Clinical Transformation and the Future of Health I.T by Intheaters

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									  Clinical Transformation and the Future of Health IT:
            A Case Study of Marshfield Clinic



Robert Carlson MD, CIO, Marshfield Clinic
Carl Christensen, CTO, Marshfield Clinic




                     This session sponsored by:




    Clinical Transformation and
     the Future of Health I.T.
                 May 7, 2009
            Dr. Robert Carlson, CIO
            Carl Christensen, CTO




                                                         1
                                                          Marcus Welby, M.D.
                                                               Aired on ABC from
                                                          September 1969 to July 1976

                                           Change in the next 5 years > previous 40



                                                          Single Payer
                                                      Medical Home

                                                            PQRI


                                                      A
                                                 PA
                              s    8   8    HI
                     re     G’ LIA
          d   ic a        DR C
       Me

               1969            1989                             2009 2015




 Evolutionary vs. Revolutionary Changes

• Aging population
• Exploding Complexities
• Data Avalanche




                                                                                        2
     EHR – The Silver Bullet?
• Retrospective Documentation
  – rec·ord: An account, as of
    information or facts, set down
    especially in writing as a means
    of preserving knowledge.
  – phy·si·cian: A person licensed
    to document the approved
    practice of medicine protocol.
  “…you make a better data clerk than a doctor”
  “…I could spend 30-40% more time seeing patients if…”




     Transforming Healthcare
• Reactive vs. Proactive care
• EHR vs. Intelligent Assistant
• Data Collection vs. Knowledge
  Management
• The effective and efficient practice of
  medicine

  Rethinking the role of Information Systems
              at Marshfield Clinic




                                                          3
                     EHR
         “A race to the starting line”
• Capturing useful data
• Physician adoption
• Decision makers are
  tethered to computer
• Strategic value of HIT
  understood
• Patients and other
  customers able to
  efficiently interact with
  system
• Need to invert current
  model




          Paradigm Shift Needed
• Current State               • Future State
   –   Provider Centric          – Patient/Population Centric
   –   Bottom Up                 – Top Down
   –   Squeaky Wheels               •   Determine Outcome
   –   Design by Committee          •   Define Measurement
   –   Airport Musings              •   Define Process Changes
                                    •   Define System Changes
   –   Trade Show Driven
                                    •   Iterate
   –   Operational Focus
                                 – Information Driven
   –   Heavy I.T. Ownership
                                 – Hypothesis Generation
                                 – Heavy business ownership




                                                                 4
Marshfield Data Warehouse Architecture

              Data Collection Systems                                                                       Information Applications
                         External
                         Sources
                                                                                             Subjects                                                                                    End User Defined                  End
                         Hospital       Sun Unix                                                                                                                                           Applications                   Users
                                                   Lawson                                                                                                                                                                 Dr. Statistics
                            Lab                                                                                                                                                           Casemix        Dr. Statistics
Data Access Pain Index




                                             NT SQL Server                                                                                                                                                                  MECCA
                                                                                                                                                                                          Diagnosis        Patient        Data Retrieval




                                                                                                                           Geography / Time
                                                                        Staff/ Customers
                         Research       Sun Unix    Oracle




                                                                                                                                                           SHP Claims
                                                                                                                                                                        Operations
                                                                                                                                              Financials
                                                                                                                                                                                             RMI           MECCA




                                                                                                                Hospital
                                                                                           Patient
                                                                                                     Clinical
                                                                                                                                                                                                                          Lab Cytology
                            SHP              NT     MARS
                                                                                                                                                                                         Transcription       Lab
                                                   Access                                                                                                                                                                 Elapsed Days
                          Clinical                                                                                                                                                          Heart          Patient
                                                   MS Excel                                                                                                                                              Satisfaction
                                                                                                                                                                                          Cost/Acct                       Patient/Provider
                                                                                                                                                                                                                             Activity
                         Business                                                                                                                                                                        Procedures
                                                                                                                                                                                         Performance                       Data
                                                                                                                                                                                           Statistics     Customer
                          Clinical                                                                                                                                                                                        Access
                         Registries                                                                                                                                                                                       Tools

                                                                    Data modeling                                                                                                    Application development Information
                                                                    Performance tuning                                                                                               Metadata capture        Access
                                                                    Metadata capture
                                  Quality assessment and feedback




                                                                                                                                                                                                                                             5
6
7
8
Improving Patient Adherence




           0.9



          0.85



           0.8


                                                             2
          0.75                                              R = 0.0693



           0.7
Quality




          0.65



           0.6



          0.55



           0.5



          0.45



           0.4
                 0   5   10   15        20        25   30            35   40
                                   Productivity




                                                                               9
                    Results
• Link to Interactive PDF




              The New I.S.?


               Knowledge
                               Analytics
              Management



                                            Reporting
Terminology            Technology          Dashboards
D.S. Rules                                 Data Mining
Literature                                 Care Mngmt
Workflow




                                                         10
              Summary
• EHRs are only the beginning
• Value is generated by doing something
  useful with the data/information
• New I.T. paradigm is needed
• Focus on patient/population




                                          11

								
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