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 The Power of One
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2011 – Vol. II
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E-mail article
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The Power of One
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Wisconsin Integrated Information Technology & Telemedicine Systems applies uniform technology platform across two large healthcare organizations
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By David Raths
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"One patient, one record. Anytime, anywhere."
That mantra drives every decision at Wisconsin Integrated Information Technology & Telemedicine Systems LLC. A Madison-based joint venture formed in 1999 by Dean Clinic and SSM Health Care of Wisconsin, WIITTS has overcome many of the interoperability hurdles that have hampered other healthcare organizations.
SSM Health Care of Wisconsin operates two hospitals and has a minority interest or affiliation with several others. Dean Clinic has 60 locations and more than 500 physicians in southern Wisconsin.
While many similar pairs of organizations across the country are struggling to share patient information between disparate systems, Dean and SSM Health Care of Wisconsin met that challenge head-on by creating a separate entity to develop a single technology platform for all providers.
The infrastructure that WIITTS has put in place positions both Dean Clinic and SSM Health Care of Wisconsin well for the big changes happening in healthcare payment reform. Both patient-centered medical homes and the burgeoning Accountable Care Organization (ACO) movement require greater communication between care team members.
"The unusual thing about WIITTS is that we created one electronic health record across both organizations rather than interfacing two separate instances, and we created one organization to support it," says Dave Lundal, vice president and regional chief information officer of SSM Health Care of Wisconsin and Dean Clinic. He likes being positioned in the middle between the two organizations. "We are aligned with the patient," he says.
Since 2002 WIITTS has been working closely with Serona, Wisconsin-based Epic Systems to implement its electronic health record (EHR), scheduling, and billing software, starting in the physician clinics. "We realized that 90 percent of the patients seen in SSM hospitals are referred by Dean physicians," Lundal says, "so why wouldn't we want them all looking at the same record? And if we really are going to be an integrated delivery network, then if patients from Dean Clinics show up at our hospitals, shouldn't we already know who they are?"
WIITTS developed a common Epic registration and scheduling system in 2005. In 2008, St. Mary's Hospital in Madison began using Epic's EHR, followed in 2009 by St. Clare's Hospital in Baraboo. These projects were all implemented on time and on budget, with WIITTS assisting the Integrated Health Technologies team of St. Louis based
SSM Health Care in its work on a clinical transformation effort called Project Beacon. Today there are more than 1.4 million patients in the system, and more than 10,000 users of the Epic system. By January 2012 the WIITTS team will have implemented systems at six hospitals and Dean Clinic. WIITTS' capability to work across six distinct legal organizations is almost unheard of in the healthcare industry.
Patient Safety and Process Improvements
The creation of a common computing platform has enabled the 153-person WIITTS team to focus on patient care and safety process improvements. In the hospitals, the benefits of the Epic implementation are apparent everywhere, says Annette Fox, WIITTS' director of clinical systems. "If you ask physicians and nurses, the biggest win is just the accessibility of the information," she says. Whether they are walking the floor, in their offices, or on call at home at 2AM, physicians can log in and see the full picture of a patient's status.
Another huge improvement is in closed-loop medication ordering. When placing orders, physicians get alerts about allergies, drug-to-drug interactions, or doses that are too large, Fox says. "When the nurse gets the medications, everything is bar-coded and scanned to make sure the right medicine is getting to the right patient at the right time."
Using one record across the care delivery system has allowed Dean and SSM Healthcare providers to vastly improve medication reconciliation, the process of obtaining a complete and accurate list of patients' current medications and comparing the list to the discharge orders, transfer list, and those taken prior to hospitalization, Fox says. The same is true with following up after a hospital visit. "We can now proactively send automated alerts to primary care physicians when one of their patients shows up in the emergency department," she adds.
Progress in Physician Offices
In both primary care and specialty clinics, the new electronic infrastructure allows providers to track and engage patients with chronic diseases such as hypertension and diabetes, says Linda Vind, the director of clinical systems focused on ambulatory practices. "We also have added clinical decision support tools that can provide reminders of best-practice alerts at the point of care," she says. "In addition, we are supporting efforts to create patient-centered medical homes and to do increased quality reporting."
Because process improvement is one of WIITTS' cornerstones, Vind's team has created a repeatable process to bring Epic-based clinics its understanding of how the software can support the clinic's work flows. "Our staff is made up of clinical, rather than IT people," she adds. "We can provide "at-the-elbow" support in the exam room, in hallways - wherever we can be the most help."
Because the quality of raining provided to clinicians on Epic software can mean the difference between successful and unsuccessful rollouts, both Vind and Fox work closely with Shannon Galindo, director of learning and development.
WIITTS has a sophisticated training organization of 30 employees that develops most of its own curriculum focusing on specific skills and workflows. "We have developed more than 100 Epic training classes, many instructor-led but also e-learning modules, webinars, and webcasts," says Galindo. Her department also does surveys and proficiency assessments with employees following the courses.
Strategically, Lundal also has worked to extend the concept of one record to medical imaging systems. The hospitals use GE Centricity for medical imaging, while Dean uses a Fuji Synapse solution and cardiologists deploy a Siemens system.
In 2009, WIITTS began working with a Milwaukee-based company called TeraMedica on a "vendor-neutral" archive of images as a solution to marry one medical imaging archive to the one electronic health record. "We are creating an enterprise archive for all our images," Lundal says. "Another benefit is that we don't have to be married to particular PACS (picture archiving and communications system) vendors." Meghan Hendricks, director of shared services, says WIITTS has migrated images from previous PACS solutions. The new archive is providing better physician and care team access to images and has cut down on storage requirements. Hendricks' shared services group also oversees the MyChart patient portal, which now has 80,000 people enrolled and is adding new features regularly based on customer feedback. In a recent survey of users, 67 percent agreed that MyChart has improved their satisfaction with clinics and services; 94 percent were satisfied with the timeliness of care team responses to their MyChart messages; and 72 percent agree a doctor's use of MyChart improves their satisfaction with their care team.
A recent improvement includes MyChart Central, which combines a patient's information from other Madison-area providers that use Epic into one record. A new module called Lucy adds a personal health record element. "Lucy allows them to enter chart information from other health systems or information that was provided on paper to them to create a more complete record," Hendricks says. WIITTS has rolled out a new feature that allows patients to go online and schedule their own appointments. (Previously they could send messages with requests for appointments.)
Community providers, such as home health agencies, that are not part of the integrated network have their own portal access. With patient consent, 2,000 providers in 40 community organizations can now access the records.
Another new feature involves self-service kiosks that allow patients to check in, update records, and make payments using an electronic signature pad. "In the first two weeks, we had more than 400 patients use the two kiosks to check in for their clinic appointments," Hendricks says.
Shared Governance
WIITTS has gradually helped Dean Clinic and SSM Health Care of Wisconsin hospital employees rethink how to prioritize health IT projects. "As we started getting more hospitals and clinics up on a shared record, we decided they really needed to start governing the record," Hendricks says. The shared services group set up regional workgroups around topics such as scheduling or the patient portal. "We take on an expert advisor role, but they raise ideas and talk through pros and cons, and work toward consensus," she adds. "I think it is a thing of beauty."
Another of Lundal's goals is building the WIITTS organization itself, which is composed of five groups: inpatient, ambulatory, shared services, training, and decision support. "They all have their heads down, working hard," he says, "so we have to take a little time to develop one company culture." But Linda Vind says the WIITTS teams already work in a well-coordinated fashion. "All the Epic software is integrated, so we need to be integrated to work with it," she says. "We can't work in silos."
Preparing for the ACO Era
Lundal says new areas of increased focus include telemedicine and business intelligence. For the past year and a half, Cheryl Gerow, director of business intelligence, has been using a tool called QlikView from a U.K.-based company called QlikTech, to help clinical department managers look at their data in new ways. For instance, surgeons are now studying metrics across facilities so they can spot anomalies by surgery type, procedure codes, delays, and complications. Some business intelligence tools are less flexible and require more handholding, she says. "This is self-service BI. It is a powerful desktop application for clinical managers," Gerow says. "It empowers them and frees up our data analysts to work on other projects."
Her team has years of experience extracting data from Epic, including for disease management reporting. "We started with the Wisconsin Collaborative for Health Quality," she says. The HITECH Act's incentive funding for meaningful use of EHRs set a national standard that leads right into the Accountable Care Organization efforts. "They all build upon each other," she says. "The key is to have metrics that allow you to compare yourself to your peers and to make all that data transparent."
As providers and insurers begin to grapple with federal health reform initiatives, integration will be a key goal, and the providers WIITTS supports have a clear head start.
Dean and SSM Health Care of Wisconsin from two legs of an integrated delivery network, with the third leg being Dean Health Plan. Approximately 40 percent of patients seen in the clinics and hospitals are Dean Health Plan members. WIITTS will provide the technology infrastructure to support new care coordination and quality reporting initiatives. Its model is aligned with where healthcare is heading: paying for value instead of volume. "The one electronic health record and other clinical technologies we implement and support will enable our care teams to continually increase quality and lower cost," Lundal says.
Although the federal regulations for ACOs are still being worked out, Lundal is confident his organization will be ready to participate. "I know it will mean more data sharing and more patient engagement. I'm focusing on building a strong organization, and then I know we will be well positioned to handle whatever comes down the pike."
Small Hospitals, Big-time IT.
The fact that a large hospital such as 440-bed St. Mary's Hospital in Madison is a sophisticated user of health information technology is not unusual. But WIITTS is also bringing Epic and other advanced tech tools to several small rural hospitals in Wisconsin, making them some of the most technologically advanced critical access hospitals in the country.
For instance, earlier this year 32-bed Stoughton Hospital in Stoughton, Wisconsin launched its Epic system after a yearlong conversion process from paper charts. Now if patients have to be transferred to St. Mary's from Stoughton, their records are immediately accessible. And like its larger counterparts, Stoughton will be able to use data from the system to measure patient outcomes and identify potential areas for improvement. "There are a few other U.S. critical access hospitals on Epic, but not very many," says Lundal.
In October, small hospitals in Columbus and Edgerton, Wisconsin will go live with Epic, and in January 2012 a brand-new hospital in Janesville (shown above and right) will have the latest in technology, which may include a real-time location system (RTLS) to track medical assets such as infusion pumps and small operating room equipment.
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