It’s Not About The Box Improving Care at Group Health with People, Process and Technology

September 28, 2009


Filed under: Electronic Chart,Epic,Oncology — Matt Handley @ 1:19 pm

Planning is starting for our technology investments for next year – and some of the opportunities are very exciting.  Lots of work to do to get there, but I can’t resist sharing some things about the Epic (our EMR) oncology module.

The oncology module is named Beacon (they always have names for new functionality), and it is a great step forward in many ways.  I am most impressed by the opportunity to improve the safety of the care we deliver.  Right now we still use paper for oncology drugs administered in the infusions center.  These are the most dangerous drugs we use (often to great benefit), where a mistake can be life threatening.  We have systems to mitigate these risks, but with Beacon we can improve the safety several fold.  We will be able to track lifetime doses of some key medications, and bar codes and standardized order sets will help us enormously.

We also will gain the ability to track the care we deliver our patients in a way that allows us to contribute new knowledge – participation in research will be much easier, and we will finally be able to track outcomes, looking at disease stage and treatment regimens (including does/wt).

It will take work.  It will work.  We have not been able to do this because we had not implemented the inpatient EMR – but that limitation is soon behind us.    We can jump start the work by using the build from Kaiser, where they will be finished with their system wide implementation in just a few months.  Our oncology community was excited when they first heard about what Beacon can do – I can’t wait to engage them when we actually have the work on our workplan.

September 24, 2009

The Conversation

Filed under: Improvement News — David Kauff @ 3:59 pm

New crane towers are going up every day here on the Epic campus. The buildings are big and beautiful. Think Redmond in the 90’s. No outward signs of a recession here.  New products, new clients, new ideas for using Epic. Epic is doing a very good job, they have even built a smaller version of their EMR for doc groups of 3-10 called Sonnet.  This is the Epic solution for the small groups, not just the Kaisers and Group Health’s.

There was no Keynote speaker this year though, the usual astronaut telling a story of courage and perseverance, or an Atul Gawande. And also there was no talk of healthcare reform, either at the national or local level and that was a surprise.  Our organization is central in that conversation, we are passionate about this, are agents of change and eager to tell our story. Epic, despite its influence, has chosen not to go there.  There was a resonating silence on this issue, I think they are worried that reform may not add to the bottom line. Good or Bad, there was silence. It was a missed opportunity, as the biggest EMR in the land, they could be in the conversation and offer solutions both technical and political. It is a reminder that we strive to deliver care and want to improve it in so many good ways.

That said, Gwen O’Keefe and I are working to represent all of us. The power of two. We have brought our requests to our Reps here, talked with IMO and Dragon, looked hard at Beacon and Kaleidoscope, the oncology and eye care modules. We have demo’d the new version of Ambulatory that will be coming our way next year. But more, we are engaging with our neighbors at Swedish, The Everett Clinic, Multicare and the UW to share patient information.  There is a great deal to learn here, and even more to share back in Washington.  We, with the help of Epic, will continue to innovate and be a leader in high quality medical care, and more, be active in the conversation about how best to deliver this care to the greatest number .

Epic Users Group 2009

Filed under: Epic — David Kauff @ 8:21 am

Back in Verona, the home of Epic, cows and cheese.  Another large users group meeting, with just short of 4000 attendees, some new to Epic and others old seasoned vets. Epic now is the medical record of about 88 million people, roughly 24% of the US population.

Despite its limitations, it remains one of the best and robust EMR’s and is improving all the time.

The major themes this year are, Interconnectivity – aptly  named ‘Care Everywhere’,  portability of the chart on the iPhone, called Haiku, and provider optimization and efficiency measurement tool called Pulse. 

Care Everywhere is an Epic feature that lets the care team, with explicit consent of the patient, obtain outside records. This can be a patients PHR, hospital records and chart, lab and radiology reports from other organizations. We are in process of setting up authorization agreements with local institutions and looking closely at the software.

This will have significant impact for our Networked patients where obtaining records will

Decrease duplication of tests and studies.  There are 49 institutions currently using this including Kaiser Colorado, who is the closest to our own model.

Haiku is Epic on the iPhone, yes, there is an App for that!  Most Epic functionality like Rx ordering, lab and note review and simple documentation can be done with the iPhone and iTouch.  This is very helpful for those on call and rounders in the hospital and NH’s.

Pulse is real time reporting on our work efficiency.  24 measurements on how well we, chart, close encounters, review results, respond to phone calls and secure messages. It also looks at how many smart tools are used like smart sets and preference lists. Better,It links to tutorials that teach in real time how to do this better. So it is more than keeping track of our work, it helps us get better at it.  This is software that comes in our next upgrade.  

 There is nice new functionality on the horizon. Tools to measure quality and effeciency and improve patient care. Will keep you posted as the conference continues.





September 14, 2009

Evolving Peer Review

Filed under: Electronic Chart — Matt Handley @ 9:04 am

large integrated medical groups have a boatload of advantages over small practices.  I love the analogy comparing medical groups to early human societies – small group practices are like hunter gatherers – they only have enough resource to sustain at a very basic level – think Maslow hierarchy level “food and shelter”.   As groups get larger they are able to pool resources to do two important things – build tools to help improve the care delivered by all of the members (think EMRs, patient portal, shared decision making tools, evidence based guidelines, etc) of the group, and to keep track of (and distribute) knowledge of what works and doesn’t so that innovations can spread efficiencies (think implementation strategies, different models of care delivery like medical home, direct access to specialists).  One generally overlooked advantage is the ability to use the practice community as a resource to continually improve in ways that can’t be measured easily using process and outcome measures – we share the same patients and charts and can provide feedback to each other at any time. (more…)

September 8, 2009

Social Networking

Filed under: Uncategorized — Matt Handley @ 10:10 am

At Group Health we have a long history of innovating  – when we are able to get out of our own way.  Unfortunately, we still have some challenges with using newer technologies for sharing innovation and ideas, like social networking.  As we are inventing our way out of the challenges that health care systems face, it will become more important for us to think out loud with like minded groups.  Be it twitter, facebook or KP’s ideabook, we need to gain experience using social networking – and it is right in line with our lean philosophies – learn from the front line and promote community problem solving.  Work in progress – I am hopeful that we can get out of our own way, stop blocking social networking within Group health and lead in this new arena also.

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