrie Vaughan is a senior editor with HealthLeaders magazine. She can be reached at cvaughan@healthleadersmedia.com.

Follow Carrie Vaughan on Twitter.

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